HEALTH inspectors have raised concerns that “many patients” at a Scottish hospital did “not appear well cared for” – with a report telling how they saw the Accident & Emergency department operating at 230% of capacity.
Healthcare Improvement Scotland (HIS) visited Forth Valley Royal Hospital in Larbert, near Falkirk, with their report describing the “extreme pressures” on services there. The inspectors said: “In some areas, including the emergency department and admission units, many patients did not appear well cared for.”
Inspectors saw patients being treated in chairs, with IV drips that had “run dry”, while one person had to wait 25 hours before being found a place on a ward.
Staff were seen to be “tearful” and “appeared worried about not being able to provide appropriate safe care and dignity for patients due to overcrowding”.
HIS staff made two visits to Forth Valley Royal Hospital in April, and an unannounced follow-up inspection in September, which they said “raised further serious concerns about the safety and quality of care at Forth Valley Royal Hospital”.
Inspectors have raised these concerns with both NHS Forth Valley and the Scottish Government.
Their report said the emergency department was under “extreme pressure” with occupancy “reaching 230% at points throughout the day”.
It stated: “This meant an increase of 130% more patients in the department than it was designed to accommodate.”
The longest wait time for patients awaiting transfer to ward areas was 25 hours. Meanwhile, ambulance crews were forced to wait to transfer patients to the hospital “due to lack of physical space, or staff capacity to take over the care of these patients”.
The inspectors said: “We observed staff working under extreme pressure which impacted staff and the patients receiving care.”
In the emergency department and other areas, the inspectors found “many patients were being cared for in chaired areas in corridors and within the departments”.
The report stated: “Some patients told us they had been in non-reclining upright waiting area chairs through the night. In one instance, a patient described being in a chair for at least 16 hours and had been given no information about when they would be transferred to a ward area or bed.”
It said such patients were not always “easily visible to staff”, adding: “In these areas we observed patients with intravenous infusions that had run dry. Another patient, who was on a chair and using oxygen therapy, had an empty oxygen canister and inspectors had to alert staff to this.”
Inspectors said they were “approached by patients in the emergency department and admission units who were struggling to access medicines for pain relief, or not receiving their scheduled medicines at the correct time intervals”.
Meanwhile, some patients were being treated in “contingency beds” – these allow for a fifth patient to be placed in a space designed for four beds.
But with staff not always able to draw screens around these beds, the report said workers had to “assist other patients out of the room to maintain the privacy and dignity of individuals receiving emergency care”.
The report also detailed “unsafe practice” with regards to medicines, saying inspectors had seen staff in one unit prepare intravenous medicines, before handing these to staff in another unit to be administered – “without staff checking if it was the correct medicine, the correct dose or the correct patient receiving the medicine”. including in some ward areas, the inspectors seeing medicines cupboards “left unlocked and unattended”.
The inspectors said that “during this incredibly busy time in the emergency department and admission areas, we did not observe senior management support within these departments”.
The report said: “Senior managers were not visible in the departments during the inspection and staff also described a lack of senior management support.”
HIS has now issued a further 11 requirements for improvement at Forth Valley Hospital, having made nine requirements earlier this year.
Donna Maclean, the head of service at HIS, said: “At the time of our follow-up inspection, NHS Scotland continued to experience a range of pressures including increased hospital admissions and reduced staff availability.
“We observed Forth Valley Royal Hospital experiencing extreme pressures from increased patient numbers, delayed discharges and high levels of staff absence.“This report highlights our concerns on the limited improvement and, in some cases, a deterioration in safe delivery of care since our April 2022 inspection.
“This resulted in us formally escalating our concerns to Scottish Government in line with our escalation process.”
Maclean added: “Many of our concerns were directly related to the safe delivery of care, particularly in the emergency department and admission units where many patients did not appear well cared for.”
Cathie Cowan, chief executive of NHS Forth Valley, said: “I would like to apologise to those patients whose care and treatment fell below the high standards we aim to provide.
“The report highlights a number of serious issues, and immediate action was taken following the visit to quickly respond to the concerns raised by the inspectors.
“We recognise that there is still more work to do, and we are committed to fully addressing all of the report recommendations and working with the Assurance Board set up by the Scottish Government to drive forward the changes and improvements required across the organisation.”
“Local staff continue to deliver high standards of clinical care and treatment in very challenging circumstances, and I want to thank them for their hard work and commitment.”
A Scottish Government spokesperson said: “The concerns raised by HIS and escalated to the Scottish Government are one of the factors that has led to NHS Forth Valley’s escalation to Level 4.“We have established an Assurance Board bringing direct government oversight and monitoring in response to NHS Forth Valley’s escalation.
“We will scrutinise NHS Forth Valley’s Improvement Plan and hold the leadership to account for the effective delivery of improvement actions. ... We expect urgent improvements to be made in the areas of concern HIS have highlighted in their report.”
