CQC publishes damning report into Noble's ED

"Toxic, bullying, blame culture, low training levels and 'insufficient numbers to ensure safe care"  - they're just some of the words and comments used to describe Noble Hospital's Emergency Department.

It comes as the Care Quality Commission has published its report after spending four days at Noble's in June earlier this year.

Ultimately, the CQC asked five questions about the department - Is it safe? Is it effective? Is it caring? Is it responsive to people's needs and is it well-led?

The assessment was one of a number of visits the CQC will complete - as requested by the Island's Department of Health and Social Care - the visit was announced and staff knew the CQC was coming.

Some of the comments made by the CQC include:

• Mandatory training levels were low, including life support training.
• No staff had undertaken safeguarding adults and children training to the appropriate level, 'inconsistent messages' and 'staff did not always have the skills to identify or action a safeguarding concern.'
• Inconsistent processes to ensure cleaning or maintenance
• Substances which could cause harm to patients were not stored securely.
• Insufficient numbers of staff to ensure safe care and effective management of patients.
• Records not always stored securely.
• Reporting was discouraged and there appeared to be a 'blame culture' in the department.
• Consent policy out of date and needs reviewing.

However, one area of concern, which the CQC says it has escalated to the Department of Health and Social Care was Culture:

"The culture within the department was of significant concern. We found lack of support for staff health and wellbeing, relationships were “toxic” and there was a bullying and blame culture."

Further, leadership has also been escalated to the DHSC:

"At the time of our onsite visit we had concerns around skills, attitudes and behaviours of both medical and nursing leadership teams. There was a significant disconnect between the nursing and medical staffing in the department which could have the potential to cause or contribute to patient harm."

Ultimately - in four of five areas, the CQC found the service was not meeting expectations.

Notably, problems around the storage of medication were highlighted - the quality dashboard showed there had been three medicine errors which resulted in moderate or severe harm or death between December 2021 - April 2022.

A further 17 medicine errors involving high risk medication (Including insulin, sedatives, anticoagulants or opiates) were also flagged.

Further, investigators said staff did not always wash their hands or use alcohol gel before or after providing care and treatment to patients , it adds they saw one staff member wearing nail varnish and a number of staff wearing rings with gemstones which is not recommended to prevent the spread of infection.

In regards to nutrition and hydration Investigators noted staff could not evidence that they gave patients enough food and drink to meet their needs and improve their health:

"During our visit, we saw staff providing patients with food and drinks if they were experiencing long waits in the department. However, we did not see this documented in patient care records and comfort rounds did not take place."

One area praised, was care - the CQC said staff treated patients with compassion and kindness:

"Some staff spoke passionately about wanting to make a difference for patients and their families. They explained that the wanted to care for people in the same way they would want their own families to be cared for."

You can find the full report here.