Cumberland Infirmary emergency care remains requires improvement as safety rating falls

Urgent and emergency care at Cumberland Infirmary has again been rated requires improvement after inspectors identified concerns around patient safety, overcrowding, staffing and the environment in which people were being treated.

The Care Quality Commission inspected the service, which is run by North Cumbria Integrated Care NHS Foundation Trust, during February and March as part of its winter pressures programme. While the overall rating remains requires improvement, the rating for safety has fallen from requires improvement to inadequate and caring has declined from good to requires improvement. Effective, responsive and well-led remain rated requires improvement.

Following the inspection, the CQC issued the trust with a warning notice after identifying significant concerns about the safe care and treatment of people using the emergency department. The trust was required to make immediate improvements, while an additional condition was imposed requiring it to keep the regulator informed about changes being made within the department.

Inspectors found that some concerns raised during the previous inspection had still not been resolved. The system intended to direct people to appropriate services after they arrived at A&E was not working effectively, resulting in more patients waiting within the department than staff had the capacity to manage.

Long waits and the way patients were monitored were among the concerns raised. Inspectors found people could remain on chairs and trolleys for extended periods because of a shortage of beds and treatment areas, while monitoring was not always sufficient for patients whose condition could deteriorate or those requiring support for their mental health.

A shortage of cubicles meant some patients were being cared for in temporary escalation areas. These spaces did not always have call bells and did not provide adequate privacy and dignity. Nurses were also unable to continuously observe the areas, creating a risk that changes in a patient’s condition might not be identified and responded to quickly.

The physical condition of parts of the department also concerned inspectors. Some areas appeared visibly dusty or unclean, while resuscitation bays and temporary treatment spaces were cluttered with equipment, making them more difficult to clean effectively. Staff were also not consistently following appropriate hand hygiene practices.

Other concerns included patients not always having individualised care plans to support their ongoing needs and a significant backlog of incidents awaiting review or investigation. Inspectors also found the paediatric area did not have its own toilet, baby-changing facilities or a dedicated space for breastfeeding.

The inspection resulted in breaches of regulations relating to safe care and treatment, staffing, premises and equipment and the management of the service.

Despite the problems identified, inspectors found staff were kind and working hard to care for patients while operating under considerable pressure. They also highlighted examples of effective multidisciplinary working, including physiotherapists helping people return home safely with appropriate equipment and community support, reducing the likelihood of them needing to return to hospital.

Roger James, CQC director of operations in the north-east, said leaders needed to manage the risks within the department more effectively, particularly during periods of high demand. He said the regulator had made clear where rapid and sustained improvements were required and would continue monitoring the service closely.

The findings leave urgent and emergency care at Cumberland Infirmary rated requires improvement overall, but the deterioration in its safety rating and the warning notice issued following the inspection mean the trust is now expected to demonstrate that immediate action is being taken to address the risks identified.

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