CQC and Urgent and Emergency Care
- Meeting of Health and Adult Social Care Overview and Scrutiny Committee, Wednesday 28 July 2021 10.00 am (Item 9.)
Jo Beer (Chief Operating Officer, University Hospitals Plymouth NHS Trust) was present for this item. It was highlighted that:
· the Care Quality Commission (CQC) came to the hospital for an unannounced inspection on 8 March 2021 and focused the inspection on urgent and emergency care and diagnostic imaging;
· sustained improvements made in diagnostic imaging was recognised and reflected in CQC’s feedback;
· concerns identified about the risk to patients while they wait to be seen in the emergency department and how these risks were being mitigated, particularly when the department under pressure;
· on the 25 March 2021 a Warning Notice under Section 29A (S29A) of Health and Social Care Act 2008 was issued with regard to urgent and emergency care;
· S29A correspondence indicated the CQC were assured by the information they shared that immediate risk being managed to ensure patient safety, but not assured UEC provided in a safe way and risks not being fully mitigated while patients waited to access the emergency department. They gave the following reasons for their view that the quality of health care provided requires significant improvement:
· Performance data shows delays in patients both accessing the emergency department and waiting to be seen.
· CQC were not assured there was adequate oversight and responsibility of the patients who were waiting to be seen.
· Patients were not being seen in priority based on their clinical need.
· The CQC were not assured patients were safe while they waited in crowded areas.
The CQC issued 4 ‘must do’s’
1) Ensure patient care and treatment is provided in a safe way and risks are being fully mitigated while patients wait to access the ED. Ensuring there is adequate oversight and responsibility of the patients who are waiting to be seen, while they wait in ambulance queues or walk into the Emergency Department, and they are seen in priority based upon their clinical need.
2) Ensure patients are safe while they wait in crowded areas. To include appropriate protection in line with Covid-19 infection prevention and control guidelines and for staff to be clear on how they monitor patients while they wait in these areas.
3) Ensure the appropriate personal protective equipment is always used by staff to reduce the risk of infection and prevent and control the spread of infection. The trust must ensure staff are maintaining good levels of infection prevention and control, including wiping down surfaces and computers following use. High levels of cleaning should be maintained within the Emergency Department
4) Ensure the mitigations, in the absence of a full-time paediatric emergency medicine consultant are effective to ensure children are provided with care or treatment by clinical staff with the correct qualifications, competence, skills and experience to do so safely. The trust should ensure there is clear allocation of medical cover (or equivalent) for the paediatric department and timely response to emergencies.
Questions from member’s related to:
· the recruitment of a hybrid Paediatric Emergency Physician– when would this post be filled?
· people turning up to the emergency department because they cannot get access to their GP;
· what was the biggest staffing pinch at the hospital and was there a way to educate patients on which services to access?
· Covid surge at the hospital was that affecting the staffing and provision at the emergency department;
· were the CQC coming back to ensure measures were in place?
The Committee noted the CQC and Urgent Emergency Care Report and the progress made.