Three patients tried to self harm at A&E after assessments fell short, inspectors find

That was one of the findings of the Care Quality Commission (CQC) when they visited the Norfolk and Norwich University Hospital (NNUH) on November 6.

However in the report published on Tuesday inspectors found a number of improvements in the emergency department, including:

• Processes which prevent and control the spread of infection;

• Significant building alterations;

Mark Davies, chief executive of the Norfolk & Norwich University Hospital. Photo: NNUH (Image: Archant)

• And while patients were still being cared for in corridors when it was busy, more were being looked after in an appropriate place.

But three patients - one in May, another in July, and another in September - had been admitted after having self harmed, but a lack of risk assessments meant they were then found trying to self harm again in the department.

In some cases the records inspectors reviewed showed assessments had fallen short of patients' needs.

In one case the CQC found records which showed a patient was 'obviously disturbed, threatening, agitated or unpredictable in their behaviour'.

But the assessment found no special observations were required.

Inspectors said: 'This meant that, whilst the number of risk assessments had increased, we were not assured that they were being completed accurately to ensure steps were taken to keep patients safe.'

It remained rated as inadequate.

Mark Davies, NNUH chief executive, said: 'We welcome this latest report from the CQC, which recognises the improvements that have taken place in our urgent and emergency services over the last year. Progress has been made and we accept that we have more work to do.

'Our emergency department team have made great strides in improving services by increasing the size of the children's ED and establishing the first older people's emergency department (OPED) in the country.

'The most recent CQC inspection found that staff understanding of the Mental Capacity Act has significantly improved and the establishment of a mental health board within the trust has improved the focus on mental health care within the organisation. Work is ongoing to increase staffing to ensure patients who come to ED at a time of crisis are cared for in a safe environment.

'Three quiet rooms have been constructed in ED as a suitable alternative to a cubicle for some of our patients. Patients with mental health issues often benefit from a quiet environment and this area can be the best option. However, safety of both patients and staff is paramount and so the area is used only when it is appropriate and safe to do so.

'Eight new rapid assessment and treatment spaces have been opened in a new unit at ED since the CQC visit in November and the opening hours of OPED have also been extended.

'Our staff continue to work hard on implementing the CQC's recommendations and actions in order to improve the services for our patients.'