Patient died waiting for treatment at hospital 'under extreme pressure'

The death was among several failings uncovered at Portsmouth Hospitals Trust by the Care Quality Commission during an unannounced inspection of its urgent and emergency care services.

Inspectors also found:

• two patients waited more than 24 hours to be admitted after the decision to admit had been taken;
• inadequate numbers of doctors working overnight at the emergency department; and
• the trust’s winter plan had not been effective and was instigated “too late”.

Trust chief executive Mark Cubbon said the report was a “stark reflection of the often harsh reality” faced by frontline staff who worked under “extreme and sustained pressures” over winter.

He said the trust is planning a “large scale” redevelopment of the emergency department and acute medical unit, which the CQC agreed was “not fit for purpose”.

Portsmouth is one of the worst performing trusts in the country against the national four hour A&E target. In January, when the inspection was held, the trust treated 62.7 per cent of patients attending Queen Alexandra Hospital’s type one A&E within four hours, and 73 patients waited more than 12 hours to be admitted following the decision to admit.

This was despite A&E attendances at the hospital dropping from 8,906 in 2017 to 8,691 in 2018, a reduction of 2.4 per cent.

The trust’s winter plan was instigated “too late to effect substantial change”, the CQC said. According to the CQC’s report, the trust acknowledged this and blamed “personnel changes in the leadership team”.

Winter pressures led to three whistleblowers contacting the CQC over concerns about patient safety and “undue pressures” placed on staff, which prompted the inspection.

Other departments were affected by the pressure on the hospital’s A&E.

The cardiac day unit “had been used extensively for non-cardiac medical patients”, the CQC said.

It was reported that urgent waiting list times for cardiac procedures were “well beyond acceptable or benchmarked waiting times”, which had led to three serious incidents, including one death.

“All [the three serious incidents] were felt to be avoidable if waiting times (two weeks) were maintained,” the inspectors said.

The acute oncology service had also been closed for more than 40 days, which had diverted patients to their GPs, A&E, or the acute medical unit.

According to the CQC, the hospital’s A&E department required two middle grade doctors at night, but only one was working overnight when inspectors visited.

Junior medical staff “felt unsupported and vulnerable” at night, and consultant staff were “frequently working additional hours to support their junior colleagues”.

However, the CQC praised the way the A&E department treated patients with acute mental illness and the use of a “dedicated discharge ambulance”, which helped improve patient flow.

Professor Ted Baker, CQC chief inspector of hospitals, said there had been a “renewed focus” on improving performance, but it was clear that “changes have not yet been fully embedded”.

He said the trust must take further action to improve its urgent and emergency care service. The trust was not re-rated after the inspection and remains rated overall as requires improvement.

The CQC have returned to inspect the trust’s core services this week.

Mr Cubbon said the long term solution to the trust’s urgent care challenges would take time to embed.

He said the trust has recently appointed a project team to lead the process of redeveloping the A&E and acute medical unit.

Earlier this week the financially stricken trust apologised after patients died due to x-rays not being reviewed properly, while concerns about long elective treatment waiting times were raised last year.

Two months ago a patient at Northampton General Hospital Trust died “due entirely to the dangerous overcrowding of the A&E department”, according to its medical director.