Pressure on trust’s A&E staff 'unsustainable', regulator warns

Consultants working at the Princess Royal Hospital, run by Shrewsbury and Telford Hospital Trust, said the level of pressure in the emergency department was “unsustainable”, as part of an inspection carried out by the Care Quality Commission.

Following the inspection, carried out in December, the trust was rated requires improvement.

The news comes as local commissioners push towards public consultation on the controversial reconfiguration of emergency services, which will see the emergency department at PRH in Telford downgraded to an urgent care centre.

Last month, the trusts’ chief operating officer warned that PRH could be forced to “temporarily” shut its emergency department overnight because of staffing shortages.

The CQC report highlighted concerns over staffing levels in both the trust’s emergency departments at PRH and the Royal Shrewsbury Hospital. It said the trust had “insufficient numbers of emergency department consultants” and “consultants work excessive hours to ensure care was delivered”.

The trust has six substantive consultants across its two emergency departments. Two consultants working at PRH told the CQC “they rarely left the department before 5pm and were then frequently called back in overnight. They told us this level of pressure was unsustainable.”

The CQC also said nurse staffing levels are not planned effectively and do not take into account the acuity of patients.

“The trust was also short of middle grade doctors in both emergency departments and relied heavily on locums to cover shifts. Consultants told us the trust supported them well with requests for locums, but recruitment was problematic,” the report added.

Despite concerns raised about emergency services the trust was praised by the CQC for its “openness and transparency about safety”.

The trust’s maternity services are currently under investigation following a series of infant deaths. The CQC rated that the trust’s two midwife led maternity units requires improvement.

The trust was rated good in the effective and caring domains and requires improvement for well led, responsive and safe.

Trust chief executive Simon Wright said: “The CQC recognises a number of improvements since its last inspection. However, they still rated us a requires improvement.

“The trust has made significant improvement in the past two years, with 64 per cent of the areas inspected now rated as good. This improvement is particularly noticeable within medical care, but there is also positive movement within surgery and end of life care.

“We must not, however, gloss over the areas where we can and must improve. The fragility of our A&E departments and some of our other services is no secret, but we are working hard to resolve the challenges these services are facing. The need to resolve these challenges is the driving force behind our plans to reconfigure hospital services and to work more closely with GPs.”