ENGLAND'S chief inspector of hospitals has issued a damning verdict on emergency services at Russells Hall Hospital in Dudley.

The Dudley Group NHS Foundation Trust, which runs the borough's main hospital, has been given another 'requires improvement' rating after an inspection by the Care Quality Commission - just over three years after the care watchdog ordered improvements following the last review.

Inspectors rated the trust as 'requiring improvement' in the category assessing whether services were safe, effective, responsive and well-led - although the care provided by staffed was judged to be 'good' in the category assessing whether services were caring.

But Professor Ted Baker, chief inspector of hospitals, said: "Our inspectors were disappointed that several ratings at The Dudley Group NHS Foundation Trust had declined since we last inspected.

"Our main concerns were with what we found in the urgent and emergency services, which we rated as inadequate overall."

Dudley News: Russells Hall Hospital topped NHS England's national A&E Attendances and Emergency Admissions ‘league table’ for October with 98.9 per cent of patients being dealt with within four hours

He said triage processes were" inconsistent and not exercised in line with the trust policy or national guidelines" and added: "Patients attending the emergency department did not always receive robust and sufficient assessment of their clinical presentation and condition."

This, he said, "posed a significant risk that life-threatening conditions would not be identified and treated as quickly as they should have been".

He continued: "The culture within the emergency department was not open and senior staff did not recognise significant areas of risk and potential harm to patients. Governance systems were not robust and did not ensure safe and effective care was being delivered.

"The trust as a whole also needs to ensure appropriate staffing levels are maintained and to keep bank and agency staff cover to a minimum."

Inspectors did, however, observe areas of good practice and "found patients were treated with kindness, dignity and respect across the trust" and he added: "Patient dignity and comfort was a priority and we saw this attitude reflected in the staff working across the trust. This is why we rated the trust as 'good' in the caring domain overall."

He added: "The trust leadership knows what it needs to do to bring about the necessary improvements and we will return to check on progress."

Dudley Group chief executive Diane Wake, pictured below, said it was "disappointing" the trust's rating remains at 'requires improvement'.

Dudley News:

She said: "We are particularly disappointed that our emergency department has been rated inadequate especially given how hard our staff have worked in very challenging times.

"We absolutely recognise there is work to do to ensure our services are the best they can be for our patients and we are supporting our staff to make the improvements we need to ensure safe, effective, responsive and well-led services.

"Our emergency department has an improvement plan in place which will support the staff to deliver the safe quality care they all aspire too. One of the key areas for improvement highlighted was the need to ensure patients in the department are triaged in a timely manner and that staff do this consistently and in line with the guidance.

"We have taken immediate actions with our emergency department to ensure patients are safe in our care including additional training in triage processes for all staff, extra support for our resus team in the department and daily audits of the care of deteriorating patients to make sure changes are maintained.

"The CQC also had concerns about the use of temporary staffing to fill gaps in our staffing establishment. This is an issue we are working hard to address and have had success in our recruitment and retention drive over the last 12 months as we strive to recruit our own staff."

She said it was "pleasing", however, that inspectors had judged services to be caring and care rated as good and she added: "We are very proud of our community services whose overall rating was good and the team found examples of outstanding practice. In particular the innovative multi-disciplinary working to provide good care to patients. Compassionate care was obvious to the team and the feedback from patients confirmed this."

She said she was also pleased with improvements in maternity services which have been rated as good overall and that medical care including how the trust cares for older people remains good and she said the trust's stroke service was "one of the best in the region".

She added: "Our staff are committed to making all of the improvements necessary on our journey to become outstanding.

"The inspectors could see there had been improvements in the incident reporting process since their last inspection and that staff could demonstrate learning. They also received excellent feedback about how the team have tailored services to meet the needs of individuals and processes in place to keep patients safe."

The latest report can be read in full online at http://www.cqc.org.uk/provider/RNA.

CQC inspectors carried out the inspection at Russells Hall Hospital and its community adult services, including sexual health services, between December 5 2017 and January 18 2018.

The inspection came three years after the CQC gave the trust a 'requires improvement' rating after a comprehensive inspection off the back of the Sir Bruce Keogh review in 2013.