DERRIFORD Hospital have been told to make rapid and widespread improvements to its Accident and Emergency department after receiving an official warning notice from The Care Quality Commission.

Following an unannounced inspection in March this year, the CQC have highlighted that the hospital, run by University Hospitals Plymouth NHS Trust, must take action in regards to keeping people safe, as well as improving access and overcrowding within the emergency department.

Urgent and emergency care at Derriford Hospital has been rated as ‘requires improvement’ overall as have the ratings for safe, effective, responsive and well-led. The area of caring was not examined as part of this inspection.

During the visit, inspectors found:

• Not all staff received feedback from leaders when incidents had been raised, leading to a culture of staff being less inclined to report incidents.

• The layout of the waiting room made it difficult for staff to safely observe or hear people call out for assistance.

• The waiting room was not large enough to safely accommodate the high volume of people in the area. We saw all areas of the department were very busy and the waiting room was crowded with people in very close proximity to each other with some areas being standing room only.

• The pathway for people with mental health needs had improved. There was a dedicated nurse currently in place to support people through the pathway.

• There was better support and focus across the trust which meant that departments were able to work together more effectively.

However, the overall rating for the trust and the hospital remain as requires improvement.

CQC deputy director of operations in the South, Catherine Campbell, said: “On previous inspections we had highlighted the pressures at Derriford Hospital being mainly due to limited availability of social care beds and community care, which impacted on the number of medically fit people able to be discharged. That hindered flow throughout the hospital, causing people to experience long delays.

“During this inspection, we found people were still experiencing long waits in ambulances and the emergency department waiting room was still overcrowded. This included people experiencing long waits to be triaged, treated or discharged. One person’s relative was told there may be a 48-hour wait for their loved one to be admitted to hospital.

“However, some told us they had been assessed and treated relatively quickly. People gave positive feedback about staff, describing them as ‘brilliant and lovely’. This doesn’t alter the fact that in October 2021, we highlighted the same problems to the trust’s leadership and local stakeholders.

“There is a new leadership team in place at the trust and we are aware that emergency department delays in treatment is one of the areas that has been priortised to improve care. But, continued focus is required on what the trust can do to improve the safety, quality and experience of care for people through the emergency department, by making the improvements requited in the warning notice will focus attentions on the areas we want to see significant and widespread improvement particularly regarding overcrowding in the emergency department.

“This includes focusing attention on the areas that we want to see significant and widespread improvement particularly regarding overcrowding in the emergency department.

“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can receive safe and appropriate care.”

Interim chief executive of Derriford Hospital Mark Hackett said: “At the time, we know the quality and speed of care we were able to offer patients coming for Urgent and Emergency Care was not what we aspire it to be when the CQC inspected our services back in early March. They arrived during an Internal Critical Incident and what they saw was fairly reflected in their report, but that was eight months ago now and we have made good progress in improving our performance since then.

“Our staff are doing all they can to ensure the safety of patients at all times – we know there is still work to do, but it is important to reflect the improvements we have made since the inspection, which are many. We have made significant improvements since March, but we are striving for better and there is more to do.

“I want to highlight how complimentary the inspectors were about our staff and reiterate we are seeing an improving picture for urgent and emergency care through our One Plan.

“The inspectors gave us some immediate feedback, some elements of which were notably different to previous inspections and relate to an improvement in our culture – they fed back that the staff they spoke to were very open about the challenges they faced, but also positive about the culture and wanting to work for the Trust; patient feedback was exceptionally complementary about the care and compassion received.”