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Five months to act

Serious patient safety and staff morale issues have been highlighted in the emergency department at an acute hospital.

Both consultants and junior doctors at Cumberland Infirmary have reported bullying and harassment, with senior clinicians claiming they were pressured by senior management to move patients inappropriately.

Consultants also told the Royal College of Emergency Medicine they were working in an environment that prioritised the 12-hour target for trolley-waits in emergency departments ahead of other aspects of quality and safety.

Junior doctors have also raised serious enough concerns that North Cumbria Integrated Care Foundation Trust itself believes it will soon be back under enhanced monitoring of its training by the General Medical Council.

A total of 12 new doctors have told Health Education England they had either seen or been subjected to bullying and harassment, that night cover was also down, and handovers “chaotic”.

The GMC is now considering whether to put the trust under enhanced monitoring.

The organisation — which has seen apparent improvements in quality in recent years, emerging from care quality “special measures” — said it was taking steps to improve upon the issues raised by the junior and senior clinicians.

But it faces a race against time to make the changes, or risk consequences such as the GMC taking its trainees away. The trust’s medical director says there is “less than five months to act” on the concerns raised by HEE and the juniors.

More than a technicality

HSJ has revealed a warning in a Department of Health and Social Care report — momentarily published before being taken down — that clinical commissioning groups were not meeting their requirements under section 140 of the Mental Health Act. 

This piece of legislation requires a CCG to give local authorities a list of hospitals to which a person can be admitted “in special urgency”, and to also have a joint plan in place.

The report was not the first time HSJ had heard this was an issue, but it marks a significant acknowledgement from the DHSC that commissioners are not doing what they legally should be. 

And falling foul of the law represents far more than a technicality. When section 140 isn’t adhered to, people who need to be admitted may not be because mental health professionals are not aware of available beds they can use. 

This issue was mentioned in another report from the Care Quality Commission, published on Thursday, which revealed at least seven patients died after being assessed as needing admission but were not admitted due to a lack of available beds.

The CQC’s report, published annually, has investigated the wider use of the Mental Health Act across all providers. Although improving, provider and staff’s appropriate use of the act is still below where it should be. It seems not just commissioners are struggling with the legislation.