Legal regulation breached three times at Eastbourne District General Hospital as overall rating downgraded

It follows inspections of the DGH on January 27-28 this year.

The overall rating for the DGH was downgraded from good to requires improvement.

The CQC has told East Sussex Healthcare NHS Trust (ESHT), which runs both hospitals, to submit an action plan showing how it will make improvements.

In the CQC report, three action plan requests were made to ESHT based on breached regulations, with evidence showing ‘significant shortfalls in the standard of care’.

Safe care and treatment, which the DGH was found to be in breach of in 2018, remained a shortfall. According to the report, there was an ‘increased risk people could be harmed’ in the department.

The report found the emergency department was not ensuring care and treatment was provided in a safe way as sustained pressure caused overcrowding. There were also insufficient triage assessment processes and repeat clinical observations of patients.

Risk of infection was reportedly not always assessed and managed while effective systems for medicines management were not ensured, with limited pharmacy support and delays in medicines reconciliation increasing the risk of errors and omissions.

The CQC also found failings to monitor waiting areas due to insufficient staff, and ambulance patients were streamed by the nurse in charge without sight of the patient. A clear exclusion criteria for ‘walk in’ children and young people, where paediatric provision was limited, was also found to be lacking.

The report found mental health patients were not always cared for in a safe and suitable environment. Patients, including children and young people, experienced delays in accessing assessment and support, and staff cared for them in areas that ‘did not adequately mitigate identified risks’.

The department was also found to be in breach for its governance, with leaders reportedly failing to take sufficient action to address known risks including, overcrowding, patient flow, staffing, mental health and paediatric care. Issues remained unresolved for prolonged periods and, despite efforts, actions taken had not resulted in sustained improvements to patient safety.

Staffing was also recorded as a breach. The report found staff did not consistently have the ‘skills, knowledge and competencies’ required to effectively triage patients. Some resuscitation practitioners were found to not be up to date with intermediate or advanced life support training.

The report also found that insufficient numbers of suitably qualified paediatric staff were available to provide safe care for children and young people in line with national standards, with less than half of the nursing staff having completed paediatric competencies.

However, staff were praised for consistently treating patients with kindness and compassion.

Jayne Black, Chief Executive East Sussex Healthcare NHS Trust said: “We accept the findings of the CQC and recognise that there were areas where the care provided in our emergency departments was not consistently at the standard our patients should expect.

“These inspections took place in January and February and we have made a number of changes since then. These include strengthening rapid assessment at the front door, increasing senior clinical oversight of patients waiting in our departments, improving staffing and escalation arrangements, and strengthening the day-to-day management and oversight of our emergency departments. We are also continuing work to improve patient flow and reduce overcrowding and long waits.

“There is more to do, particularly around flow through our hospitals, and we are not complacent about that. Our focus is on making sure the improvements are sustained and translate into safer, more timely care for patients.

“We are grateful to our colleagues who continue to work extremely hard under considerable pressure, and welcome the CQC’s recognition of the kindness, compassion and professionalism shown by our teams.”