Derriford Hospital

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• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

We reviewed the equity in access quality statement for the responsive key question. The main problem was with crowding and limited capacity. The whole hospital was exceptionally busy and had declared an internal critical incident. Although policies and procedures were available to staff to help them respond to the continued increased attendance in the department, patients were not admitted, triaged or treated quickly to ensure they received care in the right place at the right time. The high numbers of patients attending the department put increased pressure on staff. The service maintained up to date policies and processes for patients requiring reasonable adjustments.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Person-centred Care during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Care provision, Integration and continuity during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Providing Information during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Listening to and involving people during this assessment. The score for this quality statement is based on the previous rating for Responsive.

Some patients told us they experienced long waits accessing care on ambulances or in the ambulatory waiting room. One patient said they had been there for 24 hours and was waiting to be admitted. However, other patients told us they were seen relatively quickly. One patient told us they had a good experience, staff were great and pain medicine was given quickly. While some patients said communication about their care was good, others said they were not kept informed. One patient did not feel in control of planning their care and said they did not know what was happening.

Staff told us that every department was full and patients had long waits to be treated. The department was very busy and there were delays for onward transfer of patients to wards. Staff told us they could access advice from specialist teams to support people with a learning disability and autistic people. Staff told us there was a dedicated nurse for people with mental health needs and support could be slow when required. Staff told us end of life patients were supported in the department by palliative care staff. They supported patient discharges to the right locations.

Accessibility to services was not timely. Data showed waits on ambulances of up to 24 hours and wait for triage in ED was 1 to 1.5 hours. This was outside of the NHS England Guidance for Emergency Departments Initial Assessment of within 15 minutes of arrival. The department was not providing treatment when people needed it. There was an Escalation Policy to respond to increased pressures. However, due to continued challenges with the number of attendances and flow through the department it was not always possible to ensure patients received timely assessment or treatment. Streaming of patients was limited. Following triage, some patients were streamed to the emergency department GP hub. However, this was limited to 8am to 5pm daily and the GP hub premises was not accessible for people using wheelchairs. The service maintained up to date policies and processes for patients requiring reasonable adjustments. For example, Interpreting and Translation Policy to ensure the service was accessible for patients with communication needs; Mental Health Escalation Policy and Procedures for supporting people with mental health needs; Learning Disability & Autism Policy for equality of access to services for people with learning disabilities or people who were autistic. There was a clear process for staff to arrange interpreters or translators for patients requiring communication needs.

We did not look at Equity in experiences and outcomes during this assessment. The score for this quality statement is based on the previous rating for Responsive.

We did not look at Planning for the future during this assessment. The score for this quality statement is based on the previous rating for Responsive.