PAH: Report grades A and E inadequate after inspectors intervened over deteriorating patients

Health / Wed 17th Nov 2021 at 07:03am

THE Care Quality Commission (CQC) has told The Princess Alexandra Hospital NHS Trust that the quality of its urgent and emergency, maternity and medical services need to improve.

CQC carried out an inspection in July, August and September at the trust’s urgent and emergency, medical and maternity services to follow-up on concerns about the quality of care people were receiving. An inspection of the well-led domain of the trust overall was also carried out.

Whilst at the A and E Department, the inspectors found patients were being left in the hospital’s corridor after being brought in by ambulances.

In one example, a patient who had been brought to hospital after being found collapsed and unresponsive, was not seen for two and a half hours, despite the CQC’s inspectors alerting hospital staff. 

In another incident, a patient who was actively bleeding from the head was left in the corridor for 45 minutes with no assessment.

Following the inspection and due to the serious concerns found regarding the lack of monitoring of patients waiting to be seen in the emergency department – conditions were placed on the trust’s registration.

The conditions require the trust to introduce a process for ensuring patients with the most urgent needs and at risk of their health deteriorating can be prioritised. The trust must also report staffing figures and weekly audits of risk assessments to CQC on a weekly basis.

As a result of the inspection, the overall rating of the trust remains as requires improvement. The rating for well-led has moved down from good to requires improvement. The trust remains good for being caring and requires improvement for being safe, effective and responsive.

The rating of maternity services overall remains as requires improvement, urgent and emergency services remain rated as inadequate and medical services remain as requires improvement. 

Philippa Styles, CQC’s head of hospital inspection, said:

“Our inspection of The Princess Alexandra Hospital NHS Trust found several areas where improvements were needed, particularly within the emergency department where inspectors found concerns around the monitoring of patients and the absence of a system to ensure priority could be given to those who needed urgent attention.

“We recognise the enormous pressure that NHS services are under and that usual expectations can’t always be maintained but it is important that hospital trusts do all they can to mitigate risk within the resources available to them.

“It was very concerning that inspectors had to intervene to ensure two patients in the waiting area with deteriorating conditions and at risk of harm were given medical attention. 

“Once admitted into hospital, timely observations weren’t always carried out or recorded meaning patients could be placed at risk. This situation was worsened by the service not having enough nurses and healthcare assistants to provide safe care.

“We saw similar concerns in maternity services with understaffing that had led to bed shortages and delays in women receiving care.

“Staff told us they were exhausted, were not getting breaks, had been in tears while on duty and did not feel they were listened to by senior staff. Despite these challenges, staff should be commended for how kind and caring we saw they were with all their patients.  

“The director of midwifery was new to the role of running the service and understood the priorities and issues the service faced, however, they were only at the early stages of making improvements.

“We will continue to monitor the trust to ensure they are keeping people safe during this time and will return to check whether sufficient improvements have been made and take further action if we don’t see this.”

Trust leaders needed to work on identifying and improving these areas as a priority. There had been several new appointments at board and director level and the leadership team now need to work together to make the necessary changes.

Senior leaders were proud of the resilience of their staff and saddened that morale was low. They acknowledged the effects the pandemic had had on staff well-being and encouraged an open culture for speaking up.

Following the inspection, CQC told the trust it must make several improvements, including:

In urgent and emergency services:

• There must be enough numbers of suitably qualified, skilled and experienced nursing staff to meet the needs of patients.

• The trust must complete a review of clinical risk assessments, care planning and physiological observations to ensure patients’ needs are individualised, recorded and acted upon.

• Every patient must have an initial assessment of their condition to enable staff to identify the most clinically urgent patients and ensure they are triaged and assessed.

• Toilet facilities for adult patients presenting with mental ill health must be safe and free of potential risks.

• Patient observations must be completed within 15 minutes of arrival at the department.

In maternity services:

• The service must ensure all steps are taken to appropriately manage and maintain safe staffing in the maternity unit.

• There must be a robust maternity triage system in place, with appropriate guidance and training.

• Staff must complete mandatory training to comply with the trust’s policy.

