NHS Wales: Grange Hospital A&E needs urgent improvement - HIW

Urgent improvements are being called for at a new south Wales hospital's emergency department.

Healthcare Inspectorate Wales' (HIW) main concern is poor patient flow through the Grange Hospital in Cwmbran, which opened only two years ago.

They also had concerns about potential cross contamination in the "Covid corridor", out of date medicines and the security of harmful substances.

Aneurin Bevan health board said it welcomed the findings.

Staff told inspectors they could not always deliver the standard of care they wanted to, due to increasing pressures and demand on the department.

This report mirrors concerns raised in a previous inspection of Cardiff's University Hospital of Wales, where patients were found sitting on bins in waiting areas.

The Grange, Wales' newest hospital, which opened on 17 November, 2020, has come under heavy criticism.

A report by the Royal College of Physicians in 2021 found that some trainee doctors and consultants were scared to come to work, with chronic understaffing and excessive workloads.

Earlier this year the hospital's medical director said the site needed to expand because demand had been higher than anticipated.

The health board said it had acknowledged and responded to concerns raised, adding: "We're also pleased to see that the report highlights the hard work and dedication of our staff during periods of extreme pressure on our services, during which patients were treated with courtesy, dignity and respect."

Today's report paints a more positive picture of the running of the hospital, with staff feeling supported and patients praising the medical teams and their treatment.

However, the flow of patients through the hospital is hindering care.

Inspectors said until it can be improved, "the health board will find it challenging to address a number of our concerns".

One anonymous member of staff said patient flow was "a national problem" and believed there was "good evidence that patients come to harm".

They used the analogy, "If the bath is full and overflowing, don't make a bigger bath, sort out the plug hole".

Across Wales - and the rest of the UK - a shortage of staff in social care means patients are unable to be safely discharged from hospitals, despite being medically well enough.

This means beds are unavailable for those arriving at A&E needing to be admitted to hospital.

In turn, this causes longer waits for patients in the emergency department.

Inspectors noted the waiting area at The Grange was very small and unfit for purpose.

They said lengthy waits for patients caused some to be "frustrated and sometimes angry", though "the majority were very complimentary about the staff".

Some patients told inspectors they had sat on the floor because of a lack of space.

The report said there could be more than 50 patients in the waiting room, with the majority physically or mentally unwell, posing "a significant risk" which "placed stress and risk on the staff members".

Inspectors spent three days at the hospital during August.

During August 7,530 people turned up at The Grange hospital - making it the second busiest A&E in Wales that month.

Nearly one in five patients waited longer than 12 hours during that month.

On the inspectors' first day, 14 ambulances were waiting outside, with one patient waiting 18 hours to be "offloaded" from the ambulance to hospital staff because of an infection control risk.

Patients were assessed and triaged to reduce risks, but efforts to free up ambulances were sometimes hindered by the lack of space in the hospital.

In response to the HIW report, Welsh government said it was "providing an additional £25m this year to transform urgent and emergency care services across Wales, with Aneurin Bevan UHB receiving £3m".

In a statement it added that it had "provided an additional £260k to the health board for improvements to its emergency department waiting areas this winter".

"I fully accept there are mounting pressures on the NHS across Wales, but the problem seems particularly acute in Gwent where patient complaints at The Grange continue to mount," said Monmouth MP and Welsh Secretary David TC Davies.

He added: "We are being let down by those in charge who are pretending the current situation is acceptable when it is clearly not."