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| Manchester Tameside A&E shortfalls worry NHS inspectors | Manchester Tameside A&E shortfalls worry NHS inspectors |
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| NHS inspectors have found worrying shortfalls in the operation of the A&E unit at Tameside general hospital in Greater Manchester and have demanded urgent improvements to protect patients, it emerged on Monday. | NHS inspectors have found worrying shortfalls in the operation of the A&E unit at Tameside general hospital in Greater Manchester and have demanded urgent improvements to protect patients, it emerged on Monday. |
| The Care Quality Commission (CQC) sent inspectors into the hospital on 11 and 15 May after concerns about poor care and patient safety were raised in an independent report commissioned by Tameside from emergency care experts and the local postgraduate medical dean in charge of junior doctors' training. | The Care Quality Commission (CQC) sent inspectors into the hospital on 11 and 15 May after concerns about poor care and patient safety were raised in an independent report commissioned by Tameside from emergency care experts and the local postgraduate medical dean in charge of junior doctors' training. |
| The hospital's chief executive, Christine Green, and medical director, Dr Tariq Mahmood, resigned on 3 July, hours after the Guardian published details of how two highly critical reports by NHS experts had highlighted major problems at the hospital. | The hospital's chief executive, Christine Green, and medical director, Dr Tariq Mahmood, resigned on 3 July, hours after the Guardian published details of how two highly critical reports by NHS experts had highlighted major problems at the hospital. |
| These included chaotic scenes in A&E; patients sleeping overnight in chairs and facing long waits to see a senior doctor; a lack of doctors and nurses in key departments; and a lack of consultant presence on the wards. | These included chaotic scenes in A&E; patients sleeping overnight in chairs and facing long waits to see a senior doctor; a lack of doctors and nurses in key departments; and a lack of consultant presence on the wards. |
| A new report published on Monday by the CQC reveals how the four-strong inspection team – two people with a nursing background and two others with experience of working in the NHS – raised concerns about several aspects of Tameside's A&E, which was failing to meet three key national standards: | A new report published on Monday by the CQC reveals how the four-strong inspection team – two people with a nursing background and two others with experience of working in the NHS – raised concerns about several aspects of Tameside's A&E, which was failing to meet three key national standards: |
| Those concerns included: | Those concerns included: |
| • Patients arriving at A&E in an ambulance ended up being handed over to the care of A&E staff in a corridor between the major and minor injuries units, "meaning that the privacy of patients' confidential information was not always respected". | • Patients arriving at A&E in an ambulance ended up being handed over to the care of A&E staff in a corridor between the major and minor injuries units, "meaning that the privacy of patients' confidential information was not always respected". |
| • When inspectors reviewed care plans of patients who had been transferred from A&E to other wards and departments, they were concerned that "in some cases transfer times had not been documented and discharge paperwork was incomplete, which could lead to a risk of inconsistent care and treatment". | • When inspectors reviewed care plans of patients who had been transferred from A&E to other wards and departments, they were concerned that "in some cases transfer times had not been documented and discharge paperwork was incomplete, which could lead to a risk of inconsistent care and treatment". |
| • During both visits, which took place outside office hours, A&E was quiet. Inspectors found there were enough properly qualified staff to meet the needs of patients. "However, inspectors were told that during periods of high demand the trust relied on agency staff to fill vacant shifts." | • During both visits, which took place outside office hours, A&E was quiet. Inspectors found there were enough properly qualified staff to meet the needs of patients. "However, inspectors were told that during periods of high demand the trust relied on agency staff to fill vacant shifts." |
| The report adds: "There were beds available on wards on both days of the inspection, meaning that escalation procedures were not operational. However, prior to the visit, CQC had received information that the assessment and management of patients transferred to the escalation area was variable. | The report adds: "There were beds available on wards on both days of the inspection, meaning that escalation procedures were not operational. However, prior to the visit, CQC had received information that the assessment and management of patients transferred to the escalation area was variable. |
