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CQC Ordered Improvements in Emergency Care at Liverpool Hospital

An NHS urgent and emergency care service in Liverpool has been ordered to make care improvements, after it was found to be under excessive pressure, with patients at risk of harm due to long waiting times.

The Care Quality Commission (CQC) has today published a report on the urgent and emergency care services provided by University Hospital Aintree, part of Liverpool University Hospitals NHS Foundation Trust, following an inspection in October.

CQC carried out an unannounced focused inspection after receiving information of concern about the safety and quality of care being provided, and as part of CQC's ongoing review of urgent and emergency care services.

During the inspection, inspectors found the department exceeded its maximum planned capacity and some patients were being cared for in the corridor, which CQC notes remains a national issue for hospital trusts.

The service was not rated following this recent inspection and the previous ratings remain – 'inadequate' overall and for being safe, responsive, and well-led. Effective remains rated 'requires improvement' and caring remains rated as 'good'.

Following a previous inspection in June 2021, CQC imposed conditions on the Trust's registration in relation to patient access and flow, to ensure people are not exposed to further risk of harm, and these conditions remain in place.

During this latest inspection at University Hospital Aintree, CQC Inspectors found:

  • Patients did not always receive appropriate care and treatment in a timely way, exposing them to the risk of harm. There was a risk that staff did not always recognise or respond appropriately to signs of deteriorating health. Staff did not always complete risk assessments for patients swiftly
  • People could not always access the service when they needed it and did not always receive the right care promptly. Waiting times from attendance to treatment and arrangements to admit, treat and discharge patients were not always in line with national standards
  • The service did not always have enough nursing staff and support staff to keep patients safe from avoidable harm and to provide the right care and treatment

However, the service had enough medical staff to match the planned numbers, patients were monitored regularly to see if they were in pain and gave pain relief in a timely way, and patients were given enough food and drink to meet their needs (except for the waiting room).

The CQC's overall rating for University Hospital Aintree remains rated 'requires improvement'.

Karen Knapton, CQC head of hospital inspection, said:  "When we inspected urgent and emergency care at University Hospital Aintree, staff were working hard under sustained pressure to deliver care. However, we found people didn't always receive appropriate care and treatment in a timely way, exposing them to the risk of harm.

"Additionally, staff didn't always identify and quickly act upon people at risk of deterioration in the waiting room, or complete risk assessments in a timely manner.

The reports says that inspectors saw staff treat people with "compassion and kindness" and "took account of their individual needs". However, due to "pressures the trust was facing" and "lack of space", staff " did not always respect patient privacy or dignity or keep their care confidential, due to people being able to overhear private conversations".

'Committed to Learning and Improving'

Commenting on the CQC's findings, David Melia, chief nurse at Liverpool University Hospitals NHS Foundation Trust, said: "We accept the findings in the report and are committed to learning and improving.

"The CQC found that, like every other emergency department in the country, there are too many people waiting in the department, and they recognised the challenges we face in admitting these patients to hospital beds, due to being unable to discharge patients who no longer need a hospital bed but are waiting on social care or community support.

Mr Melia said the trust is working on recruiting nursing staff and addressing the issues raised in the report.

"Though health and care services are incredibly challenged, we are working to address the pressures we're facing," he said. "We've taken further action to provide timely access to treatment, we've introduced more measures to monitor patients in the waiting room, and we're working with local partners to support patients leaving the hospital with support in the community."

Record Pressure on Emergency Services Nationwide

The CQC's report comes as the NHS reported a record number of patients attending emergency services in December (2,283,196), with continuing significant pressure this month.

The most serious emergency (category one) ambulance call outs in December were also the highest on record (101,099) – and almost a fifth higher than the previous record (85,392). Call handlers answered more 999 calls in December 2022 than ever before (1,014,489) – up one fifth compared with pre-pandemic (December 2019 – 845,524).