CQC inspectors find some improvement at Southmead Hospital but emergency and urgent care is still rated Inadequate

The Chief Inspector of Hospitals has said that he will continue to monitor the performance of Southmead Hospital in Bristol after the latest inspection found that the emergency & urgent care service remained Inadequate.

The Care Quality Commission had issued North Bristol NHS Trust with a warning notice in December last year following concerns which were found in the quality of the service provided to patients in the hospital’s emergency zone.  The trust was told that it must take action to deal with demand in the emergency department, where patients were waiting too long to be assessed and treated.     

In a further unannounced inspection in May, CQC has found that the emergency service has made some improvement but is still rated Inadequate for being safe and responsive, and requires improvement to provide effective and well led services. A full report of that inspection has been published on the CQC website

The Chief Inspector of Hospitals, Professor Sir Mike Richards, said:

“During our inspection last year we were so concerned at the delays facing patients in the emergency department that we issued a formal warning to North Bristol NHS Trust, setting a clear deadline for improvement. The trust set out a plan to meet those requirements by 1 April.    

“While I recognise that there have been some important changes at Southmead since our first inspection, it is clear that the requirements of the warning notice have not been fully met.

“Southmead Hospital provides a vital service to the people of Bristol, South Gloucestershire and North Somerset at all hours of the day and night.  It is not acceptable that at times the emergency service is not safe enough and that people are waiting too long for pain relief or treatment.  

“We will undertake a further unannounced inspection of the emergency zone to follow up on these issues in the near future. If those concerns still remain, we will consider further enforcement action.

“In the meantime I have asked the chief executive to provide regular updates about the quality of the service provided to patients in the emergency zone, with particular focus on the issues we have identified in our latest inspection.  We will monitor this information closely and take further action if that is required.”

Overall, inspectors found that there had been improvements in the management of patients within the reception area and minors’ area of the emergency department.  Since the last inspection the trust had recruited two additional consultants which allowed rapid assessment and treatment to be carried out during weekdays.

But inspectors found that patients arriving by ambulance who had to wait in the Crossroads corridors leading to the major treatment cubicles did not always receive a timely assessment of their needs.  At times the area was overcrowded, staffing levels had not increased to reflect predictable surges in activity and patients did not always receive timely pain relief.

Staff who were deployed to support the emergency department in times of overcrowding in the crossroads area did not always have the skills or experience required. Access and flow was poor. Performance against the standard requiring patients to be discharged, admitted or transferred within four hours of arrival remained consistently below the 95 per cent target.

Access to food and drink while patients waited in the department had improved with better availability of water and the recruitment of a housekeeper who undertook regular tea rounds.  Inspectors found that staff continued to demonstrate resilience and professionalism while working in challenging conditions.

The Care Quality Commission took part in a local Risk Summit, including NHS commissioners, providers, regulators and other public bodies where the issues found on the inspection were discussed. The Summit heard that performance had improved since May 2015 and range of actions had been taken to address the issues previously raised.