Ongoing challenges remain with the Emergency Department at Morriston Hospital in Swansea

During the three-day inspection in November 2024, inspectors found staff working hard under challenging conditions in an overcrowded department, which raised significant patient safety concerns. Many patients told inspectors they were frustrated by long waiting times. This was the knock-on effect of poor patient flow through the hospital, to the point of patient discharge. Despite these pressures, staff were attentive and consistently treated patients with professionalism and respect.

The inspection identified several areas requiring immediate improvement, including the management of the hospital’s surge areas, which were used to accommodate an unexpected increase in patients. This included overcrowding in non-bay areas where patients had no access to call bells, which posed safety risks, as well as delays in patient assessments. Inspectors were not assured that the health board had effective processes in place to manage risks, allocate staff appropriately, and conduct risk assessments in these areas. 

Immediate improvement was also needed regarding the safe management and administration of medication. Inspectors found medication and fluids stored in unlocked drawers, incomplete temperature and stock checks, and a lack of quiet, clean spaces for nurses to prepare medication without interruption.

Efforts have been made to improve patient flow, including the introduction of the Older Persons Assessment Unit (OPAU) and direct GP referrals, which help reduce pressure on the ED. However, delays in discharging patients from other areas of the hospital continue to impact care and contribute to overcrowding.

While Infection Prevention and Control (IPC) audits were up to date, inspectors observed inconsistent hand hygiene practices and reminders were given to doctors to adhere to policies. The health board must ensure IPC safety measures are reinforced to improve patient and staff safety. 

Effective communication among staff within the departments, particularly during handovers, was noted as a positive practice. Inspectors noted the department’s leadership team was continually striving to improve the service despite the challenging conditions. However, when asked the feedback from staff was generally negative, particularly around staffing levels and concerns regarding patient safety and an unsafe care environment.  The health board must consider staff comments and develop an improvement plan to address these safety concerns. 

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said:

There are mounting pressures on NHS services and Morriston Hospital, like all hospitals across Wales, continues to face extraordinary challenges due to increased demand. Patient flow is a nationally recognised problem, caused by system-wide pressures. While challenges remain, the health board’s improvements, such as the Older Persons Assessment Unit and direct GP referrals, are steps in the right direction to improve patient flow and waiting times. We will continue to engage with Swansea Bay University Health Board to ensure improvement and progress against our findings.

November 2024 - Hospital Inspection - Emergency Department – Morriston Hospital, Swansea