Letter to Editor: Has PAH head downplayed seriousness of CQC report?
Politics / Thu 18th Nov 2021 at 04:56pm
I WAS concerned by the response of the Princess Alexandra Hospital Chief Executive as it seemed to me that he played down the seriousness of the CQC’s findings in their latest inspection report. For whilst the overall score for the hospital was found to be Requires Improvement and the overall Caring Services score was Good. The Accident and Emergency Services were found to be Inadequate.
The Your Harlow article PAH: Report grades A and E inadequate after inspectors intervened over deteriorating patients, details some of the concerning incidents the CQC Inspectors witnessed during their visits.
Following their visit the CQC told The Princess Alexandra Hospital Trust that it must take following action to bring services into line with legal requirements.
• The trust must ensure that governance, risk and assurance systems are effective and embedded throughout the trust. (Regulation 17 (1)(2)(a)). Urgent and emergency care
• The trust must ensure there are sufficient numbers of suitably qualified, skilled, competent and experienced nursing staff at all times to meet the needs of patients within all areas of the Emergency Department at the Princess Alexandra Hospital (Regulation 18 (1))
• The trust must operate an effective system which will ensure that every patient attending the Emergency Department at the Princess Alexandra Hospital has an initial assessment of their condition to enable staff to identify the most clinically urgent patients and to ensure they are triaged, assessed and appropriately streamlined. (Regulation 12 (1)(2)(a))
• The trust must devise a process and undertake a review of current and future patients clinical risk assessments, care planning and physiological observations, and ensure that the level of patients’ needs are individualised, recorded and acted upon. This must include, but not limited to skin integrity, falls, and mental health assessments. (Regulation 12(1)(2)(a) )
• The trust must ensure that it implements an effective system with the aim of ensuring all patients who present to the emergency department at the Princess Alexandra Hospital patient observations are completed within 15 minutes of arrival and as appropriately thereafter in line with trust policy. (Regulation 12 (1)(2)(a))
• The trust must ensure that the paediatric mental health room is fit for purpose and meets the standards set out in Facing the Future, Standards for Children in Emergency Care Settings. (Regulation 13 (1))
• The trust must ensure that there are safe toilet facilities for adult patients presenting with mental ill health. (Regulation 13 (1))
• The trust must ensure that there is a clear record and oversight of patients being admitted to clinical decisions unit. (Regulation 17 (1)(2)(a)).
This may sound harsh given the Covid pandemic but in both 2019 and 2020 the Emergency Department was rated by the CQC as Requires Improvement it now rates as Inadequate. So will the Chief Executive tell us which of the legal requirements stipulated by the CQC have now been complied with? Which are still are outstanding? Why are they are still outstanding and how and by when will the issues be addressed.
In conclusion, this letter should not in any way be construed as critical of front-line staff who have struggled and continue to struggle with huge pressures and demands on their services, but rather as a plea for the management support, systems and resources to be put in place to enable the staff to function in a safe and effective way and for the public to know they will receive a safe, effective and caring service.
Cllr Tony Edwards
I, like many, wonder what the root cause of this issue is? So, I did a bit of digging. I found a British Medical Association report titled 'Medical staffing in England: a defining moment for doctors and patients' published 13 July this year. The headline points were: "According to the medical workforce’s current trajectory of growth, it will take until 2046 before the NHS has the number of practising doctors per 1,000 people required to match today’s OECD EU nations’ average; – We are therefore 25 years behind where we should be to sit on par with comparator nations; – Meeting the OECD EU nations’ average of 3.7 doctors per 1,000 people would require scaling up our medical workforce by an additional 31%; – Using this OECD EU average, and including known medical vacancies, we estimate a shortage of around 49,162 Full Time Equivalent doctors and doctors in training in England; – These shortages mean that, on average, each FTE doctor in the NHS currently does 1.3 roles; – Mounting evidence suggests that when doctors are working under conditions of chronic stress, and or suffering with fatigue and burnout, mistakes are more likely to happen and moral injury/distress occurs." "There are currently 2.8 doctors per 1,000 people in England, while the average in OECD (Organisation for Economic Co-operation and Development) EU (European Union) countries is 3.7. Other than Poland, this gives England a lower doctor to population ratio than any other OECD EU nation." You can download the report from: https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/workforce/medical-staffing-in-england-report