LEADERS of North Cumbria's NHS trust have reflected on the findings of an unfavourable CQC report at their latest meeting, outlining the work that has been done to address the failings it identified in the trust's Emergency Department.
The discussion, at North Cumbria Integrated Care's (NCIC) board meeting on Wednesday, centred around the findings of Care Quality Commission inspections in February and March.
CQC inspectors initially visited the Emergency Department (ED) at Carlisle's Cumberland Infirmary on February 16 and 17, providing early feedback to the executive at the close of the second day.
A follow-up inspection took place on March 18 and the CQC wasn't satisfied that the trust had addressed previously raised concerns around "care of mental health patients in the emergency department."
The CQC therefore issued NCIC with an enforcement notice.
Message to patients
Gill Findley, Chief Nurse said: "As an organisation, we do recognise the seriousness of this, we do recognise that the patients that the CQC saw when they came in were having a poor experience in our ED. I don't think we can get away from that.
"I do want to apologies to all our patients who had that poor experience, it's not we would want. We want a much better experience for patients and we don't want them to be kept waiting and to be worried about their mental health.
Ms Findley said: "We do take those concerns incredibly seriously and are working really hard to address them."
Immediate action
Ms Findley said that the NHS trust has directly addressed the issues outlined by the CQC "revising the mental health risk assessment process," including it in the triage process.
Triage is carried out when a patient attends the ED, prioritising them according to how severe their injury or illness is.
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Ms Findley said: "We have consistently achieved 100 per cent of patients now having that mental health risk assessment at triage."
A member of staff will be allocated to supervise patients during their wait in the ED if they are deemed to be at risk following their assessment.
The changes have been made across both the Cumberland Infirmary and West Cumberland Hospital in Whitehaven.
Questions raised
The trust has not yet received the full report from CQC, meaning that further regulatory action could be taken, the board heard.
Non-executive board member Teresa Griffiths CBE ARRC described some of the failings in the CQC report as "real own goals," asking what is being done to ensure "failures in the really basic things they identified are being managed."
Ms Findley said: "I think a lot of the things they found were basic things and I think it's symptomatic of the department being overwhelmed at the time the CQC came."
She added that the overcrowding at Carlisle's ED "wasn't news to us" and noted that the board recently invested £1,219,433.15 into the full staffing of Carlisle's Urgent Treatment Centre (UTC).
Ms Findley that a steering group has been established, examining progress against an action plan from the CQC visit.
The UTC, neighbouring A&E, provides treatment for injuries and illnesses that are not life threatening, but require urgent attention - it is expected the new facility will be fully operational by June 1.
Future improvements
Directors expect the trust's performance around waiting times will be 'transformed' by 2027, thanks to the investments they approved in March.
The board approved four business cases at the March meeting, investing in additional consultants; expansion of Medical Same Day Emergency Care Units (SDECs) and the establishment of Hospital at Home Hubs.
Executive Medical Director, Doctor Adrian Clements has identified aspects of Carlisle's A&E layout which could be changed to improve staff's line of sight and clinicians are discussing how patient flow could be improved.
Cultural shift
The Chief Nurse said that leaders are "getting back to basics" with staff ensuring that everyone understands their role and takes pride in where they work.
Directors agreed that while staff are working in a challenging environment, a cultural change is needed because "what you walk passed is what you accept."
Chairman, Dr Stephen Singleton agreed with Dr Clements that there is no criticism of staff's clinical performance, "but of their leadership I think there is," he said.
"And I think some of the doctors and some of the nurses, particularly the ones in leadership positions, could've done better."
He said that while it is positive the trust is looking at changes to the estate to support good clinical care, "we need that leadership."
Ms Findley added that staff will be asked to consider discharging a patient from hospital earlier in the day as it improves the experience of four other patients.
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