Arrowe Park Hospital criticised after damning report into urgent and emergency care service

In January, the Care Quality Commission (CQC) published a report into Urgent and Emergency Care and Medical Services at Arrowe Park Hospital.

Inspectors identified one patient had waited 14 hours to be admitted to a ward which they deemed ‘unacceptable’ and said it should be looked at as a matter of ‘urgency’.

The CQC carried out the unannounced inspection of Arrowe Park Hospital last October after receiving concerns about the quality and safety of the emergency and urgent services.

The peninsula’s main hospital is still rated as ‘requires improvement’ for its urgent and emergency services following the inspection, which also found improvement is required in terms of ‘being safe’.

It was found staff ‘did not always identify and quickly act upon patients at risk of deterioration in the urgent and emergency department waiting room’.

The hospital’s medical service did not always have enough staff to care for patients and not all staff had training in key skills, while mandatory training compliance did not meet trust targets.

Inspectors found that people could not always access services when they needed them and patients did not always receive timely care and treatment.

However, the hospital has improved in other areas – including in medical care, which has gone from requires improvement to good.

Further positives to come from the inspection were that staff were found to have treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions.

They were found to have provided emotional support to patients, families and carers.

At a meeting of Wirral Council’s Adult Social Care and Public Health Committee, some councillors heavily criticised the hospital in light of the report.

While others emphasised the hard work staff were doing at Arrowe Park Hospital and the fact the pandemic put emergency services under an abnormally high level of pressure.

Cllr Tony Cottier, a Labour member, said he was concerned that urgent and emergency care services at the hospital were still rated ‘requires improvement’, the second worst out of four ratings, for being safe and responsive, two of the five criteria it is measured on.

He added that A&E was the first impression people got of how the hospital operates and the report’s findings were of “grave concern” to him.

Dr Nikki Stevenson, deputy chief executive and medical director at Wirral University Teaching Hospital, the trust to which Arrowe Park Hospital belongs, noted the other three criteria, effective, caring and well-led, were rated as ‘good’, the second best of the four possible ratings.

On the issue of responsiveness, Dr Stevenson said that if the hospital is full and people cannot get in it has an impact on the emergency department.

She added this was an issue nationally and was something she wanted to see an improvement in.

Responding to the criticism of Arrowe Park Hospital at the time of the report, Dr Stevenson said: “As with other Trusts, our Urgent and Emergency Care Services have faced very high levels of attendances over the past year, which has also affected our ability to reach pre-pandemic targets on waiting times.

“However, we recognise the needs of our communities and are therefore investing in a development that will transform urgent care in Wirral.

“This will offer a state-of-the-art facility for the people of the Wirral and a much better experience. The work is due to start this year and we are really excited about those plans.”

At the meeting, Conservative councillor Simon Mountney said his own mother has received the “very best treatment” and that he could not criticise it in any way.

But he referred to the section of the CQC’s report which said staff did not always identify and quickly act upon patients at risk of deterioration in the urgent and emergency department waiting room.

He said this was surely the “absolute minimum” and the CQC said the hospital was not doing it.

Dr Stevenson said dedicated personnel did go to the waiting room and made sure people got the necessary observations, but that it was not usual practice to treat patients in the waiting room.

Dr Stevenson said she did not excuse the finding in the report, but said this situation was a system risk and what can happen when you cannot get patients into and out of the hospital.

While the committee was critical of the issues with emergency care found in the report, members did praise staff at the hospital.

Conservative councillor Dr Ivan Camphor, said it was easy to criticise the system, noting that GP surgeries have not been inspected during the last two years due to the pressures of the pandemic, but acute services were inspected despite facing demand of 100% of capacity and above.

He said health workers had not had many, or any, holidays during the pandemic and they were “true heroes”.

He added while things had not always worked well, it was not out of laziness or a lack of motivation, and he wanted to recognise that people had worked hard.

Graham Hodkinson, Wirral Council’s director of health and strategic commissioning, said that at the time of the inspection the whole system was under huge pressure due to “unprecedented” levels of community covid infection and the fact that over 90% of care homes were shut down with infections at the time.

Mr Hodkinson said this meant until quite recently the hospital had run at over 100% of capacity and all services, from A&E right through to discharge were under huge pressure and it was very different to a normal time of operation.

He added that the context of the time the inspection took place had to be recognised.

As the October inspection was focused on the Medical Care and Urgent and Emergency Services, the result did not change the CQC overall Trust rating for the three hospitals which make up Wirral University Teaching Hospital, which is ‘Requires Improvement’.

The Trust’s overall rating was compiled from CQC visits in May 2018, October and November 2019 and a final report in March 2020.

Since then, the Trust has been implementing an action plan of improvements and has successfully bid for capital investment in facilities to improve staff and patient experience.