The Royal Bolton Hospital's emergency department has been praised by a watchdog but warned that it needs to be safer according as inspectors downgrade the A&E's safety rating.
The Care Quality Commission (CQC) has published a report this morning (February 17) following an inspection of the emergency department and medical services at The Royal Bolton Hospital in November. The rating for safe in the emergency department has moved down from good to requires improvement amid concerns that people attending with mental ill health often experienced long delays in being assessed.
However, the emergency services remain rated good overall. The overall rating for Bolton NHS Foundation Trust remains as good.
Karen Knapton, CQC deputy director of operations in the north, said: “When we inspected the emergency department and medical services at The Royal Bolton Hospital, we saw a good level of care across most areas, but some improvements were needed in the emergency department to ensure people are safe.
“We were impressed that emergency department staff not only knew how to identify and treat sepsis; they were also supported by an electronic reporting system to record symptoms. This is important when staff are busy when it’s easy to miss or misjudge symptoms. This supported patients with suspected sepsis to successfully receive treatment in line with national standards.
“However, people attending with mental ill health often experienced long delays in being assessed. The service had recognised this and updated its procedure to include hourly checks with people to ensure they were safely cared for and their nutrition and hydration needs were met."
“Medical services were run by an effective leadership team, with staff who were clear about their roles and responsibilities and treated people with respect and kindness.
“Doctors reported that nurses were competent and quick at recognising deteriorating patients and that consultants were responsive to any requests to review patients.
“We will continue to monitor the trust, including through future inspections, to ensure the necessary improvements are made so people can continue to receive a good standard of care.”
The inspectors found the following during this inspection that in the emergency department leaders ran services well using reliable information systems and supported staff to develop their skills; the service had enough staff to care for patients and keep them safe; staff felt respected, supported and valued and were focused on the needs of patients receiving care; and the service managed safety incidents well and learned lessons from them.
But staff did not always have training in key skills such as safeguarding children. Patients experiencing mental health illness could wait extended periods of time in the waiting room and not all areas where patients waited were ligature free, added the CQC.
Meanwhile, in medical services staff treated patients with compassion and kindness, respected their privacy and dignity and took account of their individual needs; managers monitored the effectiveness of the service and made sure staff were competent; staff assessed risks to patients and acted on them; the service engaged well with patients and the community to plan and manage services; and staff provided emotional support to patients, families and carers.
However, in some of the paper “do not resuscitate” records we saw there was not enough detail around the clinical decision with reasoning and clinical information. There was more appropriate detail in the electronic records.
Tyrone Roberts, Chief Nursing Officer at Bolton NHS Foundation Trust, said: “We welcome today’s report from the CQC, and we will use these findings to focus our attention on areas where we know we can improve and make an even greater difference to what our staff and patients experience.
“Given the sustained pressures and challenges our workforce has faced over the past three years, I’m so proud that their compassion, care and dedication shone through during the inspection. I would like to thank them all for embodying Bolton’s values by continuing to deliver such high-quality care and doing all they can to look after our communities every single day.”
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