Hospital staff pressures takes its toll on emergency care, inspectors find

Addenbrooke's Hospital in Cambridge

Staff shortages at Addenbrooke’s Hospital mean there have not always been sufficient workers to care for patients in the emergency department, inspectors have said. - Credit: PA Archive/PA Images

Staff shortages at Addenbrooke’s Hospital mean there have not always been sufficient workers to care for patients in the emergency department, inspectors have said. 

Problems with capacity also meant that people did not always receive the right care promptly. 

The Care Quality Commission (CQC) highlighted the issues following a focused inspection in March this year. 

An unannounced inspection was carried out at Addenbrooke’s Hospital in Cambridge, looking specifically at urgent and emergency care and medical care services. 

Inspectors also looked at the urgent and emergency care pathways across Cambridgeshire and Peterborough to assess how patient risks were being managed across health and social care services during “increased and extreme demand”. 

While issues were raised with the services, inspectors highlighted the “compassionate and kind” care provided by staff. 

The hospital’s overall CQC rating is currently rated as good. 

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However, the specific safety rating of the urgent and emergency services was downgraded and is now rated as requires improvement. 

The report said: “Although staff understood how to protect patients from abuse and the service worked well with other agencies to do so, compliance with safeguarding training did not always meet the Trust target. 

“The design and use of facilities and premises did not always keep people safe. 

“The service did not always have enough staff to care for patients and keep them safe. Managers regularly reviewed staffing levels and skill mix and efforts were made to increase staffing levels for each shift.  

“However, this did not always provide established levels of staffing.” 

Inspectors found that “compliance with life support training for staff did not always meet the Trust target. 

“People could not always access the service when they needed it and receive the right care promptly due to pressures on capacity.  

“Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.” 

However, the report said that infection risk was controlled well, and that staff assessed risks to patients, acted on them and kept good care records. 

Inspectors highlighted that the service worked well with others in the wider system and regional organisations to plan care. 

The report explained that hospital leaders had the skills to run the service and managed the priorities and issues the service faced, adding that staff felt “respected, supported and valued” by their leaders. 

Inspectors also highlighted issues with staffing in the medical care services at the hospital. 

The report said: “The service did not always have enough nursing and support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment. 

“Staff did not always complete risk assessments for each patient, however staff identified and quickly acted upon patients at risk of deterioration. 

“People could not always access the service and receive the right care promptly when they needed it due to pressures on capacity. 

“Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards.” 

However, the report did highlight that staff treated patients with “compassion and kindness”, adding that they also respected the “privacy and dignity” of patients and helped them to understand their conditions. 

Inspectors also said that infection risk was controlled well, and that doctors, nurses and other healthcare professionals worked together as a team to benefit patients, supporting each other to provide good care. 

A spokesperson for the Cambridge University Hospitals (CUH) NHS Foundation Trust said: “We welcome the CQC comments on urgent and emergency care services at CUH and across the wider health and care system in Cambridgeshire and Peterborough. 

“The findings reflect our own analysis, and we continue to work with our partners to help address the challenges identified. 

“This includes recruiting additional staff and building new wards to help meet the extremely high demand we’re facing for both emergency and planned care.” 

The Trust also highlighted the “significant pressure” the emergency department at the hospital is currently facing, with staff helping around 360 patients every day, a rise of 13 per cent compared with the same time in 2019. 

It also explained that all patients who attend the emergency department are reviewed by a registered nurse who then prioritises those with the greatest need. 

The Trust also said that people can support the NHS by using the right service at the right time, to allow the emergency department to provide care for people who have an urgent or emergency healthcare need.  

It added people can call 111 if they are unsure where to go for help.