In medical services:

• Patients at risk of falls and pressure ulcers must be assessed and appropriate measures taken so they are not placed at harm.

• Patient records must be completed in a timely manner.

• There must be enough trained and skilled nursing and health care staff, including those requiring additional supervision.

• Staff must follow systems and processes to safely prescribe, administer, record and store medicines.

The PAH Trust has been approached for a comment

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10 Comments for PAH: Report grades A and E inadequate after inspectors intervened over deteriorating patients:

Pauline S
2021-11-17 09:27:28

Morale is important in any workplace and being short staffed does not help. With the increased density of the population in the catchment area the problem could get worse. What does the CEO say? He or she needs to say what might be proposed to overcome the present sad state of PAH and why it has deteriated. We deserve to now.

Ellen Deering
2021-11-17 09:47:50

‘This is not the fault of the hospital or staff. But useless governments. Princess Alexandra has such a very large catchment area. GP are also very much to to blame. Once again government. Tony Blare gave them shorter hours, no weekends etc. People in pain trying to get appointments and not even getting through to their doctors surgery’s Harlow has expanded so much now, so therefore the hospital cannot cope. They are building thousands of homes and no infrastructure. Any gobshite could see this happening. Well done PHA. 👏👏👏👏

Mary Deacon
2021-11-17 10:02:35

I wateing 7 hours for scan results with a leg blood clot and 6 hour for another scan result why I am 80 years old no food no drink on ether days with no way of getting any

Robin Parish
2021-11-17 14:08:51

This hospital is a joke my wife was taken there on the 6th Aug Friday I rang on sat 7th was told by a doctor she was fine and could be home in 3 to 5 days sat night got a call to rush to hospital and my wife died early sun the 8th but we never knew what happened from sat morning to sun when she died I was shocked as a women doctor told me sat she could soon be home she had postmortem and she had problems but she was still fine in her self when she went in there and I don't belive what she had wrong would have took her life that quick so I have decided I will not visit this hospital for my treatment as I don't feel this hospital is safe the place is not clean and nurses working on covid wards are being used in other parts aswell so to me this is unsafe

Mr Grumpy
2021-11-17 14:40:24

Why anyone would want to work on the NHS front line is beyond me. Long hours, low pay and lots of stress. Along with this they also have to put up with constant abuse and bullshit inspections. Those in positions of authority are simply expecting too much from an overworked and underpaid workforce. Get rid of the pen pushers and pump the money into the front line where it is so desperately needed I say. To those on the front line (Doctors, Nurses and ancillary staff), you lot are bloody miracle workers.

2021-11-17 18:36:21

This hospital has been on a downward spiral for years. Ridiculously long waits in A & E, poor infection control, and over all medical care. That was pre pandemic. All these inadequacies have been exacerbating by the pandemic and the hospital is not fit for purpose. My mother acquired Covid whilst being nursed in PAH. Unfortunately, she died within days, how awful to be nursed back to health only to die from a hospital acquired infection. I have several friends who have had the misfortune to visit PAH in the last few weeks, all have had experienced a traumatic time, two of which have had to seek private referrals for reassurance. Not something that is an option for most people. Something needs to change and quickly to stop this inhuman treatment and the risk of further complications.

2021-11-17 18:55:00

Every experience I've had, personally or for family, has been really awful, it's not a new thing, goes back to the 90's, dreadful

Geoffrey pratt
2021-11-17 19:34:36

The staff are stretched to the limit I found the care gif myself my mother were more than anyone could do . After care also excellent

2021-11-18 00:03:49

If you're over 70, with even a treatable illness, you won't come out, unless in a Coffin. Elderly treatment is APPALLING...

2021-11-18 08:10:27

"Patients at risk of falls and pressure ulcers must be assessed and appropriate measures taken so they are not placed at harm". No clinical assessment of recent arrivals of A/E patients? Why on earth are they not doing what any basic nurse should be doing as a matter of routine. To read this hospitals CQC report is should destroying. This hospital should be in special measures, it is complete disgrace , the CEO should be removed with immediate effect.

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