Health inspectors have expressed concern that “many patients” at a Scottish hospital “do not appear to be well cared for”, with a shocking report recounting how they saw the accident and emergency department operating at 230% capacity.
Healthcare Improvement Scotland (HIS) visited Forth Valley Royal Hospital in Larbert, near Falkirk, with its report describing “extreme pressures” on services there.
The inspectors made it clear: “In some areas, including the emergency department and admitting units, many patients did not appear to be well cared for.”
Inspectors saw patients being treated on chairs, with intravenous drips that had “dried up”, while one person had to wait 25 hours before finding a spot on a ward.
Hospital staff were seen to be “tearful” and “seemed concerned that they would not be able to provide safe and dignified care for patients due to overcrowding.”
HIS staff had already made two visits to the Forth Valley Royal Hospital in April, before conducting an unannounced follow-up inspection in September, which they said “raised further serious concerns about the safety and quality of care in the Forth Valley Royal Hospital”.
Inspectors have raised these concerns with both the NHS Forth Valley and the Scottish government.
Their report on care at the hospital recounted how the emergency department was under “extreme pressure” with “occupancy within the emergency department reaching 230% at points throughout the day.”
He stated: “This meant an increase of 130% more patients in the department than it was designed to accommodate.
“The longest wait time for patients waiting to be transferred to ward areas was 25 hours.”
Meanwhile, ambulance crews were forced to wait to transfer patients to the hospital “due to a lack of physical space or staff capacity to take care of these patients.”
The inspectors said: “We observed staff working under extreme pressure which affected staff and patients receiving care.”
In the emergency department and other areas, inspectors found that “many patients were being cared for in areas with chairs in hallways and within departments.”
The report stated: “Some patients told us that they had been in non-reclining upright chairs in the waiting area overnight.
“In one case, a patient described having been in a chair for at least 16 hours and had been given no information about when he would be transferred to a ward or bed area.”
The report highlighted how patients treated in chairs were not always “easily visible to staff”, with inspectors revealing: “In these areas we observed patients with IV infusions that had dried up.
“Another patient, who was in a chair and using oxygen therapy, had an empty oxygen canister and inspectors had to alert staff to this.”
The inspectors also recounted how they were “accosted by patients in the emergency department and admitting units who were struggling to access pain relief medications or not receiving their scheduled medications at the correct time slots.”
Meanwhile, some patients were being treated in “contingency beds,” allowing a fifth patient to be placed in a space designed for just four beds.
But since staff can’t always put screens around these beds when providing emergency care, the report explains how hospital workers had to “help other patients out of the room to maintain people’s privacy and dignity.” receiving emergency care.
The report went on to detail “unsafe practices” regarding medications, saying that inspectors had seen staff from one unit prepare intravenous medications, before handing them over to staff from another unit to administer, and this was done “without the staff to verify if it was the correct medication, the correct dosage, or the correct patient receiving the medication.”
In some areas of the wards, inspectors said, “we observed unlocked and unattended medicine cabinets.”
The inspectors said that “during this incredibly busy time in the emergency department and admitting areas, we did not see support from senior management within these departments.”
The report was clear: “Senior managers were not visible in the departments during the inspection and staff also described a lack of support from senior management.”
HIS has now issued another 11 requirements for the improvement at Forth Valley Hospital, after making nine requirements earlier this year.
Donna Maclean, Head of Service at HIS, said: “At the time of our follow-up inspection, NHS Scotland was still experiencing a variety of pressures, including rising hospital admissions and reduced staff availability.
“We observed that the Forth Valley Royal Hospital experienced extreme pressures due to increasing patient numbers, late discharges and high levels of staff absence.
“This report highlights our concerns about the limited improvement and, in some cases, a deterioration in the safe delivery of care since our April 2022 inspection.
“This resulted in us formally raising our concerns to the Scottish Government in accordance with our escalation process.”
Ms Maclean added: “Many of our concerns were directly related to the safe delivery of care, particularly in the emergency department and admission units where many patients did not appear to be well cared for.”
Cathie Cowan, chief executive of NHS Forth Valley, said: “I would like to apologize to those patients whose care and treatment did not meet the high standards we claim to provide.
“The report highlights a number of serious issues and immediate steps were taken after the visit to quickly respond to concerns raised by inspectors.
“We recognize that there is still work to be done, and we are committed to fully addressing all of the report’s recommendations and working with the Assurance Board established by the Scottish Government to drive the necessary changes and improvements across the organisation.
“Local staff continue to provide high standards of clinical care and treatment in very difficult circumstances, and I want to thank them for their hard work and commitment.”