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Mid Essex emergency services issued with ‘significant improvement’ CQC warning

Mid Essex Hospital Services NHS Trust (MEHT) must make “significant improvements” in the care it provides to patients using the urgent and emergency services at Broomfield Hospital in Chelmsford. 

In April, the CQC carried out a third inspection in less than a year in response to patient concerns. It has now issued a warning notice to the trust. 

Inspectors found a “disorganised” emergency department, with patients experiencing delays in their care and treatment, with several people having to wait for more than 12 hours. 

Following the inspection, the hospital’s urgent and emergency services have been rated as ‘inadequate’. CQC has also asked the NHS Trust Development Authority to provide a package of support at executive level to ensure the trust addresses the longstanding issues which inspectors have identified as risks to patients. 

Back in August 2014, CQC inspectors raised concerns over patient safety, security for patients, especially those with mental illness and paediatric patients, incident reporting and staffing levels and training. 

After a follow-up investigation in November it was noted that the trust had “failed” to address the issues. In February 2015, inspectors returned and found that staff who were not registered with the Nursing and Midwifery Council (NMC) were providing nursing care in the Emergency Assessment Unit. 

Professor Sir Mike Richards, CQC’s chief inspector of hospitals, said: “I am concerned that the Mid Essex Hospital Services NHS Trust has not taken sufficient action to address the requirements of our previous inspections, and that patients coming in to the urgent and emergency services continue to experience a poor level of care and treatment. 

“The flow through the emergency department, the high number of staff vacancies and the arrangements to triage urgent cases still had an impact on the care patients received, which in some cases was poor.” 

The regulator added that the trust must review its staffing levels in the emergency department, ensure all safeguarding referrals for adults are completed in a timely manner, and ensure that infection control practices are improved. 

MEHT has also been told it must make a number of improvements including: 

• Ensuring medicines are administered in a timely way, especially for patients receiving intravenous antibiotics and time-critical medicines.
• Care documentation including care plans and risk assessments must be undertaken in a timely way, accurately, fully completed and reviewed when required.
• Staff training and awareness on mental health must improve so that the provision of care for patients with mental health conditions improves.
• Patients with mental health concerns must be risk assessed on arrival at the emergency department and patients with mental health concerns must be appropriately observed and monitored. 

Prof Richards said that Mid Essex has agreed to submit information to the CQC to demonstrate the safety of patients, as well as how effective systems and process are within urgent and emergency services. 

Paul Forden, chief executive officer at MEHT, said the trust has in place a number of “clear plans” to continue to improve the Urgent and Emergency Services at Broomfield Hospital and is making significant investments in terms of clinical staff, the clinical facilities, leadership, culture and training to improve patient care. 

He added that MEHT will continue to work with the NHS Trust Development Authority, its Clinical Commissioning Group and local health economy partners to build a robust, sustainable, urgent and emergency service that will ensure improved services and care for patients for the long-term future. 

Dr Ronan Fenton, medical director at MEHT, said that “immediate action” was taken in April when the concerns were raised. 

“The trust has invested in improving the emergency department environment, building an improved area for paediatric patients, a new dedicated and bespoke room for the safety of patients with mental health concerns and adding five new clinical treatment cubicles to improve the dignity and privacy of patients being treated in the department, enabling quicker handover of patients arriving by ambulance, to the increased treatment areas,” he said. 

“This has improved the flow of patients in the department and reduced waiting times.  Additionally, we made significant investments to open the new Surgical Emergency Ward in May to support the assessment and care of patients. The redefined minor injury service is also making sure patients are fast tracked to the right service for their needs.” 

(Image: c. Sean Dempsey PA)