Long waits and under-staffing issues at the Grange hospital

The Health Inspectorate of Wales carried out an unannounced inspection at the Grange between November 1 and 3 last year.

The highly critical report, which was published on Tuesday, concluded that: “Overall, we were not assured that all the processes and systems in place were sufficient to ensure that patients consistently received an acceptable standard of safe and effective care.

“This was despite all the efforts of staff who were working hard, under pressure from the number of patients presenting at the ED (emergency department).”

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Inspectors noted that, on the day of the inspection, the hospital was at full capacity, and was at escalation level four – meaning that emergency admissions were significantly exceeding predicted levels and available capacity.

One of the major issues causing this, the report said, was the flow of patients into and out of the emergency department, and the knock-on effect this had on ambulance crews.

“Until the flow of patients into and through the ED can be improved, the health board may find it difficult to address a number of our concerns,” the report read.

Figures provided to inspectors covering the period between April 1 and November 1 last year showed the median time a patient was in the emergency department was six hours and seven minutes.

Inspectors were told there have been times where ambulance queues outside the Grange have led to being unable to respond to other urgent calls.

“On the day of our arrival at the ED, mid-afternoon, there were approximately 20 ambulances waiting to move patients from the ambulances,” the report read.

“There had been insufficient discharges from the wards at the hospital and other settings to match the admissions into the ED, only two patients had been discharged that morning from the entire hospital.

“WAST (Welsh Ambulance Service Trust) staff we spoke with were not aware of any policy in place to divert patients to other hospitals, other than if a major incident had been instigated.

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“All movement of patients within the health board is controlled by the health board managed patient flow centre.

“There had been occasions, we were told, when the delay in offloading patients from ambulances had resulted in an inability to respond to other urgent calls.”

Previously, the health board has said that it is working with local authorities and social care partners to allow for patients to be discharged from hospital and treated in the community, allowing more patients to be admitted to hospital.

The report noted “all staff striving to deliver good quality, safe and effective care to patients, within very busy units.”

“However, the comments of staff in the staff survey show that they could not always deliver the care they wanted to, due to a number of issues,” it continued.

One issue raised in staff surveys was units being under-staffed.

“We noted that staffing levels in majors [an area where patients have their assessments, care and treatments] throughout the inspection showed a deficit of a safe level of permanent staffing, in majors, during the inspection,” read the report.

“There were shortages on all shifts and a high use of agency staff. Staff we spoke with indicated that they struggled on occasions in the ED.”

A spokesman for Aneurin Bevan University Health Board said: “We’re pleased to see that the report highlights the professionalism of our staff and that patients were treated with courtesy, dignity and respect.

“During the inspection, Health Inspectorate Wales identified some areas where ‘immediate assurance’ was required, and these matters were addressed promptly. We also have an action plan to focus on the other recommended areas for development.

“Health Inspectorate Wales have also indicated that improvements to patient flow are required, which is a nationally recognised problem, exacerbated by the ongoing Covid pandemic. The Health Board has since implemented an Urgent Care improvement plan, however, it’s important to recognise that the challenges associated with Emergency Department over-crowding and delayed transfers of care are ongoing.

“We’re sorry for the experiences of the patients whose care has fallen below our usual standards, and to those who are experiencing delays in their care.

“We’re incredibly thankful to our staff, who are working under significant and sustained pressure in such challenging circumstances.”