Wales' newest emergency department is putting patients at risk due to excessive waiting times, uncomfortable conditions and significant overcrowding, inspectors have warned. Healthcare Inspectorate Wales (HIW) carried out an unannounced inspection of A&E at The Grange University Hospital in Cwmbran over three consecutive days in August.
While they found dedicated staff striving to deliver good-quality care to patients, HIW said they were hamstrung by the environment in which they worked. Inspectors said some patients had been waiting on uncomfortable chairs and in the back of ambulances for more than 15 hours and described the waiting area as "very small, cramped and unfit for purpose".
They warned that the waiting room and rapid assessment unit (RAU) were not conducive to providing dignified care and added that the department would not be able to address many of their concerns until the flow of patients was improved.
Read more: Patients sit on bins at Wales' overcrowded, 'visibly dirty', struggling flagship A&E unit
The three-day inspection also identified a number of issues which required immediate action. These included out-of-date medicines being found, resuscitation equipment not being checked daily and a risk of cross-contamination in an area known as the 'Covid corridor'. They also found a lack of security around substances which could be harmful to patients.
A cross-section of staff working in A&E were interviewed by the inspectors, with many admitting they were struggling with the high demands of the department. Five of 11 staff interviewed admitted they had seen errors, near misses or incidents that could have hurt staff or patients.
However, most noted that the management and leadership was good and that they felt supported. Management was also visible within the department, including the nurse in charge who was descried as "identifiable and accessible".
The report states: "Senior staff believed that there was a positive culture in the department and staff were passionate about their job. They were frustrated because no matter how hard they worked, they were unable to solve the issues regarding patient flow and numbers of patients attending the unit."
Staffing levels were also found to be a significant issue at the emergency department, including 22 vacancies at band five level. There were also a number of healthcare support worker vacancies but "very little interest had been generated for these posts", the report adds.
"Additionally, we were told of three band five resignations recently. This has had a significant impact on the department and increased the need for bank and agency staff. On some shifts up to 50% of agency staff were used," the report states.
"A number of band five nurses we spoke with said that the workload could be excessive and unrelenting, with the demands on the system being unsustainable. This included two members of staff saying they were close to burnout and considering other jobs and career options."
Inspectors concluded that patients are not consistently receiving an acceptable standard of care at the emergency department at The Grange. The purpose-built £350m hospital became the home of accident and emergency and intensive care for people living across Gwent and south Powys in November 2020.
HIW has urged Aneurin Bevan University Health Board, which is responsible for The Grange, to carefully consider the findings of the report and undertake action to "reduce the potential for significant harm to patients and to embed all improvements into practice".
Chief Executive of HIW, Alun Jones said: "Our inspection findings are extremely concerning and we have urged the health board to take action to improve the processes and systems in place within the emergency department so that patients receive safe, timely and effective care. I hope this report will accelerate the measures taken to drive forward timely improvements. We will be working closely with the health board to ensure robust improvements are made and evidenced."
Peter Fox MS, Member of the Senedd for Monmouth which the hospital falls under, said: "Whilst I appreciate all sectors - including our NHS - are under significant pressure post-pandemic, this report is damning in so many ways. The most concerning part is the report's judgement that processes and systems were not sufficient in ensuring patients consistently received an acceptable standard of care.
"I have been calling for changes at The Grange for many months, following correspondence with anxious constituents, and I'm pleased that the inspectorate has identified the shortcomings that so many of us are concerned with. After all, patients and families expect nothing less than basic principles of care and safety when in hospital which sadly appear to be lacking in this sad case. What is crucial is that the health board and Welsh Government ministers work around the clock to introduce robust measures to address these very serious issues."
A spokesman for Aneurin Bevan University Health Board said: “We welcome the findings of the report and whilst we acknowledge and have responded to the concerns raised, we are encouraged that the report and the feedback received from HIW recognised the improvements made at the Emergency Department at The Grange University Hospital since the last report six months ago.
“We’re also pleased to see that the report highlights the hard work and dedication of our staff during periods of extreme pressure on our services, during which patients were treated with courtesy, dignity and respect. It is also reassuring that the report recognises good practice in terms of high levels of patient monitoring and safety at the Emergency Department.
“Feedback to our staff from HIW inspectors at the end of their visit was very encouraging and inspectors commented on the safe care and best practice that they witnessed in many areas.
“Like all hospitals across Wales and the UK, The Grange University Hospital continues to face extraordinary challenges due to staff shortages, increased demand and the after effects of the Covid-19 pandemic on people’s health. We are working hard to improve the experience of patients who visit the hospital. We recognise there are issues around the Emergency Department’s waiting area, but we would like to reassure people that work is already underway to increase capacity in this area.
“HIW have also indicated that improvements to patient flow and waiting times are required, which we fully accept. Whilst this is a nationally recognised problem, caused by system-wide pressures across health and social care, we are working hard to improve patient flow and reduce waiting times. We have already introduced a closer partnership working initiative between Emergency Department staff and the Welsh Ambulance Service to improve ambulance handover times, as well as introduced a Same-Day Emergency Care Unit (SDEC) to offer eligible patients more timely care and to free up space in the Emergency Department.
“We’re incredibly thankful to our fantastic staff, who are committed to providing the best possible care under such sustained pressure.”
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