PERFORMANCE: The Care Quality Commission has issued a warning to University Hospitals of Morecambe Bay foundation trust that it must improve staffing levels at The Royal Lancaster Infirmary, after an inspection of its accident and emergency department.

The quality regulator’s warning came as foundation trust regulator Monitor reported that it would be taking action to “strengthen the leadership” at the troubled Cumbrian trust.

A CQC statement issued this afternoon says Morecambe Bay must do more to improve standards of care “or face further action”.

The report comes just months after a damning CQC report on maternity services at the foundation.

Debbie Westhead, North West regional lead for the Care Quality Commission, said: “An unannounced inspection of the A&E department just before Christmas raised real concerns about staffing levels – staff themselves told our inspectors that these were ‘at crisis level’.”

She continued: “‘The advice CQC gave earlier this month still holds - local people should continue to use accident and emergency services if they need to. However, we are telling the trust in very clear terms that they must urgently address their staffing issues to make sure that the department is safe going forward.

‘I know local people will be worried by all the negative reports into this trust. But this demonstrates the level of scrutiny that the trust is under - and CQC and other bodies are using all this information to try and understand what the problems are and how they can be addressed so that people get better care.”

A Monitor spokesman said: ““Monitor will be taking action to strengthen the leadership of the trust. We will be making an announcement soon about what form our action will take.”

A CQC investigation is looking in-depth at the care patients receive when they arrive at the hospital for emergency care, and what happens to them subsequently.  The warning notice is not the outcome of this investigation, which is ongoing, but has been issued in response to specific issues around staffing identified during an unannounced inspection.

The inspection of the accident and emergency department at the Royal Lancaster Infirmary took place on 21 December, with subsequent examination of staffing records.

CQC inspectors found that staffing levels did not always meet the needs of people using the department.

An examination of shift reports completed by nursing staff for December revealed a number of concerns including:

  • On 6 December, three of the registered nurses on shift were occupied in resuscitation bays, leaving only one nurse in the main department for medication administration
  • On 9 December, by 23.00 hours, the department was ‘blocked’ and only one resuscitation bay was available
  • On 15 December, the corridor was full with people awaiting attention and assistance. The shift report showed 11 four-hour waiting time breaches and five six-hour breaches.
  • On 17 December, no cover was provided for a registered nurse who was off sick
  • On 20 December, patients were waiting in the corridor and the staff shift reports stated that staff were unable to complete all the paperwork required clinically – staff were drafted in from wards to help.
  • Staff told the CQC: “often staffing is at crisis level”