The Royal Oldham hospital has been told it must improve its emergency care after a watchdog found there was a 'potential significant risk of harm' to patients.
The Care Quality Commission (CQC) carried out a surprise inspection of the Rochdale Road hospital’s urgent and emergency care services at the height of the second Covid-19 peak at the end of November.
Chiefs say it was prompted by concerns being raised from staff and members of the public about the safety and quality of services during the pandemic.
Following the visit the CQC demoted the department from ‘good’ to ‘requires improvement’ after discovering issues, including patients waiting on trolleys for 12 hours or longer.
The five-strong inspection team found that infection risk was not always well controlled, and staff did not always maintain social distancing between patients or themselves.
During November, 271 patients waited more than 12 hours to be admitted and the high demand, cramped conditions in the building and ‘lack of flow’ meant that staff were not always able to keep patient care and treatment confidential.
The report stated that inspectors witnessed staff inserting a catheter and giving an injection in the corridor of the department.
Ambulance crews arriving with patients who had not been yet tested for Covid-19 brought them through the respiratory corridor increasing the risk of ‘cross infection’ by spreading coronavirus.
A relative was also seen being directed into the urgent treatment centre without any coronavirus screening.
The CQC report also said that on ‘multiple occasions’ staff did not keep to hygiene protocols, including inconsistent use of hand sanitiser.
One staff member was seen interacting with patients without using gloves, washing their hands or changing personal protective equipment (PPE) between patients.
Staff also did not always change their PPE when moving from different areas, such as between the paediatric department and the adult major’s area.
Inspectors also found that the floors were ‘sometimes not cleaned’ and the design and use of the facilities and signage did not always keep people safe.
Although the department usually had enough registered nurses on duty on most shifts, there were not enough health care support workers and medical staffing levels were reliant on locum and agency staff.
Staff had also not all received training on life support and safeguarding practices, including on how to recognise and report abuse.
However the inspection team also found areas of good practice, including risk assessments being completed for each patient and staff acting quickly with patients at risk of deterioration.
Staff said they felt ‘respected, supported and valued’ and had an open culture where they felt they could raise concerns without fear.
They rated the department ‘good’ for leadership, effectiveness, and caring.
Ann Ford, CQC’s deputy chief inspector for the north, said: “During our inspection in November, we could see that staff at The Royal Oldham Hospital were working hard to provide care to patients in very challenging conditions, when the North West as a whole was experiencing significant levels of Covid-19 related pressure.
“Given the pressure the trust were under, the decision to inspect during this period was a difficult one.
“However, both staff and patients told us they were concerned about the safety of care being delivered in the urgent and emergency department and we had a duty to inspect to support the trust in knowing where to make improvements.
“Upon inspection we were concerned by some of the infection prevention and control practices we saw in the department.
“Although the trust had systems and processes in place to reduce and manage the risk of infection, staff did not always follow these in order to protect patients, themselves and others from Covid-19 transmission.
“The trust must ensure that all staff in this service have the appropriate qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment they deserve. However inspectors did see that staff worked together as a team and felt well supported.”
Ms Ford added that the leadership team had taken ‘immediate action’ to address some of the concerns raised, and provided details of the continuing plans to improve the safety and quality of services.
Since the inspection the Northern Care Alliance, which runs The Royal Oldham Hospital said they have made improvements to social distancing, signage, and PPE usage.
Libby McManus (pictured below), group chief nursing officer and director of infection prevention and control said: “On the day the CQC inspected our emergency department in November last year, the inspection team saw some infection control practice which is neither acceptable nor our usual high standard and for this we are sorry to our patients and public.
“We pride ourselves on the care we provide and take the safety of our patients and staff extremely seriously. We did not wait for this report to be published.
“I want to reassure those who depend on our services that immediate and decisive action was taken to address the areas of improvement required. We continue to monitor and manage the small yet significant detail of all our practice.
“Our teams have used this report to make the necessary improvements and share learning across our organisation. We are committed to listening to our patients and staff when it comes to continuing to improve the safety and quality of care in our hospitals.
“I am encouraged that the CQC found that our staff felt respected, supported and valued and had an open culture where they felt they could raise any concerns. We continue to do everything we can to support our people.
“The CQC’s inspection has highlighted the significant challenges and demands our staff and staff right across the NHS are under in dealing with not only high attendances, but also the impact the pandemic is having on our staff and services.
“We remain focused on protecting and separating Covid patients, avoiding overcrowding in A&E, and dealing with the challenge in the reduction in bed capacity due to the need for additional Covid-19 beds.
“Our work with our local health and care partners in primary care and in social care continues to focus on improving how patients flow in and out of our hospital. We must support people in the community to avoid being admitted to hospital wherever possible.
“People should continue to feel safe and confident in accessing care and treatment at our hospital services.”
Chief operating officer at Oldham’s clinical commissioning group, Mike Barker said: “Covid-19 has brought many challenges for hospitals up and down the country.
“The team at The Royal Oldham Hospital is working extremely hard to bring about changes to improve services.
“Managing infection and prevention has never been more important or more difficult. We as commissioners are assured the team at the hospital are totally focused on making the necessary improvements.”
The Royal Oldham Hospital. Photo: LDRS.