Grange Hospital: A&E at Wales' newest hospital needs urgent improvement

Urgent improvements are needed in Wales' newest emergency department, inspectors have warned.

Healthcare Inspectorate Wales (HIW) has issued a report highlighting the need for urgent improvement in the emergency department at The Grange Hospital in Cwmbran.

HIW carried out an unannounced inspection of the emergency department on three consecutive days in August this year.

In the report, published today (November 10), inspectors say some patients had been waiting on uncomfortable chairs and in the back of ambulances for more than 15 hours and described the waiting area as "very small, cramped and unfit for purpose".

They warned that the waiting room and rapid assessment unit (RAU) were not conducive to providing dignified care and added that the department would not be able to address many of their concerns until the flow of patients was improved.

The inspection team also identified a number of issues needing immediate assurance, including the risk of cross contamination in an area known as the ‘COVID corridor’, resuscitation equipment was not being checked daily, out-of-date medicines were found and there was a lack of security around substances which could be harmful to the patients - these including medication and prescription pads.

While inspectors observed staff striving to deliver good quality, safe and effective care to patients, many staff working in A&E interviewed by the inspectors admitted they were struggling with the high demands of the department. Five of 11 staff interviewed admitted they had seen errors, near misses or incidents that could have hurt staff or patients.

Despite this, most noted that the management and leadership was good and that they felt supported. Management was also visible within the department, including the nurse in charge who was descried as "identifiable and accessible".

The report states: "Senior staff believed that there was a positive culture in the department and staff were passionate about their job. They were frustrated because no matter how hard they worked, they were unable to solve the issues regarding patient flow and numbers of patients attending the unit."

Another significant issue identified was staffing levels, including 22 vacancies at band five level. There were also a number of healthcare support worker vacancies but "very little interest had been generated for these posts", the report adds.

The report continued: "Additionally, we were told of three band five resignations recently. This has had a significant impact on the department and increased the need for bank and agency staff. On some shifts up to 50% of agency staff were used,".

"A number of band five nurses we spoke with said that the workload could be excessive and unrelenting, with the demands on the system being unsustainable. This included two members of staff saying they were close to burnout and considering other jobs and career options."

The report concluded that patients are not consistently receiving an acceptable standard of care at the emergency department at The Grange.

Chief Executive of HIW, Alun Jones said: "Our inspection findings are extremely concerning and we have urged the health board to take action to improve the processes and systems in place within the emergency department so that patients receive safe, timely and effective care.

"I hope this report will accelerate the measures taken to drive forward timely improvements. We will be working closely with the health board to ensure robust improvements are made and evidenced."

A spokesman for Aneurin Bevan University Health Board said: "Like all hospitals across Wales and the UK, The Grange University Hospital continues to face extraordinary challenges due to staff shortages, increased demand and the after effects of the Covid-19 pandemic on people's health. We are working hard to improve the experience of patients who visit the hospital.

"We recognise there are issues around the Emergency Department's waiting area, but we would like to reassure people that work is already underway to increase capacity in this area.

"HIW have also indicated that improvements to patient flow and waiting times are required, which we fully accept. Whilst this is a nationally recognised problem, caused by system-wide pressures across health and social care, we are working hard to improve patient flow and reduce waiting times. We have already introduced a closer partnership working initiative between Emergency Department staff and the Welsh Ambulance Service to improve ambulance handover times, as well as introduced a Same-Day Emergency Care Unit (SDEC) to offer eligible patients more timely care and to free up space in the Emergency Department."

The purpose-built £350m hospital became the home of accident and emergency and intensive care for people living across Gwent and south Powys in November 2020.

A Welsh Government spokesperson said: "We continue to support improvement to emergency departments through a range of measures. We are providing an additional £25m this year to transform urgent and emergency care services across Wales, with Aneurin Bevan UHB receiving £3m.

"We have also provided an additional £260k to the health board for improvements to its emergency department waiting areas this winter."