Healthcare Inspectorate Wales (HIW) has published a report today setting out the need for urgent improvements in the emergency department at Grange Hospital in Cwmbran.

An inspection by HIW noted that Aneurin Bevan University Health Board did not have adequate arrangements in place at the department to ensure safe healthcare was provided.

HIW completed an unannounced inspection of the emergency department on three subsequent days in August this year. During the on-site inspection, HIW inspectors were not assured that the processes and systems in place were adequate to ensure that the patients consistently received acceptable quality care.

The inspection team identified a number of issues that require immediate reassurance and those issues are addressed in the report. They include the risk of cross-contamination in an area referred to as the ‘COVID corridor’, the fact that resuscitation equipment was not inspected daily, that we found outdated medications and a lack of safety in relation to substances that could be harmful to the patients – including medication and prescription pads.

Inspectors observed staff who were trying to provide safe and effective quality care to the patients, within a challenging and busy unit. The patients told inspectors they were pleased with the way staff interacted with them, praising the dedication of the staff and the care provided. Many of the patients were critical about the department’s wait times.

Comments from staff showed that they were not always able to provide care to the standard they wanted to meet due to the increasing pressure and demand on the department. Our findings indicated that management and leadership were good, with staff stating that they felt supported. There were managers to be found in the department, including the nurse in charge who was easy to identify and approach.

A number of improvements were needed to ensure that dignified and timely care could be provided to the patients. This includes work into the physical environment of the waiting room to ensure it is fit for purpose. The area is very small and cramped, and during the inspection, some of the patients had been waiting on uncomfortable chairs, and in the back of ambulances, for over 15 hours. Until the flow of patients into and through the department can be improved, the health board will struggle to address a number of our concerns.

In addition to the areas where immediate action is needed to keep patients safe, HIW has urged the health board to carefully consider all the findings of this report and to take steps to reduce the potential of significant harm to patients and implement all improvements.

HIW Chief Executive Alun Jones said: ‘The findings of our inspection are of significant concern and we have urged the health board to take steps to improve the processes and systems in place in the emergency department to ensure patients receive safe, timely and effective care. I hope that this report will accelerate the steps taken to drive timely improvements. We will work closely with the health board to ensure that sound improvements are made and that those improvements are evidenced.’

Aneurin Bevan health board said it welcomed the findings.

Responding to the Healthcare Inspectorate Wales report that found “urgent improvement” was needed in the Grange Hospital’s emergency department, Peter Fox MS said:“Whilst I appreciate all sectors – including our NHS – are under significant pressure post-pandemic, this report is damning in so many ways.

“The most concerning part is the report’s judgement that processes and systems were not sufficient in ensuring patients consistently received an acceptable standard of care.

“I have been calling for changes at the Grange for many months, following correspondence with anxious constituents, and I’m pleased that the inspectorate has identified the short comings that so many of us are concerned with.

“After all, patients and families expect nothing less than basic principles of care and safety when in hospital – which sadly appear to be lacking in this sad case.

“What is crucial is that the health board and Welsh Government ministers work around the clock to introduce robust measures to address these very serious issues.”

In response to the HIW report, Welsh government said it was “providing an additional £25m this year to transform urgent and emergency care services across Wales, with Aneurin Bevan UHB receiving £3m”.

In a statement it added that it had “provided an additional £260k to the health board for improvements to its emergency department waiting areas this winter”.

Welsh Secretary David Davies, who has previously called for an investigation into issues at The Grange said, “I fully accept there are mounting pressures on the NHS across Wales, but the problem seems particularly acute in Gwent where patient complaints at The Grange continue to mount,” said Monmouth MP and Welsh Secretary David TC Davies.

He added: “We are being let down by those in charge who are pretending the current situation is acceptable when it is clearly not.”