UHP makes significant improvements for patients needing Urgent and Emergency care since March CQC visit | Latest News

Staff at University Hospitals Plymouth NHS Trust have made considerable improvements for patients arriving as emergencies following a CQC inspection, but they know there is more to do.

Inspectors visited back in March of this year and have just published their report which has been delayed due to IT issues at the CQC. They carried out an inspection of Urgent and Emergency Care (UEC), Same Day Emergency Care and the Discharge Lounge, over 2 days. At the time, the CQC arrived during an internal Critical Incident and saw the reality of a crowded busy Emergency Department with significant numbers of ambulances waiting, speaking to staff, patients and partner organisations. The CQC served UHP with a Warning Notice under section 29A of the Health and Social Care Act 2008 following the inspection and gave UHP until 21 July to make improvements. This notice has now expired. The CQC overall rating for Derriford Hospital remains ‘Requires Improvement’ for UEC.

Interim Chief Executive Mark Hackett said: “At the time, we know the quality and speed of care we were able to offer patients coming for Urgent and Emergency Care was not what we aspire it to be when the CQC inspected our services back in early March. They arrived during an Internal Critical Incident and what they saw was fairly reflected in their report, but that was eight months ago now and we have made good progress in improving our performance since then. Our staff are doing all they can to ensure the safety of patients at all times – we know there is still work to do but it is important to reflect the improvements we have made since the inspection, which are many. We have made significant improvements since March, but we are striving for better and there is more to do.”

Making improvements

There has been a relentless focus on improvement through the One Plan for UEC, including creating new pathways away from the Emergency Department, initiatives to treat people in the community to avoid hospital conveyance and investing in more Same Day Emergency Care.

We have started to reduce waits for patients, improving performance against the 4-hour target from 54% in March 2024 to 66.3% by the end of October 2024. We have also reduced ambulance handover delays significantly. At the time of the visit in March, we were recording 9,326 hours lost to ambulance handover delays, we have brought that figure down to around 3,700 in October.

There is more work to do to further improve, and this is taking place right now. There is considerable work and ongoing investment to make this an organisation that offers high quality care.

Work to improve care for patients

Our One Plan

We have a single plan for improvement which ensures that patients who attend as emergencies are seen in the right place, at the right time by the right staff. This plan is about three key things: admission avoidance, flow through the hospital, and timely discharge to get people to the comfort of their own homes more quickly. We are already seeing improvements as a result of the One Plan since its introduction earlier in the year, such as an improving 4-hour performance and a decrease in ambulance delays.

As part of the One Plan, we have created new pathways for patients within Derriford Hospital. For example, people with issues in early pregnancy go straight through to our Early Pregnancy Service and patients who have gynaecological problems go straight to that specialist unit.

• Our Urology team have been amongst the first in the country to introduce a Urology Same Day Emergency care model and to help patients with urological problems attending as emergencies. 

• Work has also taken place between the Children’s Assessment Unit and the Paediatric Emergency Department to stream children up to Level 12, our children’s unit, faster.

 

• We have also seen sustained improvement in the percentage of fractured Neck of Femur (NOF) patients undergoing surgery within 36 hours, down from 59 hours. NOF patients are also spending less time in the Emergency Department, coming down from 497 minutes to 306 minutes

• More space to see and treat patients on the same day; 57% of the patients we see and treat on the same day (Same Day Emergency Care) are streamed from the Emergency Department - historically these patients would have been admitted into the hospital

• More rapid assessment spaces in the Emergency Department

• A new Medical Receiving Unit – this supports the movement of medical patients out the Emergency Department prior to admission to a ward and is making a difference in ambulance handover times

• More hot clinics – these have been put in place so patients who attend the Emergency Department, but who are well enough to return to a specialist clinic the next day or soon after, can - just like Arthur who attended our Cardiac Chest Pain Hot Clinic 

Community initiatives

Our teams, in conjunction with partner organisation Livewell Southwest, have started to rollout community initiatives that are supporting patients to receive treatment and recover in the community, whether that is at home or in another care setting.

• Community Frailty Virtual Wards – 21 virtual beds for six areas in Plymouth. This looks at all patients care needs and medicines, allowing frailty teams to devise and coordinate care with specialist input in the community. This is in addition to the Virtual Wards already in place at UHP

• Our new X-Ray Car Pilot Service – the car is out and about in the community attending frail and vulnerable patients who have had a fall, releasing 3-5 ambulances into the community every day. The project may prevent over 70 conveyances to the Emergency Department per month, with a monthly reduction of 1000 inpatient beds across the hospital.

• Our Supportive and Palliative Care Service, which is major component of our Urgent and Emergency Care One Plan programme, is well into mobilisation. The service enhances our end of life offer for our patients and their families by utilising End of Life beds at Mount Gould hospital, expanding our End of Life team in the Emergency Department, and partnering with Marie Curie to ensure a partnership approach to the provision of palliative care expertise and capacity.

• Outpatient Head Injury Support Service supporting older patients access to imaging after head injury. The service allows patients to remain in their current setting and attend a scheduled CT scan either on the same day, or the next, avoiding ambulance conveyance into the Emergency Department

Increasing our staffing

The inspectors recognised there was ongoing improvement to staffing levels in the Emergency Department. Staffing levels for nursing has improved, including the introduction of a Nurse Manager to provide the helicopter view of the department was noted by the inspectors. The number of vacancies that have been filled in the Emergency Department has been exceeding our target this year and we are investing in new consultants for Urgent and Emergency Care.

Improving the environment

CQC inspectors noted at the time, the current Emergency Department physical environment is unfit for purpose and this adds to a poor patient experience. We are addressing this through the opening of our on-site Urgent Treatment Centre (UTC), named the Dartmoor Building, in early 2025. A new facility for our Fracture Clinic will also be relocated from the main hospital site to the Dartmoor Building. This space will offer a multidisciplinary team of experts to diagnose, treat and support patients in their recovery of fractures in a larger, modern purpose-built healthcare environment.

Our plans to build a new Urgent and Emergency Care Centre through the New Hospital Programme are underway. Enabling works have commenced for the new 17,000m2 Urgent and Emergency Care Centre at the front of Derriford Hospital. This new facility will consist of four floors of emergency care facilities; one devoted to same day emergency care, a new paediatric emergency department, emergency surgery theatres, imaging facilities, interventional radiology facilities, training facilities, staff rest and welfare facilities, and all the support accommodation associated with our emergency care pathway.

Mark added: “I want to highlight how complimentary the CQC inspectors were about our staff and reiterate that we are seeing an improving picture for urgent and emergency care through our One Plan, certainly since the visit which was back in March. The inspectors gave us some immediate feedback, some elements of which were notably different to previous inspections and relate to an improvement in our culture – they fed back that the staff they spoke to were very open about the challenges they faced but also positive about the culture and wanting to work for the Trust; patient feedback was exceptionally complementary about the care and compassion received.”

 

You can see further reaction to the report, including highlights of some of the improvements we have been making since the inspection, in this video