| "Inspectors found that the trust had systems in place to assess and monitor the quality of service being provided, but they found that these systems were not always robust enough to ensure that all risks were identified and effectively managed. Staff also raised concerns that, on occasions, learning from incidents, adverse [patient safety] events and errors was not always shared." | "Inspectors found that the trust had systems in place to assess and monitor the quality of service being provided, but they found that these systems were not always robust enough to ensure that all risks were identified and effectively managed. Staff also raised concerns that, on occasions, learning from incidents, adverse [patient safety] events and errors was not always shared." |
| Tameside is bracing itself for Tuesday's publication of an in-depth review of high death rates at 14 hospital trusts. The Keogh review was ordered by David Cameron after the official report into the Mid Staffs scandal in February. Tameside is set to be named as one of those hospitals where care was worryingly poor. | Tameside is bracing itself for Tuesday's publication of an in-depth review of high death rates at 14 hospital trusts. The Keogh review was ordered by David Cameron after the official report into the Mid Staffs scandal in February. Tameside is set to be named as one of those hospitals where care was worryingly poor. |
| "The shortfalls at Tameside general hospital are a real concern and we have told the trust where changes need to be made to ensure national standards are met," said Malcolm Bower-Brown, the CQC's north regional director. "We remain in close contact with [healthcare regulator] Monitor and other agencies and will be monitoring the trust's progress carefully to ensure it makes the improvements required. | "The shortfalls at Tameside general hospital are a real concern and we have told the trust where changes need to be made to ensure national standards are met," said Malcolm Bower-Brown, the CQC's north regional director. "We remain in close contact with [healthcare regulator] Monitor and other agencies and will be monitoring the trust's progress carefully to ensure it makes the improvements required. |
| "We also await the outcome of the recent Keogh review of the trust and will consider the need for any further regulatory intervention in the light of the review findings." | "We also await the outcome of the recent Keogh review of the trust and will consider the need for any further regulatory intervention in the light of the review findings." |
| CQC inspectors planned to mount a further unannounced visit to Tameside "to ensure that the required improvements have been implemented and are being sustained", Bower-Brown added. | CQC inspectors planned to mount a further unannounced visit to Tameside "to ensure that the required improvements have been implemented and are being sustained", Bower-Brown added. |
| A spokesman for the hospital pointed out that it had commissioned an assessment of its A&E unit from the NHS's internal advisory expert body, the emergency care intensive support team (ECIST), after it knew that an earlier CQC inspection, in February, had wrongly given the A&E unit "a clean bill of health". | A spokesman for the hospital pointed out that it had commissioned an assessment of its A&E unit from the NHS's internal advisory expert body, the emergency care intensive support team (ECIST), after it knew that an earlier CQC inspection, in February, had wrongly given the A&E unit "a clean bill of health". |
| It agreed an action plan with ECIST covering the recommendations it made on 17 April and instigated changes to address issues identified by the expert body, the spokesman said. | It agreed an action plan with ECIST covering the recommendations it made on 17 April and instigated changes to address issues identified by the expert body, the spokesman said. |
| "The findings of the CQC inspection are not a surprise to us, as we had already identified them. Nevertheless, we are obviously concerned to see its revised assessment," he said. "We are pleased that the CQC confirmed that all issues they specified had already been identified by us and remedial action was in place at the time of their inspection, so we are confident we will be able to address its concerns. | "The findings of the CQC inspection are not a surprise to us, as we had already identified them. Nevertheless, we are obviously concerned to see its revised assessment," he said. "We are pleased that the CQC confirmed that all issues they specified had already been identified by us and remedial action was in place at the time of their inspection, so we are confident we will be able to address its concerns. |
| "We are pleased that the CQC has confirmed that Tameside hospital has enough qualified, skilled and experienced staff to keep people safe and meet their health and welfare needs. We are also pleased that the commission has found no issues that are having any major impact on patient care or safety, and that no enforcement action was deemed necessary over and above confirmation that the actions we have already put in place will be carried out." | "We are pleased that the CQC has confirmed that Tameside hospital has enough qualified, skilled and experienced staff to keep people safe and meet their health and welfare needs. We are also pleased that the commission has found no issues that are having any major impact on patient care or safety, and that no enforcement action was deemed necessary over and above confirmation that the actions we have already put in place will be carried out." |
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