Date Published: 15 February 2012

Standards at Royal Lancaster Infirmary A&E

England's Healthcare Watchdog, the Care Quality Commission (CQC) has recently published a report into an unannounced inspection of the Accident and Emergency Department at the Royal Lancaster Infirmary. This inspection resulted in CQC serving a warning notice on University Hospitals of Morecambe Bay NHS Foundation Trust in relation to staffing in the department.

While inspectors who visited the Royal Lancaster Infirmary on 21 December 2011 found that emergency care was being delivered according to clinical guidelines, they also noted:

• a shortage of staff during busy periods
• problems with staff training
• limited coordination in planning elective bed management within the hospital, which was affecting the working of the emergency department and the flow of patients through the care pathway.

Even though the department was relatively quiet on the night we inspected, CQC's inspectors found that staffing levels did not always meet the needs of people using the department when there were high demands. This could have an adverse impact on the level of monitoring for less urgent cases or patients awaiting transfer to an appropriate ward. Inspectors also looked at staffing records for the whole of December.

There were several causes for concern:

• One of the people using services at A&E told the inspectors that they had also been there the previous night, when it had been "really busy" and that the patients "had been lined up down the corridor and people were waiting".
• A member of staff told the inspectors that "often staffing is at crisis level"; another member of staff said "staffing levels are dangerous". People told us that staff had raised concerns about the staffing levels and the safety of people due to staff shortages at times but nothing has been done about this.
• Ambulance crews also confirmed that the previous week they had been 'stacked' ? meaning ambulance crews were waiting with patients.
• Inspectors found that a lack of bed capacity in the hospital was having an adverse impact on the emergency department. On the night of the inspection there were no surgical beds on the surgical admissions unit, but there were people waiting for beds leading to the potential for people to be kept waiting in A&E, blocking the department.
• Inspectors also checked on staff training. They did not see evidence in the department that staff had received appropriate training for medical equipment ? a training log should be kept with each piece of equipment. Staff told us that there was very little time for equipment training.

Debbie Westhead, CQC regional lead for the North West, said:

" This inspection raised real concerns about staffing levels ? staff themselves told our inspectors that these were 'at crisis level'. As a result of this inspection and other information, we served a warning notice on the trust. This report highlights the other areas where the trust needs to make rapid improvements.
_ We were concerned at the blockages caused by the trust's failure to plan effectively for admissions. This has knock-on effects in A&E and could put people at risk of poor care.
_ It is important that staff training is up to date and that staff training needs are identified and met. To ensure the safety of people using the department, the trust needs to make sure it has the proper systems in place support staff.
_ The trust must tell us how it how it will make sure it complies with the essential standards. We will check on progress."

About the CareQuality Commission:The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. It's aim is to ensure that better care is provided for everyone, whether it is in hospital, in care homes, in people's own homes, or anywhere else that care is provided. The CQC also seeks to protect the interests of people whose rights are restricted under the Mental Health Act. It promotes the rights and interests of people who use services and has a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

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