Improvements at Stepping Hill’s A&E after ‘inadequate’ rating

Improvements have been made at an A&E unit once slammed for its shortage of nurses and stress levels among staff.

Inspectors from the Care Quality Commission (CQC) returned to Stepping Hospital in August after previously rating the emergency department as ‘inadequate’.

The watchdog says improvements have been made at Stockport NHS Foundation Trust, the organisation in charge of Stepping Hill.

But inspectors said more work was still needed to raise the hospital out of its overall ‘requires improvement’ status.

Concerns had been raised over safety, high levels of stress among the workforce, too few nurses and poor leadership following a CQC visit in January.

The CQC now say steps have been taken to tackle safety concerns and staffing levels in the hospital’s emergency department.

A staffing tool was put in place to monitor staffing levels and Band 5 nursing vacancies had been reduced.

“Nurse staffing had improved since our inspection in January and February 2020 when we found the department did not have enough staff to keep patients safe from harm,” the latest report said.

“Since this inspection the nursing establishment of the department had increased following an external review of staffing in the department and the use of the emergency department safer care nursing tool.”

Yet inspectors said the adult emergency department was sometimes reliant on agency nursing staff.

This could impact the care and treatment of the patients in the department, the CQC said.

The trust was previously criticised for not having two registered children’s nurses on duty in the children’s A&E unit at all times, as required by national standards.

a car parked in front of a brick building: Stepping Hill's Hospital's A&E department

Stepping Hill’s Hospital’s A&E department

There had been two incidents on March 29 and April 25 where there was only one children’s nurse in the department at night and patients had been aggressive towards them. They were not seriously harmed.

The CQC said provision had improved and that there were two children’s nurses on duty 98pc of the time.

Mental health assessment and facilities had also improved, the CQC said.

A mental health risk assessment tool had been introduced for adults and children, plus a rolling mental health training programme for all staff in A&E.

The leadership of Stockport NHS Foundation Trust came under fire in previous inspections.

The latest CQC report said leadership had been ‘strengthened’ since January.

Some members of staff told inspectors the Covid-19 pandemic had been an opportunity to ‘reset’ the A&E department.

“As there were lower numbers of patients, staff had time to complete training and to be involved in the operational development to make the improvements needed in the department following publication of the CQC report.

“There had been involvement from staff in the development of the mental health standard operating procedure.

“We saw that patients forums had been involved in mental health developments.”

The report added: “The increase in staffing numbers and the changes in the nursing leadership had led to an improved patient safety culture in the department.”

Overall, the CQC said the ‘momentum of change’ at Stepping Hill’s A&E needed to be maintained to ensure improvements were sustainable in the medium and long term, including times of increased pressure, like winter.

“Flow through the department to the rest of the hospital should be monitored so that patients are not in the department for longer than necessary,” the report added.

To improve, the trust is urged to reduce its reliance on agency staff, continue to embed the patient safety checklist in A&E and ensure that all staff are fully engaged in departmental change.

The inspection is not rated and the overall ratings of ‘Requires Improvement’ for both the hospital and trust still stand.

Louise Robson, chief executive of Stockport NHS Foundation Trust, said: “When the inspectors came at the beginning of the year they found care that was not of the standard that our staff wanted to provide to patients.

“We took immediate action to address the concerns raised by the CQC, and it is good to see the outcome of those actions now being recognised. But perhaps more importantly the improvements we have made are appreciated by patients who need emergency care.

“When CQC inspectors returned in August they commented that they had expected to see improvements, but they were particularly surprised to see the positive changes in team culture that we had achieved over a relatively short period of time.”

Mrs Robson added: “The latest CQC report is testament to the huge amount of work the emergency team has carried out over the last few months, but the improvements could not have been achieved without the support of staff right across the Trust, for example, improving patient flow through the hospital which gave the department the opportunity to focus on making lasting changes.”

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