NHS regulator lifts warning notice on Great Western Hospital after improvements to A&E

Written by Tony Millett on .

The Care Quality Commission (CQC) has lifted their 'warning notice' on Great Western Hospitals NHS Foundation Trust having seen that improvements have been made to its emergency department - or A&E.

The CQC report issued on Monday (November 21) says: "We found that further and sufficient progress had been made to meet the requirements of the warning notice."

LATE ADDITION:  Great Western Hospitals’ Chief Executive, Nerissa Vaughan, is pleased the CQC has recognised the improvements made in the Emergency Department: “Despite national shortages of nurses, in particular I am pleased that we now have more permanent staff caring for patients in the Emergency Department."

"We’ve also recently invested in a team of specialist mental health nurses who are on hand 24/7 to support our emergency patients with mental health problems.”

“We are in a similar position to many other emergency departments and much of our improvement work is thanks to the outstanding efforts of the team in ED, who often the bear the brunt of the pressure."

“We know that with a growing and ageing population in Swindon, this problem won’t be solved quickly and managing the high demand for our services will be a priority for years to come.” 

Following an inspection in December 2015, the CQC had issued the trust with a warning notice to ensure the required improvements took place.

Inspectors checked on the work done by the trust in April 2016 when the CQC found that despite some improvements, the requirements of the warning notice had not been fully met.  

Inspectors judged then that the emergency department was still not being consistently staffed and there was not enough scrutiny of staff concerns with regard to staffing levels and capacity.

At times accurate and up-to-date records were not being consistently maintained to ensure that patients were protected against the risk of inappropriate care and treatment.

When CQC inspectors returned to GWH in October to check on progress again, they were aware the emergency department and the hospital had continued to experience unprecedented demand for unscheduled care. This was reflected, the report states, in the trust’s performance against key targets such as the four hour wait for discharge, transfer or admission to a ward.

Record keeping had improved through ongoing training and coaching. Audits showed that staff were observing patients’ vital signs more often and identifying deteriorating patients.

There was improved oversight of staffing, capacity and safety in the emergency department by the nurse in charge.   Steps were being taken to reduce the risks associated with the employment of temporary staff. The department was exploring innovative ways to improve staff recruitment and retention.

Staff  were now better equipped to care for mental health patients on the observation unit. Alterations to the premises to create a safer environment for patients and staff were underway.

Incidents relating to the management of mental health patients had reduced significantly.

Professor Edward Baker, CQC's Deputy Chief inspector of Hospitals, recognised the  'real effort' GWH leaders and staff had made: "I am aware that the trust has been experiencing unprecedented demand for urgent and emergency services."

“Although the trust has met the immediate requirements of the warning notice and despite the continuing high demand for the service, further improvements are still required."  

"Staff shortages remain a concern, particularly the lack of senior and experienced nursing staff within the emergency department during busier times and a heavy reliance on temporary staff."

“I am satisfied that the leadership team have acknowledged the need for further improvement and we will return to check on the trust’s progress.”

The full text of the CQC's latest report on GWH can be found here.