The trust with the worst performing emergency department in England has seen its urgent and emergency services rated inadequate.

A Care Quality Commission report released today rated emergency and urgent care at Hillingdon Hospitals Foundation Trust as inadequate, giving the trust as a whole a “requires improvement” rating.

The west London acute trust has missed the four hour accident and emergency attendance target for the past three years, and had the worst performance on the type one category measure on the latest quarterly data.

In quarter one of 2018-19 it saw 55 per cent type-one A&E attendees within four hours, against a target of 95 per cent.

The CQC listed significant concerns in emergency care, with ratings of inadequate in four categories. The two other categories, caring and responsive, were rated requires improvement.

The safety rating has been downgraded to inadequate with inspectors finding the general waiting area was “a matter of concern” with insufficient seating and restricted space. They “were not assured that there was safe oversight of waiting patients which many staff agreed with.”

The number of patients waiting over an hour after arriving at the hospital in an ambulance to be handed over to emergency staff has also increased. There were 515 of these cases – known as “black breaches” – between November 2016 and October 2017, with figures decreasing over this period. However, there were 75 black breaches between November 2017 and February 2018.

Infection prevention and control had deteriorated since the last inspection in May 2015. Then inspectors found staff did not follow best practice for hand hygiene. In this inspection, they discovered “staff did not always decontaminate their hands between patients”. They also found medicines were not always appropriately stored or checked in the emergency department.

Both these issues have deteriorated since the last inspection and are again listed among the areas the regulator said must be improved if the trust is to comply with its legal obligations.

The trust’s urgent and emergency care service has also seen its rating for well-led down-graded to inadequate, with several problems identified in the previous inspection going unaddressed by leadership, including infection control and the storage and checking of medicines.

The trust’s chief executive, Shane DeGaris, admitted the ratings were “not good enough”, and added: “We will use this report to help us make improvements wherever they are needed.”

Inspectors rated the overall trust as “good” for caring – unchanged from the previous inspection. The CQC highlighted the compassion shown by staff who “treated patients and their families with dignity, kindness and respect”.

It also highlighted improvements in services for children and young people, as well as end of life care, which were both rated as good. Maternity services was also counted as good overall with its leadership considered outstanding again this year.