Kettering General's A&E department requires improvement

Inspectors have given Kettering General Hospital’s emergency department another requires improvement rating following an unannounced visit prompted by ‘concerning information’.

The Care Quality Commission’s (CQC’s) inspectors found during their one-day visit on February 3 that the department was under par in a number of areas, including in the building itself, staffing numbers and how long patients had to wait to be seen.

It has now said the hospital – which now along with every acute hospital in the country is in the midst of a coronavirus battle – must ensure all patients have appropriate risk assessments, make sure patient dignity and privacy is maintained and have enough staff at all times.

In a statement the hospital’s head of nursing Leanne Hackshall said the rating and the inspection team’s findings were not a surprise as the department is dated and in need of significant modernisation. She said in the wake of the report it has sped up actions to change the department.

The department was graded as requires improvement in all aspects apart from care, which was deemed to be good. The hospital was in special measures until May last year.

In its report published on March 27 the CQC summarised its conclusions after its team of three inspectors had witnessed how the department operates.

It said: “Our high level findings were:

• The design, maintenance, and use of facilities and premises did not always meet patients’ needs.

• Risks to patients were not always assessed appropriately. For example, patients that self-presented to the department did not always receive a timely initial assessment or observations. Nursing risk assessments and safety checklists were not routinely completed.

• There were not always enough nursing staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• There were enough medical staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

• Patients could not always access care and treatment in a timely way.”

It went on to say: “However;

• The service had managers at most levels with the right skills and abilities to run a service providing high-quality sustainable care.

• Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns.

• The service had a vision for what it wanted to achieve and a strategy to turn it into action, developed with all relevant stakeholders. However, the system wide strategy had not delivered the anticipated outcomes.

• Leaders operated a governance process which considered departmental risks, incidents and quality outcomes. However, the process continued to not be fully embedded. There was poor representation at mortality and morbidity meetings which meant there was the potential for missed learning opportunities which could be used to improve patient care.”

During their visit the inspectors came across a suicidal patient who was being managed in a clinical room because there were not enough mental health beds available in the area and one mental health patient had to wait 37 hours for a specialist bed.

The hospital’s small children’s A&E department was also said to not be meeting national standards by having an open corridor for children’s waiting to be assessed. Plans are in place to improve the department after the CQC said during another inspection that the service was not fit for purpose.

Leanne Hackshall, who oversees CQC assessment at the trust, said: “We are pleased that the CQC have recognised our continued efforts to improve our emergency care services.

“We fully accept that our A&E department is dated and in need of significant modernisation – our current facilities make it a challenge to effectively stream and see all patients as quickly as we would like – so the CQC’s overall findings of requires improvement were not a surprise.

“It is why we prepared detailed plans for a £46m Urgent Care Hub to replace the department and these were approved by the Government at the end of last year.

“We will progress to build the new unit as soon as possible, taking account of the current coronavirus national emergency.

“The issues the CQC spotlighted are well known to us and plans were in place to address these.

“With their additional insights we have further expedited our actions to decompress the department making it easier to see and treat those requiring our services.

“Privacy, environment and space will be addressed in the new build – which will also enable better streaming and reduced waiting times.

“We still have many paper systems at KGH but we are currently undertaking a massive digitalisation programme which is progressing well and should enable staff to do paperwork electronically with more consistency.

“The CQC clearly recognised the great demand on services in North Northamptonshire, and our A&E in particular, and have already reviewed and enhanced staffing.

“We are pleased they have recognised that our staff have a very strong commitment to their job and are proud of their role and their team.

“I would like to take this opportunity to publicly thank all of our emergency care workers – indeed all of KGH staff – for their extraordinary dedication to patient care in the current situation.

“I am sure this is much appreciated by all of our patients and the rest of the local community.”

The hospital has been over capacity for a number of years as the number of people living in the area has steadily risen. It has to serve an area of 320,000 patients from North Northamptonshire as well as South Leicestershire.

Between September 2018 and August last year its A&E department treated 95,000 patients, a rise of eight per cent on the year before. The average time wait for patients to be seen at the hospital when arriving at Kettering Hospital accident department was higher than the national average in every month of 2019 and the number of ambulances delayed while waiting to hand over patients was one of the worst rates in the country for December 2019.

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