AN UNANNOUNCED inspection has taken place at Hereford County Hospital's A&E department after concerns were raised about the safety and quality of the service.

Care Quality Commission inspectors visited the hospital on December 15, while staff were coping with the usual winter pressures as well as the additional pressure of caring for dozens of Covid patients, after receiving information that gave them concern about staffing levels and patient waiting times.

But the department has retained its 'good' rating as inspectors found good care was being provided, while some improvements were needed around waiting and discharge times.

Inspectors praised staff, who they said had the right qualifications, acted quickly to treat at risk patients, and were focused on patient needs.

Infection risks were found to be well-managed, the department was clean, and staff observed hygiene routines and used appropriate PPE.

And changes to the department meant fewer patients were now waiting in the ambulance corridor.

Staff said they felt respected and supported, while 'strong, visible, and approachable' leaders understood the service's priorities and issues.

Planned staffing levels were reviewed at bed meetings to ensure staffing levels kept patients safe, and additional nursing staff were requested to cope with extra demand.

But recruitment problems lead to high levels of agency staff use, often around 20% of staff on shift, with some shifts not covered, and national staffing standards for children’s nurses not met.

Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were also not in line with national standards, with performance for the four-hour target averaging 68% over the previous two weeks.

And one member of staff said they were sometimes concerned for their safety due to a lack of security personnel in the department.

The CQC’s Chief Inspector of Hospitals, Professor Ted Baker, said: “When inspectors visited they were pleased to see the level of care had remained consistent despite the added pressures caused by the pandemic.

“Inspectors were impressed by the strong leadership. Staff respected their leaders, and this was reciprocated with senior staff acting in a way to get the best out of people. Many staff spoke with evident pride about the department and went out of their way to tell us that they were happy and proud to work there.

“The trust recognised medical staffing and recruitment as concerns and were in the process of carrying out a recruitment campaign. The training and development model had been restructured to make the department more attractive to recruits.

“There are, however, areas where improvements must be made and maintained. For example, waiting times from referral to treatment and discharge were not in line with national standards.

“We have reported our findings to the trust leadership, which knows what it must do to bring about further improvements and ensure it maintains any already made."

Inspectors recommended the trust continue to pursue recruitment initiatives to reduce agency use, continue to strive to meet the national standards for registered children’s nurses and a paediatric emergency medicine consultant in the emergency department, and ensure urgent and emergency services meet the national standard patient waiting times.

They also said the trust should ensure improved security provisions within the emergency department to ensure staff feel safe at work, and that it should consider installing an alarm on the patient streaming desk at the department's entrance.

Wye Valley NHS Trust's Managing Director, Jane Ives, said the trust believes the report is a balanced and accurate reflection of urgent and emergency services,

"In particular it highlights the high quality of care we are giving our patients despite the extra pressures we see in winter being added to by the pressures caused by the pandemic,” she said.

“The dedication, commitment and professionalism that our staff have shown throughout the last 12 months has been extraordinary. This is reflected right across the organisation and the CQC inspectors rightly singled this out as a key element of our success.

“We know what we have to do and will continue to build on the plans and processes we have in place. We have an extensive refurbishment of the emergency department taking place and a new same day emergency care facility is due to open its doors within days and a new paediatric assessment until within the next few weeks.

“This can only improve the quality of care and experience of our patients."