Despite an unprecedented year of challenge, Gloucestershire Royal Hospital (GRH) has maintained its overall 'Good' rating, following an unannounced inspection by the Care Quality Commission (CQC).

The inspection looked at urgent and emergency care services at GRH, including the Emergency Department (ED or A&E), considering whether they are safe, responsive and well led.

Inspectors made a number of positive observations in their report:

• Staff in the department felt respected, supported and valued by their colleagues. They were focused on the needs of patients receiving care. There were strong examples of staff feeling able to speak up and raise concerns without fear

• Leaders in the Emergency Department demonstrated the skills and abilities to run the service. They understood and managed priorities and issues the service faced. They were supportive, caring and approachable in the service for patients and staff

• Patient interactions were seen to be caring, kind and empathetic

• The department was calm and professional, despite growing activity

• Staff understood how to protect patients from abuse and acted on any concerns. They recognised when abuse might be occurring and were trained in how to deal with their concerns to keep patients safe

• Patients had an assessment of their infection risk and other clinical risks on arrival at the department

The inspection team rated urgent and emergency care services' safe domain as 'Requires Improvement'.

Gloucestershire Hospitals NHS Trust said it recognises that, at times of peak demand, when the department is at its busiest, the quality of care is impacted, despite the very best efforts of teams.

The Trust has been continually assessing and making changes to the way EDs are run and a number of measures have already been introduced which have had a positive impact. These include:

• Eliminating corridor care within the ED by creating more space in the department

• Improving ambulance drop-off times by establishing additional drop-off points

• Seeing walk-in patients more rapidly

• Ensuring patients are seen by the most appropriate doctor first time, bypassing ED if appropriate

The impact of these measures is making a difference. In March, the Trust recorded 50 occasions when patients had to wait in a corridor for 30 minutes or more, whilst there have been no such waits so far in June.

Similarly, the average wait of a patient on an ambulance in March was 63 minutes, which reduced to 18 minutes in May. On average, patients in March waited 30 minutes to be triaged after arrival, but in the latest month, this was down to 19 minutes.

Professor Mark Pietroni, director of safety and medical director, said: "Given the momentous challenges we've faced over the last year in response to the pandemic, it's right to recognise that Gloucestershire Royal has maintained its good rating overall. That's a real credit to the incredible effort put in by our staff in the last year. They've gone through so much to deliver patient care in quite extraordinary circumstances.

"It's important that we don't lose sight either of the successes we've had, particularly in delivering cancer surgery to our patients throughout the pandemic. We are confident that the way we worked in these last 15 months has saved lives, but are no less committed to ensuring we respond to the issues raised by the CQC."

Rob Stacey, emergency medicine consultant and speciality director, said: "While we are disappointed that the CQC rated urgent and emergency care services as requiring improvement, given the efforts of all staff, we are absolutely committed to turning this around for our patients.

"We've already introduced a number of measures that have had a positive impact. For example, we've eliminated corridor care in the department by expanding the footprint of ED, which we did by relocating another service.

"I'm very proud of everyone I work with in these services, who despite the year they've had, work tirelessly to deliver the very best care".

Professor Pietroni added: "We are absolutely determined to get this right and improve care for our patients in urgent and emergency care."

GRH image credit: Google Street View 2018