Inspectors warn of safety concerns at Doncaster hospital emergency department

The Care Quality Commission carried out ‘focused’ inspections at Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust’s urgent and emergency services.

They raised concerns about assessments and observations ‘by unqualified staff, that had little or no training’, although systems and processes have been put in place to ensure improvements in relation to safety in Doncaster.

Concerns were also raised about a reliance on locum consultant doctors,and patients not being observed thoroughly by experienced staff, which risked any deterioration not being treated promptly. Both hospitals were not identifying or recording risks well.

Animal officers appointed at Doncaster Royal Infirmary to give snuggles and comfort to patients

The CQC carried out the inspections at both Doncaster Royal Infirmary and Bassetlaw District General Hospital between 27 and 29 November 2018, looking specifically at the urgent and emergency services.

At DRI, the category of ‘safe’ was rated inadequate and ‘caring’ was rated good. Effective, responsive and well-led were rated as requiring improvement, and the hospital’s service, and the trust in general, was rated requiring improvement overall.

CQC’s Deputy Chief Inspector of Hospitals, Ellen Armistead, said: “We saw that staffing remained an issue across both hospitals, particularly paediatric nurse staffing. There was a reliance on locum consultant doctors at Bassetlaw, and at Doncaster we had concerns that patients were not being observed thoroughly by experienced staff, which risked any deterioration not being treated promptly. Both hospitals were not identifying or recording risks well.

“At Doncaster Royal Infirmary, to address concerns regarding initial assessments of patients arriving at the urgent and emergency service, inspectors were concerned that the assessments and observations were being done by unqualified staff, that had little or no training. I am encouraged that trust have put in systems and processes to ensure improvements in relation to safety in Doncaster.

“However, the hospital’s staff were seen to be caring and offering patients with an appropriate level of emotional support. Staff were good at keeping patients involved in their care decisions and informed them of any progress made. The service was working well to ensure patients were seen in a timely matter, and escalated appropriately.”

Officials at the trust which runs the trust say assessments and observations are done by trained nurses, supported by staff available within the waiting area.

Richard Parker OBE, chief executive at Doncaster and Bassetlaw Teaching Hospitals, said: “As a result of the initial feedback at the time of the inspection, we made immediate changes to our minor illness and minor injury pathway to ensure that the CQC's concerns regarding assessment and observation of patients were dealt with, with increased privacy when the initial assessment take place.

Animal officers appointed at Doncaster Royal Infirmary to give snuggles and comfort to patients

“We are pleased that the CQC noted that our staff are caring, offer good levels of emotional support and ensure that individuals are seen in a timely manner and escalated appropriately. As was the case before the inspection, all observations and assessments in our services are carried out by trained and experienced nurses, while support staff known within the service are utilised within the minor injury and illness waiting area to assist patients and raise concerns should their condition deteriorate.

"The CQC’s feedback regarding the provision of paediatric staff is something we are acutely aware of, and we will be continuing our efforts to recruit to this particularly speciality which is affected by national shortages within this role. The Emergency Department team, and the whole Trust are committed to continuing to improve our services and we would expect to reverse the rating change when the CQC re-inspect the services.

“Over the last five years, as standards and demand on Emergency Departments nationwide have increased, we have continued to increase the number of trained health professionals in our Emergency Departments to meet the demands. In Doncaster, Mexborough and Worksop, we have 150 nurses, 50 doctors and around 120 trained support staff, all of whom work each and every day to provide the best possible care and treatment for our patients.

“Between November and January, our Urgent and Emergency Care services have cared for around 43,000 people. This has been one of the busiest winters ever experienced at the Trust, and we must thank colleagues for their remarkable dedication throughout.”