CQC publishes inspection report

30 January 2015

The Care Quality Commission (CQC) today (Fri) published a report following its inspection of the A&E department and Emergency Assessment Unit (EAU) at Colchester General Hospital.

The CQC has placed conditions on the Trust's registration to help it improve how patients are assessed, discharged and transferred for the most appropriate medical attention.

Colchester Hospital University NHS Foundation Trust accepts it delivered care which was sometimes below the high standards rightly expected by patients, and apologises to those patients who were let down.

However, the Trust is concerned that the CQC report is not balanced and does not reflect the unprecedented pressures it was under at the time of the inspection in November and December last year or the considerable progress the Trust has made over the past 12 months.

In November, the Trust saw an increase of more than 10% in the number of patients brought in by blue light ambulances compared with the same month the previous year. In December there was an increase of more than 40% in the number of patients treated in the Trust's A&E "majors area" (seriously ill adults who were likely to need admission to hospital).

In its report, the CQC acknowledges that "staff were exceptionally busy" during their inspections and "staff stress levels were high". The regulator also noted that "surges in activity meant that people had long waits to access services". But the CQC inspectors were critical of the EAU which they said "did not operate their GP triage area because the 17 spaces had been converted into inpatient beds taking the unit to 62 beds in total" as a contingency to deal with significant pressures. The CQC also said this meant "staffing levels on EAU were not sufficient and had not been assessed based on patient acuity in line with NICE guidelines".

Dr Lucy Moore, the Trust's Chief Executive, said: "The examples of poor care that the CQC has identified in its report are unacceptable.

"They do not reflect the standards which we expect to deliver consistently for all our patients, and we have already taken urgent action to address shortfalls.

"However, I am disappointed that the CQC has decided to rate Colchester General Hospital as inadequate following visits to the A&E department and Emergency Assessment Unit.

"While being exceptionally busy can never be an acceptable excuse for providing sub-standard care, it is not unreasonable to point out the inspectors visited at a time of unprecedented demand within the NHS when, frankly, many hospitals like ours were struggling.

"Many people - including our staff - will not be surprised to read that clinicians were very busy and working under considerable stress."

Some of the measures the Trust has taken since the CQC inspectors first visited on 12 November include:

These measures have been achieved with the full support of the Trust's partner organisations.

In addition, the Trust continues to receive support from experts at the national Emergency Care Intensive Support Team (ECIST).

The CQC noted "the majority of patients we spoke with were happy with their care", "the workforce were committed and loyal" and good multidisciplinary working.

Dr Shane Gordon, Clinical Chief Officer at North East Essex Clinical Commissioning Group, said: "We do not believe that the inadequate rating fully reflects the hard work by frontline staff and the hospital's clinical leadership over the last two years. This work will take time to show real benefits, and patience will be needed.

"The CQC report notes many instances of good practice and quality services provided by qualified clinical teams. We acknowledge that there are still improvements to be made. We will continue to work with the Trust and all our partners to deliver a detailed improvement plan."

Tom Nutt, Chief Executive Officer of Healthwatch Essex, said: "Healthwatch Essex has been working closely with the Trust since the publication of our own detailed, and sometimes critical, report on patient and carer experiences of cancer care in Colchester.

"Since then, we have been encouraged by the resolve and commitment of the senior management and nursing staff charged with implementing improvements. We will continue to work with the Trust to help articulate and bring to life a vision for improvement which puts patient experience at the heart of care."

The hospital's overall assessment is based on ratings for five fields (safe, effective, caring, responsive, well-led) in each of eight different services (including A&E) - a total of 40 ratings. The Trust is currently rated "good" in almost half of these ratings and "inadequate" in just six but the CQC decided to give Colchester General Hospital an "inadequate" rating overall.