Wigan hospital downgraded over emergency care safety concerns

Royal Albert Edward Infirmary in Wigan has been downgraded from good to requires improvement after inspectors found long waits, unsafe staffing levels and failures in emergency care.

The Care Quality Commission carried out an unannounced inspection in May following concerns about emerging risks. Both urgent and emergency care and medical care were downgraded, changing the hospital’s overall rating to requires improvement.

More than 900 people had spent over 12 hours in the emergency department during the month before the inspection. The trust was among the worst performers in England for the proportion of patients remaining in the department beyond 12 hours.

Inspectors found the waiting room was frequently overcrowded and being used by people with widely different needs, including patients in mental health crisis, people receiving intravenous fluids and somebody accompanied by police.

The CQC issued a warning notice covering the hospital’s triage system, its identification and treatment of sepsis and the arrangements for adults and children experiencing mental health emergencies. In two suspected sepsis cases, required follow-up actions remained incomplete more than 18 hours later, despite national guidance stating that they should be undertaken within one hour.

Staffing also remained a significant concern. The emergency department had ten consultants in post, compared with the 18 to 25 recommended in national guidance, despite the CQC previously telling leaders that more consultants were needed.

Medical wards were using temporary escalation areas, including corridor care, to manage demand. Inspectors found that staff did not always understand which patients could be placed in these spaces, creating risks for people with greater clinical or privacy needs. Some patients were also moved repeatedly between wards and did not always receive specialist care promptly.

Despite the concerns, patients described staff as kind and compassionate. Inspectors also recognised improving morale, faster initial triage and better ambulance handovers.

The CQC found regulatory breaches involving safe care, staffing, infection control, the hospital environment and management. It has ordered Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust to make rapid improvements and will continue monitoring the service.

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