Cumberland Infirmary

Cumberland Infirmary is operated by North Cumbria Integrated Care NHS Foundation Trust. Trust operates from two district general hospital sites: West Cumberland Hospital (WCH) in Whitehaven; and Cumberland Infirmary in Carlisle (CIC). This report relates solely to Cumberland Infirmary in Carlisle.

CIC operates an emergency assessment unit; a 30-bedded unit for medical admissions.

The admission unit is supported by Acute Care Physicians (ACP). Emergency surgical admissions at CIC are via a 12 bedded and six trolleys surgical unit.

CIC also operates an emergency ambulatory care unit Monday to Friday supported by the acute medical and surgical consultants as well as nurse practitioners.

The CIC unit operates six chairs and two trolleys 9am – 8pm.

The consultant-led emergency department at CIC was open 24 hours a day, seven days a week, to provide an accident and emergency service for children and adults.

There were separate entrances for walk-in patients with a seated waiting area. Reception was used by both walk in patients and ambulance crews booking patients in to the department. There were 19 bays in the department, 10 of which were in the majors’ area and could be made available for isolation of patients. There was a separately equipped ophthalmology treatment room, a designated mental health room and a separate area of the department designated for children, with a children’s waiting area and a children’s treatment room. The resuscitation area comprised three bays, which included one equipped for paediatric patients. The emergency department was a designated trauma unit. The radiology department was adjacent to the department and easily accessible. There was a private relatives’ room with comfortable chairs, a telephone and drink making facilities.

During the inspection we visited the emergency department only. We spoke with 17 members of staff, including managers, doctors, nurses, non-clinical, and ambulance staff and volunteers. We reviewed 20 patient records. Inspectors spoke with five patients and relatives, observed the interaction of staff with patients, and observed a team huddle in progress.

We carried out an unannounced inspection of the emergency department at the Cumberland Infirmary on 24 February 2020 due to concerns of crowding and patient care.

During this inspection we used our focussed inspection methodology. We did not cover all key lines of enquiry, we looked at the safe domain and aspects of both the responsive and well led domains.

Throughout the inspection, we took account of what people told us and how the provider understood and complied with the Mental Capacity Act 2005.

Services we rate

During this inspection we used our focussed inspection methodology. We did not cover all key lines of enquiry, we looked at the safe domain and aspects of both the responsive and well led domains.

We rated it as Requires improvement overall.

• Staff did not always have the training on how to recognise and report abuse. This meant the service did not always protect patient from harm or abuse.

• The design, maintenance and use of facilities, premises and equipment did not keep people safe.

• Staff did not complete risk assessments for each patient. This meant staff could not identify or quickly act upon patients at risk of deterioration.

• The service did not have enough nursing staff or support staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm or to provide the right care and treatment.

• The service did not have enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm or to provide the right care and treatment.

• The service managed patient safety incidents well. Staff recognised and reported incidents and near misses and reported them appropriately. Managers investigated incidents and shared lessons learned with the whole team. When things went wrong, staff apologised and gave patients honest information and suitable support.

• People could not access the service when they needed it to receive the right care promptly. Waiting times from referral to treatment and arrangements to admit, treat and discharge patients were not in line with national standards.

• Leaders had the skills and abilities to run the service however had not managed the priorities or issues the service faced. Local leaders were both visible and approachable within the service for patients and staff.

• Staff did not feel respected, supported or valued. And were not always focused on the needs of patients receiving care. The service had an open culture where patients, their families and staff could raise concerns without fear but a poor safety culture meant concerns were not always reported.

• The department did not operate an effective governance process, throughout the service or with partner organisations.

Following this inspection, wrote a letter of intent to the trust to gain assurance regarding the concerns we found in particular safe staffing, timely triage and assessment for both adults and children; In addition we told the provider that it must take some actions to comply with the regulations and that it should make other improvements, even though a regulation had not been breached, to help the service improve. We also issued the provider with three requirement notice(s) that affected Urgent and Emergency. Details are at the end of the report.

Ann Ford

Deputy Chief Inspector of Hospitals (North)