The Care Quality Commission (CQC) has published reports on urgent and emergency care and medical care (including older peoples care) at the Royal Cornwall Hospitals NHS Trust following an inspection in May and July.
The inspection of urgent and emergency care was carried out in response to concerns regarding the trust's performance around waiting times. The inspection of medical care was carried out in response to concerns about the number of falls of older people on one ward.
The rating for urgent and emergency care following this inspection remains unchanged and is re-rated as requires improvement as are the ratings for effective and responsive. Caring and well-led have been re-rated as good. Safe has improved from requires improvement to good.
Due to the focused nature of the inspection for medical care, the service was not rated and it retains its previous rating of requires improvement overall as are the ratings for safe and responsive. Effective, caring and well led remain rated as good.
The hospital and trust ratings remain rated requires improvement.
Catherine Campbell, CQC deputy director of operations in the south, said:
"Throughout our inspection of Royal Cornwall Hospitals NHS Trust’s urgent and emergency care, we saw staff were working hard to provide safe care in challenging conditions.
“The trust faced issues with the high number of people attending the department and with discharging people to the local community, which in turn created a problem of flow around the hospital. We also found people who were fit for discharge were staying in the hospital longer than they needed to because their care outside the hospital wasn’t ready.
“This over-crowding in the emergency department created issues that the trust couldn’t solve alone, and further support was needed from the local health and social care system to address.
“People faced unacceptable delays for care when the department was at capacity, people could also face lengthy waits in ambulances. This had an impact on the ambulance trust’s emergency response times in responding to other people.
“We saw people being cared for in one of the corridors of the department. While they were treated with kindness, people and staff told us it was difficult to maintain privacy in such conditions.
“We found the senior leadership team was open to challenge and understood the problems the service faced. They were supporting staff to manage the priorities and issues and deal with difficult circumstances.
“In medical care, we found a good safety culture where staff regularly discussed people’s care. Staff highlighted people’s conditions when things got worse and provided safe care and treatment, using well-defined procedures to assess risks and select a personalised care plan. The environment was clean and tidy, but in need of modernisation and adjustments to make it dementia friendly.
“The trust knows where it needs to make improvements to ensure the safety of people needing urgent and emergency care. CQC will continue to engage with the trust and partners and will return to check on progress."
Inspectors found in urgent and emergency care:
- There was a strong safety culture with staff feeling confident to raise concerns
- The department had passports for people with learning disabilities and made adaptions to try and reduce any possible distress such as moving them to a quieter area of the department or an area where lights could be dimmed
- The service now had enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment
- Members of the NHS ambulance service spoke highly about the camaraderie and teamwork in the department. The paramedics and ambulance technicians said they felt part of the team and were respected by staff in the department
- The service accessed a translation service for people whose first language wasn’t English and there was an induction loop fitted at the reception desk to help people with hearing aids
- The service had also improved its staffing levels since the last inspection to support this
- There was good external partner engagement, including with the local mental health trust, but the mental health trust had its own capacity issues which caused significant delays for people needing transfers.
However,
- MRI services were unavailable between 7:30pm and 7am the next day with some staff telling inspectors they saw this as a significant risk
- There was a mental health assessment room which was due for updating as it did not entirely conform to the national guidelines. Staff had needed to place a trolley in the room so a person could lie down. This resulted in a second doorway being obstructed and ligature points being introduced
- Essential staff training had been frequently cancelled due to staffing pressures
- Staff said they were worried about the pressure they were under and how this affected their ability to provide safe and quality care. Inspectors recognised this had been relentless and with the summer months when the tourist population arrived, this was unlikely to be easing.