Many A&Es are failing now. As delays, standards, and staffing gets worse, more and more demand will come for private emergency health care – It will start in the cities. The health divide will get worse now… Like Mid Staffordshire and care standards, the problem is endemic. The North Middlesex is only an example of what is going on near you. I hope Julie Lowe does an exit interview for her board – and for the public: somehow I doubt it. The political rules have changed for the next month or so, and Brexit can be blamed on all financial rationing..
Care Quality Commission report says shortage of doctors and nurses and lack of vital equipment risking patients’ health
The chief executive of crisis-hit North Middlesex hospital has left her post after NHS inspectors found its A&E unit was risking patients’ health by forcing them to endure “excessive” waits to see a doctor.
Julie Lowe has been replaced on an interim basis by a senior executive from another London hospital in the wake of a scathing report by the Care Quality Commission (CQC) into multiple patient safety failings at the North Middlesex.
The NHS care regulator’s inspectors found that shortages of doctors and nurses in A&E were so acute, and the unit so busy, that untrained receptionists there ended up judging which patients needed medical attention first. It is one of the busiest A&Es in the capital, treating 500 patients a day.
“Walk-in patients were seen by a receptionist, who decided if they were suitable for the urgent care centre or, with a more serious condition, needed to go to the main emergency department,” according to the CQC’s report, which rated care in the A&E unit overall as “inadequate”.
“Increasing delays in time to triage [A&E patients by a nurse] can mean that it is up to two hours before a patient is seen by a nurse, where the national standard is 15 minutes, during which time their undetected condition could deteriorate. We were given several recent examples of where this had happened,” the CQC said.
“Many patients who arrived in the emergency department were not being seen by a clinician within 15 minutes and this meant that they were at risk of deteriorating and experiencing poor outcomes. Many patients were waiting too long to see a doctor and this meant they were at risk of deteriorating or not receiving prompt diagnosis and treatment.”
The report also revealed that:
- Middle-grade doctors on duty in the A&E unit overnight were endangering patients’ safety because “many … were unable or unwilling to make decisions about patients’ diagnosis and treatment”.
- Junior doctors were left in charge of the A&E unit, which serves a catchment area of 350,000 residents, despite their inexperience. The trust twice denied that had ever happened when the Guardian first revealed it last month.
- Staff’s failure to undertake hourly rounds meant “that a patient had lain dead for up to four and a half hours before being found”.
- Chronic staff shortages were implicated in one patient dying unexpectedly. Their death occurred when the A&E was “two to three nurses and one middle grade doctor short”, an internal serious incident investigation by the trust found.
- Vital equipment, including a portable resuscitation trolley, was often missing or broken and so unavailable.
The trust maintained that Lowe was “on leave”. But NHS sources confirmed that she has stepped down after national NHS bodies and regulators which are trying to help the hospital lost confidence in her ability to turn its fortunes around. Libby McManus, from the nearby Royal Free hospital, which is now likely to take over the North Middlesex, has become the latter’s interim chief executive.
The Guardian disclosed last month that the General Medical Council and Health Education England were so concerned about the situation in the hospital’s emergency department that they had threatened to close it down by stopping all doctors in training from working there because training and supervision of them by consultants was so poor.
The Labour MP and former health minister David Lammy, whose Tottenham constituents use the hospital regularly, said: “This a truly damning CQC report that has been sat on for months, and frankly it’s even worse than I feared.
“Not only has the emergency department been left in the care of junior doctors, but it now emerges that all patients arriving by ambulance were assessed and treated by nurses without any input from a doctor at all.”
He accused the health secretary, Jeremy Hunt, and national NHS bodies of covering up what he said was the “scandal” of poor care at the hospital in Edmonton, north-east London.
The CQC undertook its original unannounced inspection of the A&E and medical units in April and May, and visited the emergency department again last week.
“We have already seen some progress since that original inspection. A new leadership team is in place in the emergency department [and] there are moves to appoint more senior doctors.” The North Middlesex has borrowed five A&E specialists from nearby hospitals to help it improve staffing levels.
“The evidence from our latest inspection is that North Middlesex’s emergency department has turned a corner, but there is still much more that needs to be done,” added Richards. Inspectors will return to assess the whole hospital in September.