‘Desperation’ felt by A&E staff admitted by trust

It comes after a staff member at Northern Lincolnshire and Goole Foundation Trust wrote to the chief executive and trust’s commissioners after working a weekend shift within the emergency department at Diana, Princess of Wales Hospital in Grimsby.

In their original email, sent in January 2020, the anonymous whistleblower said they were writing out of “sheer desperation for the safety of patients”.

They added: “I have never in my whole career seen patients hanging off trolleys, vomiting down corridors, having [electrocardiograms] down corridors, patients desperate for the toilet, desperate for a drink. Basic human care is not being given safely or adequately…

“Your hospital is full, your A&E department is over-flowing, you are expecting staff to manage treble the amount of patients in majors and resus than they would do normally, without breaks, this is not safe. They cannot provide that care – which is evident.”

They also described how the hospital was relying on relatives to monitor patients, with staff “desperately trying to find a spoon so a patient can have a yogurt”.

This prompted a joint investigation by the trust and the commissioners into the claims, which was delayed by the pandemic. The trust has now released a copy of the final report to HSJ, which says all the concerns raised were either fully or partially upheld.

The specific concerns around “basic care including appropriate food and nutrition, privacy and dignity and patient comfort” were partially upheld, with the report saying: “Whilst care rounds were afforded, some elements like privacy and dignity were not always achieved.”

However, it said the “overwhelming finding” from staff whom investigators interviewed was that privacy, dignity and comfort was compromised due to the amount of activity in the department.

The investigation found all the staff interviewed described experiences of being overwhelmed and practising unsafely, stating they felt exhausted after their shifts, unable to do anything and worried about the next one.

In relation to the concerns around staffing, the report said: “Although actual staffing levels generally met the planned uplifted staffing levels for the weekend it is clear from the investigation findings in relation to the other key lines of enquiry and the feedback from staff, that the staffing might benefit from a review of working patterns.”

The urgent and emergency services at the hospital are currently rated “inadequate” for safety after an inspection two years ago.

The investigation found the weekend in question was “not an extraordinarily busy weekend in terms of the activity presenting in the ED”, but the acuity in the presentations was high, meaning the urgent treatment centre was unable to relieve pressure on the ED.

The report also sets out changes being made internally at NLAG and within the system to improve the emergency care service it provides.

Actions included a £15m capital investment to build a new emergency department, which it said will be a larger space and therefore help to improve patient privacy.

It also discussed the introduction of a new same-day emergency care initiative, the recruitment of more senior nurses within ED, and the launch of a new urgent treatment hub in north east Lincolnshire.

Peter Reading, the trust’s CEO, said a “whole raft of improvements” had been made to the A&E department in terms of patient flow and the working environment for the staff.

He added: “The report findings were welcomed by the whistleblower, who has also fed back to us anecdotal evidence from staff that improvements have been made; particularly in relation to nutrition and hydration.”

The report also included some feedback from the whistleblower, who said staff are now offered breaks, despite “internal politics” and are able to offer patients good quality hot meals.