• Dudley Group Foundation Trust issued with fourth enforcement notice in nine months
  • Trust’s accident and emergency services retains “inadequate” rating
  • Inspection in June found staff were “fearful” of leadership

An accident and emergency department has been served with a fourth enforcement notice in nine months, after the Care Quality Commission said it continued to be “extremely concerned” about the care provided.

The CQC has inspected the “inadequate” A&E department at the Dudley Group FT’s Russells Hall hospital four times since December 2017, with the latest visit taking place in August.

Despite previous enforcement notices, and the trust stating it had “made immediate changes” after an inspection in June, HSJ has learned the regulator returned again in August and identified “continued concerns regarding patient safety”.

Professor Ted Baker, chief inspector of hospitals at CQC, told HSJ that “further enforcement actions” were imposed. The regulator did not reveal details of its latest actions as the appeal period has not elapsed.

Professor Baker said: “The inspection identified continued concerns regarding patient safety. We will provide further information when the legal process allows.”

The CQC also published a report this week about its inspection in June, which was the third since December 2017. 

It said some patients with suspected sepsis were not identified or managed appropriately, there was poor accountability for the safety of patients, and there were waits of more than an hour for people to be triaged.

Concerns were also raised about how quickly staff helped patients with serious and deteriorating conditions, while staff reported a “poor leadership style from some of the executive team” that left them feeling “fearful and disempowered”.

Heidi Smoult, deputy chief inspector of hospitals in the CQC’s central region, said of the June inspection: “We were extremely concerned at what we found during our inspection.

“We continue to monitor the trust extremely closely. We have also continued to escalate our ongoing concerns with partner organisations and to work with NHS Improvement to ensure that necessary steps are taken to improve safety for patients”.

The hospital’s urgent and emergency service was first rated “inadequate” in April 2018, following an inspection in December 2017. Enforcement notices were issued in January, February, June and August 2018.

Diane Wake, chief executive at Dudley, said: “We recognise the pace of change has not been as fast as we would want and that is why we have asked for the Emergency Care Intensive Support Team to work alongside our staff to support the changes and accelerate the change process.

“We have reviewed our staffing levels across the trust and increased the number of nurses and consultants within the emergency department. We have invested £700,000 in nursing in ED and have recently recruited two additional consultants and are out to advert for a further six consultants.”

She said further improvements are being made in relation to sepsis treatment, there has been a week-on-week improvement in triage times, and a new clinical lead has been holding workshops to promote “interprofessional team working”.

She added: “We have also worked with other local providers with visits to Royal Wolverhampton Trust and University Hospitals Bristol FT to share and bring best practice back to the trust.”

Meanwhile, the trust is currently the subject of an external investigation after whistleblowing concerns about its executive board were raised in a letter by senior clinicians.