Tameside's standard of patient care has been savagely criticised by two independent reviews – conducted by expert bodies brought in by the hospital itself earlier this year – as well as by junior doctors within the hospital and GPs based in the Tameside and Glossop area to the east of Manchester.
Patients are forced to wait hours in a corridor before they could be taken into the accident and emergency ward, according to one set of reviews seen by the Guardian, while elsewhere Tameside's expert critics highlight a lack of doctors and nurses, and, in some instances, delays of several days before patients are seen by a consultant.
Overcrowding in A&E
Two NHS expert reviews found a scene of chaos in Tameside's A&E unit. The NHS Interim Management and Support team, who came in March, reported "a significant problem of overcrowding and delays in ambulance handovers in the Emergency Department [ED]", with a shortage of beds to blame for an inability to move patients out of the emergency department and onto wards.
The hospital has "stubbornly high" bed occupancy rates of sometimes 100%, found the North West Utilisation Management Unit (UM), which helps hospitals in Greater Manchester. Experts say hospitals should not exceed 85% capacity in order to guarantee safe care.
Although the emergency department had been extended, the Interim Management and Support team found that a nurse was accepting the handover of ambulance-borne patients from ambulance crews in the A&E unit's corridor.
"Up to eight patients at a time had recently been managed in the corridor with delays of up to two hours. Nurses ... noted that one patient had waited up to seven hours in the corridor," the review found.
Meanwhile, the North West Utilisation Management Unit (UM), discovered on its April visit that a nurse was meant to look after no more than four A&E patients, so ambulance crews had to stay in the corridor and look after any patients over that number.
Tameside's A&E was under "significant pressure" and had struggled since the last three months of 2012 to meet the NHS target of treating 95% of A&E patients within four hours of arrival.
Long waits to see a doctor
The reports refer frequently to patients waiting long periods to receive care or see a doctor – delays that in some instances lasted several hours or even several days.
Tameside and Glossop's Clinical Commissioning Group that represents local GPs found that nurses reported that "should the registrar [middle-grade doctor] be very busy over the weekend, patients transferred to the ward on a Friday night might not receive a senior review [by a consultant] until the following Tuesday", perhaps 84 or more hours later.
For example, "there were unexpected delays to clinical assessment by a doctor for medical patients, primarily GP referrals on the medical assessment and admissions unit", the North West Utilisation Management Unit added. That was a key area requiring urgent improvement, it recommended.
Their review of the case notes of six medical patients and one surgical patient found that they faced "apparent lengthy waits for speciality and consultant review" of up to 12 hours and 40 minutes after arriving on the medical assessment and admissions unit – which handles serious, but not life threatening cases.
In other words, patients with serious conditions were waiting as much as half a day before being assessed by a specialist or senior doctor.
Shortage of doctors and nurses
Tameside general hospital is hamstrung by a shortage of both doctors, especially consultants, and nurses in key departments. For example, the A&E unit which should have seven consultants had five, the North West Utilisation Management Unit said. Temporary freelance consultants – locums – were being used to plug the gaps.
Filling overnight and weekend rotas is a particular problem, as is recruitment of permanent staff. The medical assessment and admissions unit that handles patients with serious conditions also faces "difficulties in recruiting additional acute physicians", the NHS Interim Management and Support team found.
That review also was concerned by nurse staffing levels in the emergency department were not high enough to allow the hospital to implement what it considers to be best medical practice. For example, Tameside's failure to implement a consistent system of rapid assessment and treatment of emergency arrivals was due to "a combination of poor consultant engagement and limited nurse staffing levels", it said.
Similarly, the A&E unit's new dedicated paediatric section was not working as intended due to "limited nurse and clinical staffing".
Medical sources say that the hospital's poor reputation may lie behind its difficulty in recruiting and retaining enough staff of the right experience, some of whom may opt instead to work in Manchester's bigger hospital trusts.
Shortage of consultants
The apparent lack of consultants in some wards is a repeated feature of the Interim Management and Support team report, although it was not clear if this was due to a shortage of senior doctors or because they were needed elsewhere – for example to work in outpatient clinics.
Nurses in A&E "described themselves as working with variable consultant presence and leadership which was described as being limited on occasions". It added: "We did not meet a consultant working on majors [more seriously ill patients] while we were in the ED [emergency department], despite significant overcrowding and delays in ambulance handover and understand that there was a reaching session in progress at the time of our visit".
Some consultants, it was noted, did not undertake ward rounds every day and that "consultant presence and leadership on the wards was still relatively weak".
Supervision of junior doctors
A group of junior doctors from several departments at Tameside general hospital took the unusual step of setting out a series of concerns about care and potential threats to patient safety in a private meeting with Jackie Hayden, the postgraduate dean, who is in charge of junior doctors' education and training in the Greater Manchester area.
Their chief concerns were poor staffing, especially at weekends, and lack of supervision of relatively inexperienced doctors by consultants. Some of them were concerned that patients could be at risk because they were sometimes left providing care to patients whose condition they felt needed a more senior doctor to decide what to do.
Shortcomings in patient care
The minutes of the clinical commission group's meeting on 1 May set out the fears of the board that represents GPs who now control the budget for NHS care in the area and are duty-bound to scrutinise Tameside hospital general standards.
The hard hitting minutes highlight what the board uncompromisingly describe as are deficiencies in and even "failures" of patient care. "Some of the shortcomings highlighted in the [other bodies'] reports were currently having an adverse impact on patient care", the minutes said. "Some were serious enough to require immediate attention."
The GP group also voiced alarm at "an increasing body of evidence that delays in assessment, treatment and admission from the ED [the emergency department] adversely affected patient experience and outcomes."
Tameside said that it had drawn up an action plan to address the issues highlighted in the reports – which had been approved by Monitor, which regulates semi-independent foundation trust hospitals. Although the hospital said it took staff's views and concerns very seriously, it cast doubt on some concerns raised by staff, which "were not able to be substantiated", a spokesman said.
