• Isle of Wight Trust told to make improvements in its emergency departments
  • CQC “not assured” patients are treated fast enough
  • Agency workers account for half of nurses on some shifts
  • Trust put in financial special measures

A trust in special measures has been ordered to take immediate action, after inspectors warned it was failing to safely staff its emergency department. 

During a visit to St Mary’s Hospital, which is run by the Isle of Wight Trust, Care Quality Commission inspectors witnessed two patients in the emergency department waiting for admission to a bed for 15 hours, while another patient who was treated in a corridor compared the experience to “sitting in a goldfish bowl”.

The trust, which provides acute, community, mental health and ambulance services, has been in special measures since April 2017 after being rated “inadequate” by the CQC in a report which was critical of the trust’s leadership . There have also been subsequent safety and bullying concerns

Nigel Acheson, the CQC’s deputy chief inspector of hospitals for the south, said his inspectors were “not assured that patients were being treated promptly enough and in the right care areas”.

Trust chief executive Maggie Oldham said “critically ill patients were seen quickly and treated properly”, and added the trust had “made the commitment to increase staffing”. 

The 17-page report, published today, follows an unannounced inspection of St Mary’s Hospital’s emergency department in mid-January.

Among the CQC’s findings were:

  • A “significant” shortage of nurses in the department;
  • Periods of time during the evening when there were no nurses in the major and minor treatment areas, and rapid assessment area; and
  • Initial assessment of ambulance patients did not follow guidance by the royal colleges of emergency medicines and nursing because they were not all done face-to-face with the patient.

According to the report, only six of the scheduled eight nurses were on duty in the department when the inspectors visited.

This meant “several aspects of patient care had not been completed”, and the trust “heavily relied” on agency nurses.

A random examination of 20 shifts in the last three months discovered eight of the shifts comprise between 40 per cent and 50 per cent agency nurses.

The shortage also meant up to four patients arriving in ambulances were only assessed by a healthcare assistant, and some patients were receiving intravenous infusions in corridors as a result of the department being “crowded” and the lack of available beds.

Despite the problems, all the department’s junior doctors “spoke positively” about working there, though some nurses described working night shifts as “depressing” because it was “very difficult” to admit patients to a ward.

“Nurses found themselves constantly apologising to patients and their families about the situation,” the inspectors reported.

The CQC has told the trust it must staff the emergency department with enough suitably qualified nurses, reduce crowding to ensure patients do not have to wait on trolleys for treatment, and “rapidly identify” patients whose clinical condition is at risk of “deterioration”.

Dr Acheson added: “While we can acknowledge winter is a busy time for hospitals this should never impede on patient care.”

Ms Oldham described the report as “helpful” and agreed that there is a “major impact” on patients and staff when there are not enough staff available. 

”We are focussing on finding staff to work in the trust,” she said. 

She added the trust has “invested” £1.5m to increase staffing numbers this year and £1.3m on improvements to the emergency department. Another £250,000 will be spent creating a “dedicated minor injuries and illness area combined with GP services to create a dedicated urgent care facility”.

However, the trust has also been put in financial special measures, which Ms Oldham attributed to “costs rising significantly”. In particular, this spending relates to temporary staff.    

The £171m-income trust is forecasting a £30m deficit, despite being given a control total of £17.1m.