The Care Quality Commission has told Heatherwood and Wexham Park Hospitals NHS Foundation Trust that it must make urgent improvements to protect patients at Wexham Park Hospital.
CQC has issued a formal warning to the trust following an unannounced inspection at which it failed to meet any of the seven national standards which were reviewed.
A team of inspectors with nursing experience, supported by experts, spent four days at the hospital unannounced in May in response to concerns raised about patient care in the emergency care pathway – including the results of an NHS survey published in April 2013 which found that patients were waiting too long for treatment in Accident & Emergency (A&E).
The team visited the A&E, Emergency Department Decision Unit (EDDU), acute medical unit (AMU), medical interventions day unit (MIDU), acute stroke unit, wards 4, 6, 7, 9 and 18, the paediatrics unit and a number of the hospital’s escalation areas. A full report from this inspection has been published on the CQC website today.
Among CQC’s findings:
- Inspectors found that a combination of high attendances and a shortage of inpatient beds elsewhere in the hospital meant the A&E was overwhelmed. People could not always be moved on from A&E when they no longer needed to be there – which left A&E crowded and busy, and people at risk of receiving care which did not meet their needs. Patients were waiting up to 11 hours to be admitted to a ward.
- Inspectors observed that, while staff were trying their best to cope with the volume of patients, they were struggling to do so. While inspectors saw many instances of good care, they also saw a number of instances of poor care. Patients did not always have their needs adequately assessed, planned, and delivered. This was a particular concern for patients who were confused or who were assessed as having dementia. There was no system to ensure patients with dementia had dedicated care and support. Call bells were not always in reach, and were not responded to quickly enough.
- Privacy and dignity were not always respected throughout the hospital. Inspectors saw people lined up on trolleys by the reception desk when no A&E beds were available, and spotted a bay designed for one person being used for two due to lack of space. Patients and their relatives told inspectors that communication was often poor, and observations of care taking place backed this up.
- Poor standards of cleanliness and inadequate infection control arrangements were found in some areas of the hospital. Storage of medicines was sometimes poor, with patients and visitors on some wards able to access drugs which should have been locked away.
- Staff told inspectors that they felt there were not enough staff in the hospital to meet the needs of patients, and said that they felt they were under considerable pressure to work longer hours. A number of staff told inspectors they regularly worked additional hours, sometimes up to two hours a day, which were unpaid. Staff said there was no connection between the needs of patients on the wards and the number of staff required to meet those needs.
- While there were systems in place to identify risks to patient safety and to maintain quality of service, these were often ineffective. There was a strong emphasis on responding to national and local clinical targets, but little emphasis on ensuring that overall patient experiences were positive.
Adrian Hughes, Regional Director of CQC in the South, said:
“While we would acknowledge that Wexham Park Hospital was under considerable pressure at the time of this inspection, this is not an excuse for the systemic catalogue of failings we identified there. Local people deserve much better from their hospital.
“Our experienced inspectors – the team including trained nurses and a pharmacist in this case – and expert advisors found that there was a clear focus on managing the demand for inpatient beds in the hospital, which sometimes came at the expense of providing the expected level of care. Basic things, such as making sure people’s dignity was respected did not get the attention they deserved. This impacts on the patients and therefore is completely unacceptable and needs to be tackled immediately.
“Patients are entitled to be treated in services which are safe, effective, caring, well run, and responsive to their needs. The trust has assured us that it will take action and make the improvements required. We will keep watch on this, and our inspectors will return unannounced in the near future to check that it has made those changes.”
For further information please contact the CQC press office on 0207 448 9239 or out of hours on 07917 232143.
NOTES TO EDITORS
CQC has published a full report.
Inspectors found that Heatherwood and Wexham Park Hospitals NHS Foundation Trust was failing to meet seven standards at Wexham Park Hospital:
- · Respecting and involving people who use services
- · Care and welfare of people who use services
- · Staffing
- · Assessing and monitoring the quality of service provision
- · Records
- · Management of medicines
- · Cleanliness and Infection Control
About the Care Quality Commission
The Care Quality Commission (CQC) is the independent regulator of health and social care in England. We make sure health and social care services provide people with safe, effective, compassionate high-quality care and we encourage care services to improve. We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.