The Care Quality Commission has raised safety concerns about the urgent and emergency services at a teaching trust in Merseyside.

The safety of these services at Aintree University Hospital Foundation Trust had previously been rated “good” after a full inspection in 2014, but the regulator returned unannounced in April following concerns about patient safety. The trust has now been given a “requires improvement” rating in this domain, but is still rated “good” overall.

The latest visit focused on several areas including the emergency department, observation unit, acute medical unit and a frailty unit. 

Staffing levels were among the key concerns raised, with the CQC saying: “Nurse staffing levels were not always filled to the safe staffing establishment, and staffing was below this threshold on the surgical assessment unit, ward 31 and in the accident and emergency department at the time of the inspection.

“There were periods of understaffing over a number of days prior and post inspection and there was evidence that staff had raised staffing concerns using the incident reporting process.”

The regulator was also concerned that processes for recognising and escalating the care of deteriorating patients were not always followed, which put people at risk.

Aintree was one of 63 trusts flagged by NHS Improvement in July as warranting questions about potential over-recruitment. This was based on the trust’s pay bill growth, which NHS Improvement said would need further investigation to determine whether the growth was necessary.

A trust spokesman said: “We are aware of the pressures on our nursing staff who look after patients admitted via A&E, and at the time of the inspection, we had some gaps in nursing cover arising from staff sickness and vacancies.

“However, we have plans in place to do all we can to ensure we continue to provide high quality care – these plans include deploying experienced staff to the areas which need them most and recruiting new nurses to Aintree, both temporary and permanent.”

This story has been corrected to state that the trust retained its overall “good” rating with the CQC. It was downgraded specifically within the safety domain for urgent and emergency services.