NHS Forth Valley: Inspection report raises concerns over 'safe delivery of care' at Forth Valley Royal Hospital

The report by Healthcare Improvement Scotland (HIS) noted "limited improvement and in some cases a deterioration" in safe delivery of care at the hospital since inspectors visited in April.

Inspectors said many of their concerns related to the safe delivery of care, particularly in the emergency department and admission units where “many patients did not appear well cared for”.

The report follows an unannounced inspection at the hospital in September and its publication comes less than two weeks after the Scottish Government announced it would have "oversight" of the health board to tackle problems with out-of-hours services and unscheduled care.

The “extreme pressures” experienced by the Larbert hospital in terms of increased patient numbers, delayed discharges and high levels of staff absence, were recognised by the report.

HIS said many staff had expressed concerns related to the standard of care they were able to provide.

The report states: “We observed the emergency department and other admission areas were under extreme pressure with the occupancy within the emergency department reaching 230 per cent at points throughout the day.

"This meant an increase of 130 per cent more patients in the department than it was designed to accommodate.”

It was observed the longest wait time for patients waiting for transfer to ward areas was 25 hours, and ambulance crews were delaying in handing over care of patients to the hospital due to lack of physical space or staff capacity to take over the care of these patients.

Inspectors also noted: “We observed patients being seated in corridors and other overcrowded areas for prolonged periods of time with fundamental care needs unmet.”

The report added: “Our inspectors identified instances of unsafe practice around medicines governance which could result in serious harm to patients. In addition, staff shared with inspectors their concerns about patient safety due to staff levels, skill mix and unsafe working conditions.”

Donna Maclean, head of service for HIS, said: “We observed Forth Valley Royal Hospital experiencing extreme pressures from increased patient numbers, delayed discharges and high levels of staff absence. This report highlights our concerns on the limited improvement and in some cases a deterioration in safe delivery of care since our April 2022 inspection. This resulted in us formally escalating our concerns to Scottish Government in line with our escalation process. Many of our concerns were directly related to the safe delivery of care, particularly in the emergency department and admission units where many patients did not appear well cared for.

“We did, however, observe good communication and mutual support within the staff teams in many ward areas. In some ward areas staff appeared well organised with evidence of good team working however, many staff expressed concerns to inspectors related to the standard of care they were able to provide under the current system pressures.”

HIS has added a further 11 requirements to the nine outstanding that have not been achieved from the April inspection to support NHS Forth Valley in the safe delivery of care.

NHS Forth Valley said action was quickly taken to address many of the issues highlighted by the inspectors after their visit in September.

Cathie Cowan, Chief Executive, NHS Forth Valley, said: “I would like to apologise to those patients whose care and treatment fell below the high standards we aim to provide. The report highlights a number of serious issues and immediate action was taken following the visit to quickly respond to the concerns raised by the inspectors.

“We recognise that there is still more work to do, and we are committed to fully addressing all of the report recommendations and working with the Assurance Board set up by the Scottish Government to drive forward the changes and improvements required across the organisation.

“Local staff continue to deliver high standards of clinical care and treatment in very challenging circumstances, and I want to thank them for their hard work and commitment.”