Understaffed A&E Slammed by Care Quality Commission


The Law Of... tackling medical negligence

One of the country's busiest A&E departments has been forced to apologise following a report which found its services to be 'inadequate'. Medical Negligence Solicitor, Carley Ross, explores the events leading up to the Care Quality Commission's (CQC) damning indictment.

One of the country's busiest A&E departments has been forced to apologise

Accident and Emergency Departments are the lifeline of a local community and the services they offer provide vital care for those in often life-threatening emergencies, ensuring everybody has 24 hour access to a health professional, 365 days of the year.

But what happens when this service goes wrong, resulting in medical negligence, and how does a situation get so bad that a patient can lie dead for up to four and a half hours without being spotted?

'Significantly Improve' Services

This was the tragic case with the North Middlesex University Hospital (NMUH), which has one of the busiest A&E departments in the country, seeing over 180,000 adult and paediatric patients a year – an average of 500 per day.

In 2014, the Care Quality Commission (CQC) carried out a review and found that the NMUH was lacking in a number of key areas, due in part to the closure of the Chase Farm A&E unit in 2013. This resulted in an overall rating of 'requiring improvement'.

Since 2009, the NMUH has undergone significant structural improvement, with over £200million of investment going into the regeneration of the site. Around £123millon of this was spent on a new A&E department, but the neglect has continued.

Following an April inspection a warning notice was issued by the CQC in June of this year, requiring the hospital's NHS Trust to 'significantly improve' the treatment of patients attending Accident and Emergency – the deadline for these improvements is 26th August 2016.

A Catalogue of Neglect

Part of the problem stems from understaffing. The ratio of nurse to patients should be 1:4, but this was rarely met and most recently slipped to 1:10, with as many as 20 patients being treated in corridors at the NMUH.

The inspection's other findings included:

  • Significant delays in the assessment of patients on arrival and subsequent treatment
  • Delays in moving patients to specialist wards
  • An insufficient number of middle grade Doctors and Consultants on duty
  • Ambulance arrivals being rapidly assessed and treated without a Doctor's input
  • A lack of support towards A&E staff from Doctors in other parts of the Trust

In addition to this, patient flow was badly managed and waiting times were poor, with only 67.2% of patients in February 2016 being seen and treated within the Department of Health's four hour target – a significant reduction compared to the national average of 88%.

Carley Ross comments:

"Not only are excessive waiting times distressing to a patient in a medical emergency, they are also dangerous."

"Cuts to health budgets and an increasing population means that A&E departments are being stretched to the limit, which will result in more and more medical negligence cases going to court –currently the NHS sets aside a quarter of its budget to handle such claims."

"In this particular case, 22 'serious incidents' were logged over the past year, including the failure to spot the dead patient, which, as the CQC's damning inspection report highlights, is just not good enough."

"Apologies are all well and good, but at the end of the day recognising medical negligence when it happens and addressing its causes is important to ensure a high level of confidence for both patients and their families. It is also important that anybody who has been a victim of medical negligence can get satisfactory redress through the UK courts."

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