The Care Quality Commission (CQC) has re-rated urgent and emergency care services at Derriford Hospital in Plymouth as requires improvement following an inspection in October.
Derriford Hospital is the largest specialist teaching hospital in the Southwest peninsula and the region's major trauma centre, run by University Hospitals Plymouth NHS Trust.
CQC carried out the inspection to check on progress following a previous inspection in March 2024, when the service was rated requires improvement.
Inspectors found the service had made strong improvements since the last visit. However, there was still work to be done to ensure people's privacy and dignity were maintained when receiving care, especially in corridors.
The service remained in breach of regulations relating to safe care and treatment, dignity and respect, and good management. CQC has told the trust to produce an action plan that sets out how they plan to address these concerns.
CQC has re-rated the service for safe and well-led as requires improvement. Caring has been downgraded from good to requires improvement. Effective and responsive have been upgraded from requires improvement to good.
The overall rating for Derriford Hospital remains requires improvement as do the ratings for being safe, responsive and well-led. Effective remains rated as good but the rating for caring has dropped from outstanding to good as a result of the ratings change in this service inspection.
Catherine Campbell, CQC deputy director of hospitals, secondary and specialist care for the South West, said:
“Following our inspection of Derriford’s emergency department, we found a service that’s worked hard to improve since our last visit. Staff and leaders demonstrated a positive, compassionate culture with a strong focus on learning, and we saw meaningful progress in areas such as patient flow and teamworking.
“However, the continued high number of people attending the department is placing significant pressure on the service, which is affecting the consistency and safety of care. The trust is working with the local integrated care board and other stakeholders to address these challenges. They understand this is a long-term project that won’t bring immediate results.
“During our inspection, we found some areas were particularly crowded. Limited space meant some people were being cared for on trolleys in corridors, which isn’t always appropriate for safe treatment. In these conditions, some people waited too long to be seen by a doctor, and staff weren’t always able to fully protect people’s privacy and dignity, with sensitive conversations sometimes overheard.
“Staff also told us that space constraints in certain areas made it more difficult to move people safely and access equipment. The trust has begun work on a new purpose-built emergency care building, with a planned four-year construction programme. Staff have been supported to take part in shaping plans for this future facility alongside trust leadership.
“Until the new building is ready, leaders and frontline teams were actively reviewing risks and working in real time to improve flow around the area. It was also encouraging to see leaders give staff the time and support to develop improvements and innovation, enabling changes in care delivery.
“We have told the trust to provide a clear action plan setting out how it will address the concerns identified. We will continue to monitor the service closely and return to assess the progress made.”
Inspectors found:
- The service wasn’t able to provide people with medical reviews quickly, resulting in long waits and also affected how quickly they moved through the department.
- Staff didn't always follow infection control procedures, including hand hygiene and changing gloves between treating different people.
- The trust’s cramped ambulatory treatment area had mixed sex cubicles and offered little privacy for distressed relatives.
Inspectors also found:
- Staff demonstrated a positive culture where most felt able to speak up, with 88% saying they would raise concerns again which is important as it can be essential to improving people’s care.
- The service had developed strong partnerships with community organisations to help redirect people to more appropriate care settings freeing up their resources.