A REVIEW of quality at three hospitals run by the same trust is continuing by a health watchdog after they were all found needing to improve, and patients visiting Basingstoke hospital's emergency department were at 'risk of harm'.

The Care Quality Commission (CQC) is still carrying out a review at Basingstoke and North Hampshire Hospital, Andover War Memorial Hospital and Royal Hampshire County Hospital, all three of which are run by Hampshire Hospitals NHS Foundation Trust.

The review follows all three of the trust’s hospitals being inspected and rated as 'requires improvement'.

A statement on the CQC’s website says it will publish reports on its findings once the review, which started last summer, is complete.

As previously reported, the trust was found to 'require improvement' in all areas other than caring which was graded as 'good' after an inspection in September last year.

Basingstoke hospital was found to 'require improvement' in all areas, including safety, caring and well-led.

The CQC's most recent inspection, not part of the ongoing review, earlier this year of the emergency department at the site found improvements since the previous inspection in July 2018 when it was graded as 'inadequate'.

Following this inspection, the CQC imposed conditions on the hospital relating to the 'treatment of disease, disorder or injury'.

The report said: “We took this urgent action as we believe a person or persons would or may have been exposed to the risk of harm if we had not done so.”

The situation had improved when the CQC revisited in February, during the period of heavy snow and ice in Basingstoke, however, the department was not given an overall rating because there was not “sufficient evidence”.

A letter from the chief inspector of hospitals noted that at the time of the unannounced visit the department had declared an “internal major incident” the previous weekend and was “under immense operational pressure in part caused by extreme weather conditions resulting in patients not being discharged over the preceding weekend due to unsafe road conditions”.

Patients were seen being cared for along the main corridor, with others waiting a long time because of a lack of bed space, although this did improve during the inspection.

The trust reported there were 236 patients on the day of the inspection, 61 arriving by ambulance, whereas an average day there would be 170 with 60 arriving by ambulance.

The CQC found that provision for mental health patients “remained challenging” with some experiencing delays in being reviewed, and where they were managed was described as “not fit for purpose”.

However, the inspector found that the trust has introduced measures to “reduce the likelihood of patients being able to harm themselves or others”.

The report noted that although the department had implemented “patient safety initiatives” including a patient safety checklist, staff “did not consistently use these”.

Alex Whitfield, chief executive at Hampshire Hospitals, said: “Staff across our hospitals have been working hard to address the issues raised by the Care Quality Commission inspectors and we have made significant progress in a number of areas.

“Work has been completed to create areas for the rapid assessment and treatment of patients coming into our emergency departments at both Basingstoke and Winchester, while we also now have dedicated areas where children can be assessed away from other patients in the emergency departments. Elsewhere, a wide range of measures have been introduced to ensure that our care meets the highest standards.

“Inspectors from the CQC winter pressures team, who visit most hospitals over the course of the winter, carried out an unannounced visit to the emergency department at Basingstoke hospital at the beginning of February, just after the severe snow. It was one of the department’s busiest days ever, with more than 230 patients coming through the doors compared to an average of 170.

“Inspectors saw how improvements had been made across the department and we were delighted that they praised staff for their compassion towards patients, who told the CQC they felt listened to and that staff considered their views and opinions.

“We expect CQC inspectors to make further unannounced visits as part of their review of quality at our hospitals, which began following their initial inspection last summer. Areas that require further improvement remain a priority for us, and all of our staff are working hard to deliver consistently high-quality care to every patient.”

The CQC also found following February's visit:

• Care and treatment were not always planned and carried out in a timely way

• The process for streaming patients was not “fit for purpose”, resulting in “bottle necks” at the front door

• The privacy and dignity of patients were not always “promoted or protected”

• There was a focus on avoiding the 12-hour breach compared to providing “holistic care to patients”

One patient who was about to exceed the 12-hour target was transferred, despite having just experienced a seizure and dislocating a joint.

“Staff opted to move the patient out of the emergency department in order they did not breach the 12-hour target and to then organise for their dislocated joint to be treated once they had been transferred. This suggests the priority for the department was more focused towards performance compared to quality,” the report said.

One patient waited nine hours before being given antibiotics, despite the need for these being recognised when they arrived.

Another patient who was holding their chest “clearly displaying signs of discomfort” waited 29 minutes to be triaged, which is longer than the recommended 15 minutes. The CQC inspection team made staff aware of this patient and were told by the trust later that a review concluded the patient had not come to any harm as a result of the wait.

Inspectors also saw two patients whose back and underwear was exposed when their gowns came open as they were supported to the toilet, which “compromised their dignity”.

Dr Nigel Acheson, deputy chief inspector of hospitals, noted a number of improvements, including:

• An expansion resulting in “improved handover performance” for those brought in by ambulance

• Efforts made to improve patient experience

• Staff utilising clinical assessment rooms and cubicles to consult and treat patients, rather than using corridors

• Staff speaking to patients with compassion

He said: “Patients told us they felt listened to”.

To improve, the hospital has been told to:

• Ensure patients receive a timely assessment and a plan of care is established

• Provide care and treatment in an environment which is “fit for purpose and meets national standards”

• Ensure staff consistently utilise safety measures

• Operate “effective and safe process for receiving and assessing patients who self-present”.