Our response to HIW's report on ED

Our Emergency Department is under the spotlight once again following the publication of a report today, Wednesday March 5th, on an unannounced inspection that took place over three days in November.

Unsurprisingly Healthcare Inspectorate Wales (HIW) found a department under extreme pressure, noting that long waiting times and overcrowding were creating patient safety risks and affecting the delivery of care. Concerns over staffing levels were also highlighted in the report.

Go to the HIW website for the full report.

Our response

The HIW report is a fair and balanced review of an Emergency Department (ED) working under extreme pressure. We are pleased it acknowledges that despite the extremely challenging conditions, our staff treat patients politely and in a professional and dignified manner.

However, there is no doubt that we share HIW’s concerns about delays and overcrowding and the impact this has on patient care. This is why improving urgent and emergency care, particularly in regards to the ED, is one of our top priorities.

We are tackling this challenge on three fronts. This involves looking at staffing levels, the building itself and also the ways that we work across the health board in order to provide patients with the right care in the right place.

Patients are at the heart of this work and we have already submitted a detailed action plan which has been accepted by HIW, and many of these measures have already been completed or are due to be shortly. But while these steps will help, we know that they are not the full answer to managing the ongoing and sustained pressures that our ED – like many others – is facing.

There are concerns over whether we have enough of and the right balance of staff in ED to meet the current demand and the needs of our patients. Our Director of Nursing has therefore commissioned a baseline assessment of our workforce so that we can understand the current position and identify any changes which need to be made and how we can make these happen at pace.

Our existing department is too small and badly designed by modern-day standards. We are talking to Welsh Government about both short-term and long-term capital investment.

We hope to have a temporary measure in place very soon which will give the ED some much needed breathing space to reduce overcrowding. This is likely to be a modular building located next to the department. Proposals are also being developed for a purpose-built new facility in the future – subject to planning permission and funding being agreed.

We are liaising with Swansea Council over the pre-application consultation for planning consent for the longer term plans. As part of this, information boards will shortly be erected at Morriston Hospital giving patients, the public and our staff more details.

In the meantime, a great deal of work is ongoing across all of our services, which is key to reducing pressure on the ED.

We know that home is best for care and recovery and also where most people want to be. So we are continuing to strengthen services in the community, delivering some of the things traditionally done in hospital, to order to keep patients at home for as long as possible.

If patients need to come to hospital, we work closely with GPs and the Welsh Ambulance Service to make sure they are seen in the right place to meet their needs, which may not be the ED. Our Older Persons Assessment Unit (OPAU) is a great example of this and we are pleased HIW noted this improvement as a step in the right direction.

We have also strengthened our ability to offer same-day care so patients can be seen and return home.

For those who have been admitted, we are working even more closely with our partners in local authorities and the voluntary sector to identify and reduce discharge delays. This helps us to free up beds for those patients who are waiting.

We continue to listen to staff and patient concerns about our ED and their feedback is helping us to shape this ongoing improvement work.