• Staff told inspectors ”we don’t want to release ambulances”
  • Damning report into south London A&E describes “warzone” atmosphere and “ineffective clinical leadership”
  • Nurse told inspectors of “smelly, stinky adults”
  • King’s College FT still rated “requires improvement”

The Care Quality Commission found standards have dropped at a struggling emergency department where a nurse told inspectors: “We don’t want to release the ambulances because we know they will return with more patients.”

A report into King’s College Hospital Foundation Trust released this week found the trust’s Princess Royal University Hospital emergency department had got worse since its last inspection.

The report (attached, right) also said a senior nurse had made “flippant and misjudged” comments to inspectors about patients, referring to some as “smelly, stinky adults”.

The CQC team found a “churn of leadership” in the department, and said that while it was “clinically led with little input from operational and nursing staff”, there was “little in the way of effective clinical leadership”.

King’s College FT runs two type-one emergency departments in south London – one at the PRUH in Bromley and another in Denmark Hill. Its performance against the 95 per cent four-hour accident and emergency waiting target for 2018-19 was 72.1 per cent.

The report said: “There was a lack of traction on making improvements in the completion of falls care plans. This was despite there being numerous incidents in which patients had sustained harm, and despite falls to harm being a significant risk for the department since before November 2016.”

The CQC said the trust “must ensure patients and visitors are treated with kindness and compassion in the [PRUH] emergency department”.

The inspectors described “vehement animosity directed towards the executive team from staff across the emergency department” but added that “local leaders were not owning the internal challenges”. Staff described a “war zone” atmosphere.

The situation at Denmark Hill was not as bad but the inspectors were told the unit had significant problems in transferring patient to a ward bed. Staff said one patient had waited five days to be transferred to a ward.

A spokesman for the trust said: “The behaviour [described in the report] falls short of the high standards that we expect of our staff.”

He said the trust had begun “a dedicated executive-led organisational development programme for the senior leadership team in the [PRUH] ED”, and set up “an independently-chaired, system-wide oversight group including representatives from the trust’s senior leadership, CCG and regulators”.

The CQC’s chief inspector of hospitals Ted Baker said he was disappointed that the overall rating for the trust remained “requires improvement”.

Professor Baker added: “In fact, in some areas the trust has gone backwards. The trust must take action in response to this report to address this.”

Since the inspections in January and February this year there has been significant turnover at board level.

The trust has a new interim chair, chief executive, chief operating officer at Denmark Hill, executive managing director for the PRUH, and its director of strategy has left.