Government inspectors say they have some 'significant concerns' over emergency care at Doncaster Royal Infirmary.
Inspectors from the Care Quality Commission were concerned the emergency department did not always have enough doctors or nursing staff of the right level to keep patients safe from avoidable harm.
They have rated the Doncaster and Bassetlaw Teaching Hospitals trust as 'requires improvement', following an inspection this winter, although it was rated good for being well-led, caring and responsiveness.
Since the last inspection in 2015, the Trust has made a number of improvements, highlighted within the report.
Read more: Hospital told it must improve after latest inspection
But the CQC identified 19 areas where the trust must take action to meet its legal requirements.
The Chief Inspector of Hospitals, Prof Ted Baker, said: “Since we last inspected, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust there has clearly been improvement in some areas.
“However it is disappointing that some significant concerns remain, particularly in emergency care where we found the service did not always have enough doctors or nursing staff of the right level to keep patients safe from avoidable harm.
“We found the ambulance handover bays and the overflow areas were cramped and did not provide confidentiality or dignity for patients, who were being nursed in close proximity to each other in an open area.
“I note that since our previous inspection, the trust has appointed a new Chair and Chief Executive who, together with other executive team members, have made efforts to improve services- but we do need to see further progress and improvements embedded.
“We will return in due course to monitor and check that these significant improvements have been made.”
Inspectors found there was limited assurance about safety, especially within the urgent and emergency care services at Doncaster Royal Infirmary and Bassetlaw Hospital.
They identified the need to improve triaging and initial assessment of patients in both emergency departments. Patients were still not receiving a timely assessment. There were extended waits for patients who walked into the department and those who arrived by ambulance which were a potential risk to patient safety.
Although staffing in the emergency departments had increased since the last inspection, neither department was meeting national guidance for the levels of consultant or paediatric trained nursing staff. The hospital says recruitment is a national problem.
On medical wards, all areas visited were clean and well-maintained and staff practised safe infection control techniques. Staff assessed patients for risk of deterioration and escalated their care when necessary. There were safe medical and nurse staffing levels in place and staff said they were supported to develop professionally.
In maternity, the service was not meeting their target of 90% for women receiving one to one care in labour. Doctors and midwives were not up to date with mandatory training or appraisals. Some staff said morale was low.
In services for children and young people, staff cared for patients with kindness and compassion, ensuring they involved patients and their families. But there were significant gaps in the medical staffing.
The trust says steps have since been taken to improve ‘booking-in’ arrangements to reduce queues, in addition to improving staffing levels. An innovative system called ‘Smart-ER’ has recently been implemented which makes diagnosis much more efficient, and the inspection was during a period of increasing winter pressures and attendance.
Overall, 72 per cent of the services inspected at Doncaster Royal Infirmary were judged to be ‘good’ with no service rated ‘Inadequate’.
Mr Sewa Singh, Medical Director at DBTH, said: “On behalf of the Trust, I welcome the CQC’s scrutiny of our services and we are pleased that they have recognised good practice and the fantastic work which takes place here. We also recognise that there are areas where we could improve further and have started work to deliver this.
“Our patients told inspectors that members of Team DBTH are caring, compassionate and communicate well. Importantly, those staying with us expressed a feeling of safety as well as involvement within their care and treatment, and this is very important to us as an organisation.”
“We accept the recommendations from the CQC, and, with the creation of a detailed action plan, we will be taking the required steps to make further improvements to our service as well as address the issues highlighted by the inspection teams. I would also like to express my thanks to our staff who work tirelessly each and every day caring for patients.”
“Over the past number of years, the trust has been on an improvement journey. The next 12 months will bring with it another set of challenges, and it’s paramount that, as an organisation, we remain focused upon our goals, ensuring that our patients remain at the centre of all we do, that our staff remain focused on continuous improvement and that as an organisation we make the best use of public money. We have a fantastic team at DBTH and I believe we will only continue to make good progress to become an outstanding organisation.”