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An unannounced inspection of St Mary’s Hospital’s emergency department has led to the Care Quality Commission issuing a Warning Notice to ensure Isle of Wight patients receive the high quality care they deserve.

Inspectors visited St Mary’s on 21st January this year and witnessed a number of causes for concern, including patients being given intravenous infusions in the corridors; a significant shortage of qualified nurses with a heavy reliance on agency staff; times when no nurses were in the major treatment, minor treatment or rapid assessment areas and initial assessment of ambulance patients did not take place according to guidance.

In addition, it was found that staffing information displayed in the department during the inspection showed that 8 nurses were expected to be on duty but only 6 were present. As a result, the nurse in charge was having to assess newly arrived ambulance patients, look after patients requiring care in the corridor, assist in the resuscitation room, take over from nurses on meal breaks as well as co-ordinate the care of all the patients in the department. It was not possible for 1 nurse to do all of this and inspectors found several aspects of patient care had not been completed.

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At least 1 patient was in the emergency department for 15 hours during the period of the inspection and spent 4 hours in a corridor. Other patients were being assessed by a healthcare assistant as no nurses were present to meet newly arrived ambulance patients. Inspectors found that during a review of records in the major treatment area, 4 out of the 6 patient safety checklists were incomplete.

Following the issuing of a Warning Notice, St Mary’s Hospital must now ensure that:

• there are sufficient numbers of suitably qualified, competent, skilled and experienced nurses to meet the needs of patients in the emergency department
• crowding is reduced so that patients do not have to wait on trolleys int he corridor in the major treatment area.
• patients whose clinical condition is at risk of deteriorating are rapidly identified and monitored appropriately

That said, staff spoke positively about working in the emergency department, all critically ill patients were seen quickly by a senior doctor and junior doctors felt well supported and were positive about the training they received in the emergency department.

Dr Nigel Acheson, CQC’s Deputy Chief Inspector of Hospitals for the South, said:

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“While we can acknowledge winter is a busy time for hospitals this should never impede on patient care. Our inspectors visited the emergency department of St Mary’s Hospital at the end of January and were not assured that patients were not being treated promptly enough and in areas which were not designated as care areas.

“Handovers from ambulance teams to the hospital were done in a timely manner, but there was again concern that the initial assessment for patient treatment was not always seen by a nurse in the first instance. This is unacceptable and we have warned the trust that we want immediate improvements within the emergency department to ensure people receive the high-quality care they deserve.

“We will continue to monitor the trust extremely closely and will return to inspect services again on an unannounced basis in the near future.”

In response to the CQC inspection, Maggie Oldham, Chief Executive of the Isle of Wight NHS Trust, has said:

“The CQC inspection of the emergency department at St Mary’s hospital, in January, during the winter pressures period has been really helpful in acknowledging how services have improved, but also where we still need to provide better services to patients.  The report vividly captures the dedication and professionalism of staff, but also the significant pressure they can be working under.  Staff spoke positively with the inspectors about working in the ED and the inspectors also commented on the improvements to patient flow through the department.

“All critically ill patients were seen quickly and treated properly.  Junior doctors also spoke well of the quality of the training they received.

“The inspectors also saw and want improvements to the strain the ED can at times be working under.  We agree with them that patients must be treated in appropriate clinical areas and that there is a major impact on the experience of patients and staff when there are not enough staff available.  In particular this impacts how we monitor and handover patients properly at all times and creates additional stress for staff when we cannot fill the full rota on a shift due to unplanned absence or sickness at short notice.

“The CQC’s report is welcome for the recognition it gives of the progress we have made, the care we provide and the commitment and excellence of our staff.  However, we take very seriously the warning notice they have given us on where we need to continue to improve.  We need enough staff and the right environment to truly provide the quality of care that patients expect and that we and our staff want to provide.  We have made the commitment to increase staffing and now are focussing on finding staff to work in the Trust and join our dedicated teams. 

“The Trust invested £1.5 million in this financial year to increase staffing numbers and £1.3 million on improvements to the department.  A further £250,000 will be spent next to improve the layout of the department.  This investment in staff and the department’s space means that we will have a dedicated Minor Injuries and Illness area combined with GP services to create a dedicated Urgent Care.

“A further investment which we have wanted to make for some time, and which also addresses concerns raised by the earlier CQC inspection is that we will be investing £200,000 to refurbish and modernise Shackleton Ward.  This work will start at the beginning of April and take 9 weeks and result in an enhanced ward that is designed for the needs, comfort, dignity, care and safety of our patients”.

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