CQC: Derby Burton Hospitals Downgraded to 'Requires Improvement'

• The Care Quality Commission downgraded the overall ratings for both Royal Derby Hospital and Queen’s Hospital Burton from good to requires improvement.
• Urgent and emergency care services at Royal Derby Hospital were downgraded, while Queen’s Hospital Burton's urgent and emergency care was re-rated as requiring improvement.
• Inspectors identified significant overcrowding, compromised patient privacy, and insufficient staffing levels in emergency departments at both facilities.
• An elderly patient at Royal Derby Hospital spent 21 hours on a stretcher, highlighting risks of pressure injuries due to environmental issues.
• The CQC has mandated an action plan from University Hospitals of Derby and Burton NHS Foundation Trust to address identified regulatory breaches.

The inspections revealed serious concerns regarding patient safety and dignity, particularly stemming from severe overcrowding and inadequate staffing levels in urgent and emergency care departments.

The Care Quality Commission (CQC) has issued revised ratings for services provided by the University Hospitals of Derby and Burton NHS Foundation Trust, following inspections conducted in February. Both Royal Derby Hospital and Queen’s Hospital Burton have seen their overall ratings fall from 'good' to 'requires improvement'. This significant change reflects a series of concerns identified by inspectors across key service areas.

Specifically, urgent and emergency care services at Royal Derby Hospital were downgraded from 'good' to 'requires improvement'. Concurrently, urgent and emergency care at Queen’s Hospital Burton was re-rated as 'requires improvement'. Medical care at Royal Derby Hospital also experienced a downgrade, moving from 'good' to 'requires improvement', while medical care at Queen’s Hospital Burton was re-rated as 'good'. These findings have prompted the CQC to demand an action plan from the trust, outlining the steps it will take to rectify the identified issues.

Inspectors uncovered several breaches of regulation, primarily centered on patient safety, dignity, and adequate staffing within the urgent and emergency care settings. At Royal Derby Hospital, the emergency department was found to be severely overcrowded, with patients on trolleys positioned directly in front of other cubicles. This arrangement not only restricted staff access in emergencies but also meant emergency equipment was not readily available in these makeshift spaces. Furthermore, patients lacked curtains for privacy, and one elderly individual endured a 21-hour wait on a stretcher, raising serious concerns about the risk of pressure injuries.

Similar issues plagued Queen’s Hospital Burton, where the urgent and emergency care department frequently experienced overcrowding. This congestion compromised patients' privacy and dignity, with some individuals not requiring urgent treatment waiting up to seven hours to be seen. On particularly busy evenings, the lack of space forced patients to sit or lie on the floor. Compounding these environmental challenges, staffing levels in the emergency department were often insufficient to ensure patient safety, with registered nurse numbers sometimes falling below planned levels, leading to anxiety among staff, especially during night shifts.

The CQC's findings underscore the critical importance of maintaining high standards in NHS urgent care compliance. Sarah Ivory-Donnelly, the CQC’s deputy director of hospitals, secondary and specialist healthcare in its central region (east), acknowledged the dedication of staff at Royal Derby Hospital, noting their warmth and politeness despite long waits. She also highlighted the hospital's effective collaboration with partners to reduce unnecessary emergency attendances and facilitate care closer to home. However, these positive aspects were overshadowed by the serious safety concerns.

The inspections revealed serious concerns regarding patient safety and dignity, particularly stemming from severe overcrowding and inadequate staffing levels in urgent and emergency care departments. The CQC has made it clear that leaders at the University Hospitals of Derby and Burton NHS Foundation Trust must take immediate and decisive action to address these safety deficiencies. The regulatory body has committed to continuous monitoring of the services to ensure that the required improvements are implemented effectively and sustained over time.

These CQC inspection findings serve as a stark reminder of the pressures facing NHS urgent care services and the potential impact on patient welfare. The downgrades for both Royal Derby Hospital and Queen’s Hospital Burton signal a need for comprehensive operational and strategic adjustments within the Derby Burton NHS Foundation Trust. The identified breaches of regulation, particularly those related to overcrowding and compromised patient dignity, highlight systemic issues that require urgent attention beyond mere superficial fixes.

The CQC's insistence on an action plan from the trust emphasizes the accountability of healthcare providers in maintaining safe and dignified environments for patients. For other NHS Trusts and healthcare providers, these findings from the Care Quality Commission inspection findings offer valuable insights into potential areas of vulnerability, particularly concerning urgent and emergency care protocols, staffing levels, and patient safety measures. Proactive review of these areas is crucial to mitigate similar regulatory risks and ensure robust NHS urgent care compliance across the sector.

Compliance officers at other NHS Trusts and healthcare providers should review their urgent and emergency care protocols, staffing levels, and patient safety measures in light of these CQC findings to proactively address similar regulatory risks. Legal counsel advising healthcare clients should be aware of CQC's current enforcement priorities regarding overcrowding and patient dignity.

Source: Reporting based on recent Care Quality Commission findings.