CQC report highlights serious failings at Blackpool Vic

A new report has highlighted a host of serious failings at Blackpool Victoria Hospital.

The Care Quality Commission paid an unannounced visit to the Vic in January.

Their findings have now been published.

They include A&E patients having to sit on the floor, long delays for triage and mental health services, and what they described as 'unkind' care during a violent incident.

The report also highlighted how staff were subjected to increasing levels of threatening behaviour, and that they did their best in often challenging circumstances.

Bosses have been told they must urgently improve the standards of both care and staffing levels.

Professor Edward Baker, Chief Inspector of Hospitals, said: ‘’This was an unannounced, focused inspection to review the safety of the emergency department as part of a focussed winter inspection programme. It took place between 1pm and 10pm on Monday 7 January 2019.

We did not inspect the whole core service therefore there are no ratings associated with this inspection.’’

The key findings were:

• The emergency department (ED) did not have space and capacity to cope with the number of patients and their relatives who presented there. We observed patients sitting on the floor of the waiting room and trolleys, beds and equipment blocking corridors and exit routes, which limited the standard of care.

• The paediatric ED was not compliant with staffing levels set by the Royal College of Paediatrics and Child Health (RCPCH).

• There were significant delays in most aspects of the service, including triage delays of over three hours. We found delays in transferring patients awaiting a mental health bed of over 17 hours whilst awaiting review by the mental health provider, which was separate to the trust.

• Flow to the rest of the hospital did not meet demand and there was very limited input from acute medical physicians.

This reflected our discussions with nine members of medical staff, during which they said there was a culture in which specialty teams did not work well together for the improvement of patient experience.

• Patients were accommodated in corridors for extensive periods during our inspection. This included elderly patients and those with severe dementia and staff did not always meet their individual needs. Use of corridors was part of the trust’s surge plans during periods of exceptional demand.

• Overnight medical cover was restricted to one doctor with higher specialist training at grade ST4 (specialist trainee) with one or two doctors at basic specialty trainee level (ST3). This caused lengthy delays to assessment and all staff we spoke with told us it resulted in additional pressure.

• Provision for mental health patients was lacking and the trust had limited influence to improve the service provided to their patients.

• We saw isolated examples of very poor, unkind care in the acute medical unit during a violent incident.

• Staff described increasing levels of threatening behaviour, aggression and violence towards them from patients and relatives.

• There were senior decision-makers present in the resuscitation area and in the rapid assessment and treatment (RAT) area who managed patients appropriately.

• There was effective clinical collaboration between the consultant in charge and the nurse in charge and it was notable that staff systematically did their best in challenging circumstances.

• Staff demonstrated resilience and compassion when trying to help patients who had waited significant periods of time in the ED for a mental health review. This included when they faced aggression and verbal abuse.

• The patient and staff safety team had wide-ranging responsibilities and provided considerable support, including in safeguarding and child protection circumstances.

• The trust had a range of developing strategies to improve access, flow and capacity. These were in the early stages of development at the time of our inspection and we saw limited impact of them to date. Staff provided evidence the improvement works had resulted in faster treatment and an improved experience for some patients, particularlythose who arrived by ambulance.

The Trust have been they now must:

• Further improve performance in the national 15-minute triage recommendation.

• Improve standards of care, including triage, time to assessment and time to mental health review, for patients with mental health needs.

• Ensure the paediatric ED is compliant with RCPCH staffing level standards.

• Review the availability of medical staffing in ED overnight.

• Improve governance processes and clinical governance oversight of the number of refused referrals to the urgent care centre through the streaming process.

• Improve the management of the waiting area in the main ED to ensure patients who are vulnerable are not put at risk by patients who pose a threat to their safety.

• Continue to work in partnership with the mental health provider and other providers to review the tools used to assess and improve the mental health pathway.

• Ensure staff working in the acute medical unit have the training and supervision to provide a caring and compassionate service.

• Effectively manage crowding in all areas of the ED.

• Review the flow of patients through the paediatric ED to reduce the time children spend waiting with adults.

• Ensure there is a clear, defined and ratified standard operating procedure for the ambulatory emergency care unit

and ensure that staff understand this and adhere to it.

• Ensure patients have access to food and fluids during their time in the department.

There were also areas of outstanding practice:

• Senior ED staff had introduced more consistent support for staff following an incident, including a ‘support basket’ with items to encourage staff to come together and debrief for 15 minutes. Staff spoke highly of this initiative and said it helped them to focus again on patient care after a stressful period or incident.

• The trust had facilitated the implementation of a ‘synergy car’ service for patients who called 999 with urgent mental health needs. The service was staffed by a police officer, mental health crisis worker and a paramedic. In its first week of operation the synergy service had prevented seven unnecessary ED attendances and 17 attendances for patients detained under section 136 of the Mental Health Act.

• Although ED nurses lacked formal training in the management of mental health conditions, they demonstrated exceptional resilience and compassion when faced with patients who were clearly deteriorating. This included an ED nurse who remained kind and compassionate despite a patient screaming in their face after being in the department for 17 hours.

You can read the full report here: https://www.cqc.org.uk/location/RXL01

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