Glan Clwyd Hospital: No major improvement at troubled A&E - report

A third inspection in a year failed to find any major improvements at a north Wales hospital's emergency department.

Staff at Glan Clwyd Hospital's A&E were said to be working tirelessly to give the best care possible, but the service still requires significant improvement.

Inspectors said poor sepsis screening and triage and pain relief delays were putting patients at significant risk.

Health Minister Eluned Morgan admitted there were still "very, very serious problems" at the department.

Betsi Cadwaladr health board said progress needed to "accelerate".

Inspectors' concerns about standards in the department were classified as the most significant, with minimal improvements since their two previous visits.

The report comes a month after the health board was placed back in special measures following a damning audit report, and 11 independent board members were told to quit by the Welsh government.

Healthcare Inspectorate Wales (HIW) visited the emergency department of the hospital in Bodelwyddan, Denbighshire, in November after previous visits in March and May of 2022.

Their report again highlights an "incredibly busy department, struggling with shortages of staff, high numbers of seriously unwell patients and a lack of space to treat them".

The same could be said of emergency departments across Wales, but the fact that so little has been done to improve things since two previous visits means it remains under HIW's highest level of scrutiny.

HIW chief executive Alun Jones said: "This inspection found evidence of a department struggling to cope with the day-to-day demand of providing a safe service to patients.

"It has highlighted areas such as poor team working between the ED [emergency department] and other departments within the hospital which, in turn, is compounding nationally recognised challenges around patient flow.

"The health board will need to take strong and decisive action to tackle the issues identified in our inspection. We will continue to engage with the health board to ensure sustained action is taken in relation to our findings.

"Inspectors found the standard of patient notes had improved, however rotas were challenging as there was a heavy reliance on bank and agency staff because of recruitment and retention issues.

"While waiting times to see a doctor had improved since May, the flow of patients through the department was still extremely challenging.

"Waits to see a specialty doctor varied and inspectors found on some occasions those doctors refused to review patients waiting in the ED, leading to further delays."

HIW said it would continue to monitor the response of the health board very closely.

The health board has apologised to patients who may not have received "the level of care they deserved".

Dr Nick Lyons, executive medical director and interim deputy chief executive of Betsi Cadwaladr health board, noted improvements highlighted by inspectors but acknowledged "we still have some way to go" to improve care for all patients."

"It is true staff within the ED at Glan Clwyd Hospital have been under enormous strain for the past three years and this has increased since restrictions eased," he said.

"Attempts to attract permanent members of staff to support the ED's work continues and another recruitment open day is planned within the next few weeks.

"However, the fragility in staffing and the volume of acutely unwell people we receive each day means we remain a service requiring significant improvement.

"The vast majority of our colleagues are a credit to our organisation and we value their hard work and professionalism. We will continue to strive to make sure they feel supported by colleagues in other specialties and their hospital management teams."

Dr Lyons said he noted "with pride" inspectors' comments about the commitment of staff, and the satisfaction of the "majority of patients" with their care.

He added: "Despite the issues raised in the report inspectors acknowledged progress has been made but we know this needs to accelerate.

"Our colleagues within ED, and in other areas of the hospital, are fully focused on driving this change forward and we are pleased to see the proportion of patients moving through the department within four hours continuing to rise."

Following publication of the inspection report, Health Minister Eluned Morgan agreed there were "still very, very serious problems" at Ysbyty Glan Clwyd and its emergency department "in particular".

Answering questions in the Welsh Parliament, the minister said there had been "serious discussions" with Dr Lyons "to ask about what exactly has been put in place" to improve the situation.

"There seems to be a specific problem here with the emergency department in Ysbyty Glan Clwyd," she said.

"We've got to encourage" the department to learn from the other emergency departments within Betsi Cadwaladr health board that are "working better", the minister said.

There had been "some encouraging improvements after the previous inspection" but it was "very disappointing that many of the issues have still not been fully resolved".

Ms Morgan was answering questions from members including Vale of Clwyd Conservative MS Gareth Davies, who later urged Ms Morgan to "get a grip on the situation" and "stop passing the buck".

"Patients, along with the people of North Wales, deserve better," he added.