THE Care Quality Commission (CQC) has found some improvements following an inspection of the emergency department (ED) in March at The Princess Alexandra Hospital, run by The Princess Alexandra Hospital NHS Trust. This inspection sees the rating for the ED move up from inadequate to requires improvement.

The inspection was undertaken to follow up on the progress of improvements implemented by the trust after CQC imposed urgent conditions at a previous inspection. These included:

• To ensure the department had sufficient numbers of suitably qualified, skilled, nursing staff.
• Ensure that every person attending the ED has an initial assessment enabling staff to identify those people with the most urgent clinical needs.
• Devise a process and undertake a review of current and future clinical risk assessments, to ensure that the level of people’s needs are individualised, recorded and acted upon.
• To implement an effective system with the aim of ensuring observations take place within 15 minutes for people who arrive at the emergency department at the Princess Alexandra Hospital.

Following this inspection, CQC found enough improvements had been made to meet these conditions.

As well as the overall rating for the ED at The Princess Alexandra Hospital moving from inadequate to requires So have the ratings for how safe and well-led the service is.  Effective and responsive were also inspected but not rated.

This inspection doesn’t affect the overall rating for The Princess Alexandra Hospital NHS Trust which remains requires improvement overall.

Hazel Roberts, CQC deputy director in the east of England, said:

“At this inspection it was evident that The Princess Alexandra Hospital NHS Trust had made some of improvements that were needed and ensured they were embedded, but there is still further work to be done in order to keep people safe.   

“Leaders need to do more to make sure they have a good grasp of the issues they’re facing, in order to drive improvement. “Although there has been improvement, leaders still need to do more to make sure they have a good grasp of the issues they’re facing, in order to drive improvement. For example, whilst there were some improvements in staffing levels in some areas since the last inspection, leaders didn’t have enough oversight of staffing across the whole department, especially over a 24-hour period. This was having an impact on the safety of care being delivered. 

“During the inspection we had to escalate staffing concerns on two occasions and on one occasion we saw staff escalate a situation and they didn’t receive the support needed. Leaders must do more to support staff to provide better care.

“However, we did also see areas where improvements had been implemented. At our inspection we saw a full reception area, and more people waiting to be register in the emergency department. There was a nurse triaging people, as well as a hospital ambulance liaison officer who employed by the East of England Ambulance Service NHS Trust but based at the hospital.

“This person liaised with the nurse in charge and the ambulance crew regarding people waiting for rapid assessment and treatment.  Although it was very busy we felt assured people waiting for treatment had been triaged and those people at risk of becoming very unwell were prioritised. This is a great example of the local health care system working together to improve outcomes for people.

“It was also reassuring to see that people with mental health conditions were now receiving appropriate care and treatment.  The trust had addressed our previous concerns and people were now being treated in areas that were fit for purpose and were fully risk assessed.  

“Following the inspection, we fed back our findings to the trust leaders and they know the areas where we want to see them build on the improvements we’ve seen, ensure they remain embedded, and make further  rapid changes. We’ll  continue to monitor the trust  to make sure people are safe while that’s happening and return to check on their progress.”  

During the inspection CQC found:

• The service now had a nationally recognised triage tool in place for people needing care or treatment.
• All people received an initial set of observations in line with trust policy.
• The service made sure staff were competent for their roles.
• The service was inclusive and considered individual needs and preferences.

However, inspectors also found the following: 

• Staff didn’t always complete risk assessments for each person in a timely manner.
• Staff didn’t always keep up to date care records.
• People couldn’t always access the services when they needed them and waiting times for treatment was consistently worse than the national average.
• Follow up observations for people weren’t always completed in line with trust policy.
• People weren’t always given pain relief in a timely way.
• The service’s processes didn’t always allow for effective patient flow throughout the department and risk management.
• The service didn’t have a strong streaming system to match people to the service that they needed.
• During the previous inspection people couldn’t always reach call bells and staff did not always respond quickly when called. At this inspection call bells still weren’t always in reach of people.

The reports will be published on the website on  Friday 16 June.