NHS trust emergency care 'requires improvement'

The CQC inspections were carried out in May and June

Improvements are still needed at a hospital trust providing care in Cornwall, according to a health watchdog.

The Care Quality Commission (CQC) rerated urgent and emergency care at Royal Cornwall Hospitals NHS Trust (RCHT) as "requires improvement" following inspections in May and July.

Inspections were carried out due to concerns about waiting times and the number of falls of older people on one ward, the watchdog said.

It said the rating for urgent and emergency care was unchanged following the previous inspection.

Delays from overcrowding

The trust was also rerated "good" in the caring and well-led category, while it improved from from "requires improvement" to "good" in the safe category, the watchdog said.

Catherine Campbell, CQC's deputy director of operations in the south, said inspectors found people who were fit for discharge were staying longer than needed because their care outside the hospital was not ready.

She said overcrowding in the emergency department had also created delays.

"Throughout our inspection... we saw staff were working hard to provide safe care in challenging conditions," she said.

The CQC said inspectors also found:

• There was a mental health assessment room which was due for updating as it did not conform to national guidelines

• Essential staff training had been frequently cancelled due to staffing pressures

• Staff said they were worried about the pressure they were under and how this affected the quality of care

It added:

• The department made adaptions for people with learning disabilities to try to reduce any possible distress

• The service now had enough staff with the right qualifications, training and experience to keep people safe

• The service accessed a translation service for people whose first language was not English

• There was good external partner engagement

'Challenging circumstances'

RCHT chief executive Steve Williamson said the report was "fair".

He said it was reassuring to see some ratings improve, although he recognised more needed to be done.

A critical incident was declared for Cornwall's NHS services on 3 January, which then ended on the evening of 8 January.

The trust added a "great deal" had been done to improve urgent and emergency care since the inspections but hospital teams faced "challenging circumstances".

Since September, community-based staff have been present in the emergency department and other wards so community nurses can help hospital colleagues assess patients and get them home sooner.

Bernadette George, director of nursing, midwifery and allied health professionals, said: "What does shine through the CQC's report is the kindness and compassion of our staff who assessors observed were 'doing their best to mitigate risk at times of very high occupancy'."