Ysbyty Glan Clwyd A&E ambulance queue criticised by HIW
Up to five ambulances regularly have to queue outside A&E at a north Wales hospital due to a shortage of staff and beds, a critical report has found.
Glan Clwyd Hospital in Denbighshire was also "very poor" at responding to patient complaints, inspectors discovered.
Health Inspectorate Wales (HIW) made 20 recommendations for improvements.
Betsi Cadwaladr University Health Board said it accepted the report's findings and was working to resolve issues.
Phill Banfield, chairman of the British Medical Association (BMA)'s Welsh Council and an obstetrics consultant at Glan Clwyd, said: "This report documents the exceptionally high quality care given by medical and nursing staff at Glan Clwyd hospital.
"This is despite severe pressures from an under-resourced accident and emergency department and delays to the discharge of patients compounded by excessive bed closures and a failure to expand a primary care service that is facing meltdown in north Wales."
Dr Eamonn Jessop, a Prestatyn GP who represents the BMA in north Wales, said: "The Healthcare Inspectorate have tried to put the blame on the problems of 'inappropriate admissions' and discharging patients when the real issue lies in a lack of beds at the hospital and in the whole system.
"The real problem is the closure of community hospitals like the Alex in Rhyl which has placed increasing pressure on Glan Clwyd at a time when an ageing population means that there is a tidal wave of demand."
Darren Millar, Conservative health spokesman and Clwyd West AM said: "Glan Clwyd, like other hospitals, is facing an uphill struggle to cut costs and juggle numbers.
"It's no wonder that performance against targets suffers dramatically as a result.
"Recruitment must be improved and I urge the health minister to work with Betsi Cadwaladr UHB to give staff the support they deserve."
Peter Meredith-Smith, of the Royal College of Nursing (RCN) Wales, said: "On a daily basis, we are hearing from nurses about clinical services that are working close to or beyond capacity, with not enough staff on duty to deliver the care that they are capable of and wish to provide.
"It is particularly concerning in this case that the conclusions arrived at by the inspection team are not based on hearsay, but on their own experiences on the ground.
"It is clear from the report that at one point during their visit things were so bad regarding nurse staffing that the inspectors (most of whom are experienced clinicians) had to escalate their concerns to a director of the local health board."
HIW said it was a "regular occurrence" for as many as five ambulances to be lined up at A&E.
In the report, inspectors said: "We were told by many patients of long waits both within the departments and on ambulances queuing outside the door.
"Patients queuing up on ambulances for significant periods of time before even receiving an assessment at the A&E department is unacceptable."
Once patients were seen, there was often a "bottleneck" in the task of finding an available ward bed for them, inspectors said, and once they were admitted many patients were moved around the hospital too often.
HIW examined seven of the hospital's 25 wards, as well as the A&E department and the acute assessment unit.
Inspectors were asked to look at how the hospital operates after Wales' public services ombudsman cited four cases in which failings in care were identified.
Among other concerns expressed and problems found were:
- A regular shortage of trained staff on some wards
- A shortage of consultants on A&E, a lack of ward beds leading to bottlenecks for people admitted through A&E and the Acute Medical Unit
- Failings in how complaints are dealt with
The care provided by staff was generally good, the report found, but morale "was not great in some areas" and some nursing teams had high (6.75%) levels of staff illness.
The report said: "It was clear to us from observations and discussions that staff were feeling under pressure and working at a perceived 100% bed capacity."
The use of mixed sex beds in the acute medical unit was a particular concern for the inspectors, with them saying it was not appropriate for use by longer-staying patients.
After discussions with the health board, the HIW inspectors found only 28% of patients' concerns met the 30-day deadline for response.
End Quote Report on Glan Clwyd Hospital Health Inspectorate Wales
A complainant whose father had died received, after a significant delay, a substantive response in which the deceased's name was incorrectly spelt”
An example of the badly-handled complaints included one by a person whose grievance about the poor standard of care of their father, who subsequently died, was upheld by the public services ombudsman, Peter Tyndall.
A cheque was sent to the complainant as a result.
"However this cheque was not accompanied by a letter or an apology and worse still was merely in the form of a remittance advice note that could not be used by the complainant," the report said.
"This naturally greatly upset the complainant. In another example a complainant whose father had died received, after a significant delay, a substantive response in which the deceased's name was incorrectly spelt."
The HIW inspectors said they were impressed by the health board's response following Mr Tyndall's report but there was "still more work to be done to ensure that the highest standards of patient care are reached at Glan Clwyd Hospital".
They also found what they described as "tension" between the hospital and the health board that "needs to be recognised".
In its statement for the report, Betsi Cadwaladr said: "The health board accepts the recommendations of the review and will continue to work to address the issues raised."
It added that a report on progress would be published within six months.