Service Requiring Significant Improvement designation lifted at Ysbyty Glan Clwyd

The emergency department at Ysbyty Glan Clwyd has been deescalated as a Service Requiring Significant Improvement (SRSI) following a Healthcare Inspectorate Wales inspection.

The unit was designated as an SRSI in May 2022 following a damning report which identified “risks to patients” and concerns that Betsi Cadwaladr University Health Board did not have adequate arrangements to support the delivery of safe healthcare in the department.

The inspection in May was undertaken to follow up significant concerns identified during a previous quality check in March 2022.

The May 2022 inspection also identified several additional areas of concern relating to patient safety around the effectiveness of arrangements for assessing, monitoring, observing, and escalating unwell or deteriorating patients.

A follow-up inspection then took place in November 2022, which noted only minimal improvement, therefore the designation remained in place.

Marked improvement

The most recent inspection took place over three consecutive days in April and May 2024 when inspectors found a marked improvement within the areas of significant concern identified in 2022.

These areas included the timely escalation of patients with critical and high-risk conditions and strengthened oversight of the waiting area compared to previous inspections.

Overall, inspectors highlighted an improved culture, an increasing in staffing levels and stronger leadership.

As a result of these improvements, HIW has decided to de-escalate the department as a SRSI.

However, several areas of concern remain including excessive waiting times, issues with medication management, and insufficient checks of life-saving equipment.

Inspectors have also expressed concern that pressure and demand within the department was leading to an increased risk to patients.

Poor patient flow

A key issue they identified was poor patient flow throughout the hospital. Patient flow is the movement of patients through a healthcare system from the point of admission to the point of discharge.

We noted that oversight of the unit’s waiting room had improved with patient emergencies escalated and well managed. Overall, the department was clean and tidy, with robust infection prevention and control measures in place; and general health and safety risks assessed.

Patients were waiting roughly four hours for treatment within the department, with just under a quarter of patients waiting over twelve hours before being seen.

Inspectors found that one patient was not seen by a doctor for over 10 hours with a suspected neck of femur fracture, and no record of pain relief. Some patients also complained they had waited up to 48 hours and had not been informed or updated on their care and treatment plans.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said: ‘The pressure and demand on healthcare services continues to create significant challenges for the NHS.

“During this inspection we found staff working extremely hard in challenging conditions to provide patients with safe and effective care. It is reassuring to see improvements have been made since our previous inspections of the department, but further improvement is still needed.

“I hope this report will provide the health board with a clear understanding of the challenges being faced by the service and support the action they need to improve. We will be working with the health board to ensure these improvements are made and evidenced.”

Carol Shillabeer, Chief Executive of Betsi Cadwaladr University Health Board said: “I want to thank all staff involved in helping to improve Emergency Department services within Glan Clwyd Hospital, and particularly the staff in the department for their dedication to continuous improvement, while working under constant pressure.

“Whilst clearly there are still issues that need to be addressed, we are all committed to provide the very best care and experience possible.

“Our Emergency Departments are always extremely busy and we are looking at ways to provide services differently to help improve the waiting times and people’s experience of healthcare services. This report shows that tangible and positive difference is being made, whilst indicating the further improvements we are totally committed to taking forward.”