Urgent and emergency care at Peterborough City Hospital rated as Requires Improvement

Urgent and emergency at Peterborough City Hospital has been rated as Requires Improvement following an inspection from the Care Quality Commission.

Unannounced inspections were carried out in July 2024. Urgent and emergency care was inspected following concerns about waiting times, complaints about staff and quality of care, poor discharges, and management of care of people with mental health conditions.

An inspection of medical care was carried out in response to concerns about access and flow, delayed discharges, staffing shortages, and culture, while

Following this inspection urgent and emergency care has been re-rated as requires improvement as have the ratings for safe and responsive.

Well-led has improved from requires improvement to good. Effective has been re-rated as good. Caring was not looked at during this inspection and retains its previous rating of good.

The overall rating for medical care following remained unchanged and has been re-rated as good, as are the ratings for effective, responsive and well-led.

Safe dropped from good to requires improvement. Caring was not looked at during this inspection and it retain the previous rating of good.

The overall ratings of Peterborough City Hospital and the trust remain unchanged as requires improvement, which has been the case since it was inspected April 2023.

‘We remain concerned about ongoing issues with people movement and corridor care’

Stuart Dunn, CQC deputy director of operations in the East of England, said: “When we inspected urgent and emergency care and medical care services, we found effective care across both services, and caring staff who worked well together to secure good outcomes for people using the services. We were encouraged by how the leadership is driving positive change. Leaders listened to people who had concerns or complaints and sought ways to improve the service, however, people were still facing long waits for treatment and a lack of continuity in care.

“In urgent and emergency care services, although we found leadership had improved, people were waiting too long to be seen, more than 12 hours in some cases, and quite often due to staff shortages. Leaders need to focus their attention on addressing the root cause of these staff shortages which was impacting young people’s care in the children’s emergency department. Despite the shortages, staff worked well together under pressure to manage these delays as best they could.

“Staff shortages also meant the service didn't always identify people who attended the emergency department whose health was at risk of deterioration quickly enough. Only 54% of people arriving in the department underwent safety screening to receive proper monitoring while awaiting treatment and only 73% of eligible people were screened for sepsis.

“Leaders told us staff shortages and capacity issues were also behind someone absconding from the urgent and emergency department during our inspection, without being seen in a timely way by the psychiatric liaison team. Leaders added capacity problems were behind the issue of managing risks related to people admitted with acute mental health problems.

“In medical care, we found staff worked well together to provide effective care and make continuous improvements. Staff worked hard to remove any barriers for people to access care. There was a strong culture to prevent discrimination and inequalities. The service worked closely with external organisations to identify barriers to people's experience and discuss improvements.

“Staff felt confident to raise concerns and used risks as opportunities to learn and improve, and incidents were appropriately investigated. People told us staff were very caring and sympathetic to them.

“We remain concerned about ongoing issues with people movement and corridor care. Over 250 people were moved to other wards in the middle of the night in just one month, disrupting people's sleep and slowing their recovery. Additionally, some people were moved at least four times during their stay, with some moved as frequently as 11 to 15 times. Frequent moves can impact the continuity of people’s care and can lengthen their hospital stays.

“We’ve shared our findings with the trust, so they know where improvements must be made and where there is good practice to build on. We will continue to monitor these services closely, to ensure improvements are being made, and to keep people safe while this happens.”

Medical care services (including older people’s care)

Inspectors found: The hospital’s virtual ward programme, developed in partnership with the Integrated Care Board (ICB) across the East of England, is an example of good practice and innovation. The programme has saved more than 2,500 days that people would have otherwise been spent in hospital beds. This has also saved an estimated £500,000 of public money helping to reduce pressure on hospital beds and supporting people in their own homes.

Most staff had completed training to prevent falls and pressure ulcers. The number of falls and hospital acquired pressure ulcers had reduced, showing this has had a positive impact on people’s safety.

Leaders had created a discharge lounge for people waiting for transport or medicines before going home, freeing up beds on wards to improve flow around the hospital.

However...

Staff escalated concerns to leaders regarding people being cared for in corridors but despite reporting, this continued to occur. This breached the hospital’s own policy, which states that only people deemed appropriate should be placed in temporary locations, such as corridors while waiting for a permanent bed to become available.

Most people inspectors spoke with told CQC they had access to meals and drinks when required, and that their nutrition and hydration needs were met. However, this was not the case for people being cared for in corridors, they didn't always have access to meals that were specific to their dietary requirements.

Staff shortages sometimes delayed meal support, meaning people who needed assistance with eating had to wait longer.

Urgent and emergency services

Staff had access to a psychiatric liaison team to assist people with mental health concerns attending a daily handover to support people.

There was an active overseas recruitment programme and a dedicated team to support the staff recruited which helped to reduce staff turnover and improve people’s care.

The service held monthly management meetings to discuss incidents, identify trends, themes and lessons learned. These were carried out collaboratively both within the service with medical services and with another NHS service to share learning and implement improvement.

However….

There were space constraints in some areas of the service such as the fit to sit area.

Due to a large-scale transformation programme at CQC, these reports have not published as soon after the inspection as they should have done. The programme involved changes to the technology CQC uses but resulted in problems with the systems and processes rather than the intended benefits. The amount of time taken to publish the reports falls far short of what people using services and the trust should be able to expect and CQC apologises for this.

While publication of some reports has been delayed, any immediate action that CQC needed to take to protect people using services was not affected and was carried out in a timely way. CQC is taking urgent steps to ensure that inspection reports are published in a timelier way.

Jo Bennis, Chief Nurse at North West Anglia NHS Foundation Trust, which runs Peterborough City Hospital, said: “I would like to thank our teams in our Urgent and Emergency Care services and Medicine division for their efforts in providing good quality care for our patients under what can often be challenging circumstances.

Their dedication to care and their desire to improve clearly shone through in their discussions with the inspection team.

“Since the inspection took place last summer, we have continued to implement a programme to improve the experience of our patients. We have been able to reduce the number of instances where we have needed to provide corridor care and have a dedicated improvement workstream in place to address patient moves, discharge processes and delivering the fundamentals of care.

“I am pleased to see a number of key domains inspected by the CQC have either held their ‘good’ rating or been elevated to ‘good’ – which is a testament to the hard work of all colleagues and our journey of improvement. It is particularly pleasing to see the leadership development in both service areas recognised with a ‘good’ rating for the well-led domain, indicating that effective leadership is a vital element in transforming services.

“We know there is more work to do. We are all committed to making the changes that will give our patients a better experience.”