This report provides the Health, Care and Wellbeing Scrutiny Committee with the background and findings of the Care Quality Commission’s (CQC) inspection of Wye Valley NHS Trust: The County Hospital.

The committee considered a report on the background and findings of the Care Quality Commission’s (CQC) inspection of Wye Valley NHS Trust (WVT), The County Hospital: Link to the inspection report.

The slide pack was published as part of agenda: Link to the presentation 'Care Quality Commission Inspection: Emergency Department'.  The slides presented by WVT representatives are outlined below (in italics), with summaries of the responses provided to the key lines of questioning by the committee.

A       The Managing Director (WVT) introduced the presentation and welcomed the opportunity to update the committee on progress since the publication of the inspection report.  The committee was advised that: emergency demand had increased nationally since the Covid pandemic; the principal issue for the County Hospital was congestion in the Emergency Department (ED), this being the result of increased demand, discharge delay, and prioritisation given to offloading ambulances; and recent data (29 July 2024) showed the ED as being in the top quartile of performance nationally on ‘time to treatment’, and mortality indices were below the national average.

B       The Chief Transformation and Delivery Officer (WVT) presented:

Emergency Department: Overview

b.1     Clarifications were provided about attendance types and conveyances.

Emergency Department: Care Groups

b.2     Questions were asked about the inconsistent use of colours in the graphs.

b.3     It was noted that the slide pack had been updated following the postponement of the 28 May 2024 meeting, Link to the original presentation.

Minors by Herefordshire PCN (Primary Care Network)

b.4     It was considered unlikely that the ambulance service would dispatch a crew to attend a minor injury or illness; a ‘hear and treat’ approach triaged and directed callers to self-care, pharmacy or other services.  Examples were provided of scenarios where crews would respond but which might not result in conveyances to hospital, by providing care on-scene or through the deployment of different health resources.

b.5     The committee was advised that people with complex needs were driving the pressures in the ED, rather than those with minor injuries and illnesses; over 90% of minors were treated and discharged within four hours.

Emergency Department: Acuity

Emergency Department: Performance

Discharge Delays

b.6     It was reported that: a dashboard was being developed to combine health and social care data; there were significant discharge problems relating to Powys; and the Community Wellbeing Directorate was working jointly with WVT to reduce pressures in Herefordshire.

Acute Bed Occupancy

C       Chief Nursing Officer (WVT) presented:

Care Quality Commission

c.1    An overview was provided of the roles and background of the inspection team and their advisors.

CQC findings requiring urgent attention

c.2     The Chairperson outlined a personal experience involving triage at reception.  The Chief Nursing Officer explained that, given congestion and the findings of the inspection, the ED had returned to nurse led triage and risk assessment.

CQC safety summit – Friday 8^th December

ED Dashboard

c.3     It was reported that the dashboard provided the nurse in charge with a ‘helicopter view’ of the whole department to help manage risks  ...  view the full minutes text for item 7

This report provides the Health, Care and Wellbeing Scrutiny Committee with the background and findings of the Care Quality Commission’s (CQC) inspection of Wye Valley NHS Trust: The County Hospital.