Dr Gray’s: Surprise inspection lays bare ‘extreme pressures’ on Moray’s flagship hospital

Inspectors have praised staff at Dr Gray’s Hospital for their “care and compassion” – but have raised concerns about the “extreme pressures” the hospital still faces.

Officials from Healthcare Improvement Scotland (HIS) made an unannounced visit to the Elgin hospital in July, with the findings only released today.

Following a troubling inspection in October 2023, inspectors remarked that NHS Grampian has made “positive progress” in relation to significant concerns.

However, they also noted that on the first day of their inspection, they found one patient who had been in the emergency department for 22 hours while waiting for an inpatient bed.

The inspectors also revealed Dr Gray’s Hospital was operating at 123% capacity that day – and at one point, four ambulances were queuing outside the emergency department waiting for available space.

One ambulance had been waiting three hours and 50 minutes.

The inspectors said: “(We) also observed that there was one patient being cared for in the corridor of the emergency department.

“While we do not promote the care of patients within corridor areas or other non-standard care areas, we recognise the extreme pressures associated with over occupancy and high number of attendances at emergency departments, has impacted on this.”

‘Critically unwell’ patient waits in ambulance for approximately five hours

Additionally, inspectors asked NHS Grampian to provide evidence of any incidents reported by staff in the three months prior to inspection.

This included one where due to lack of space within the emergency department, a patient remained outside in an ambulance for approximately five hours.

Upon being brought into the department, the patient was found to be critically unwell.

The inspectors said this incident is currently under review by senior managers.

Dr Gray’s nursing staff reported ‘not feeling valued’ by senior management

Some members of staff that inspectors spoke to within the emergency department described supportive and effective teamwork, including from senior managers.

However, some nursing staff told inspectors they felt there was a disconnect between ward staff and senior management and that they did not feel supported or valued.

Medical staff in the emergency department also raised concerns regarding a proposed
reduction of medical staffing on the overnight rota and highlighted the potential impact this may have on patient safety.

These staff members also revealed that they felt their concerns were not always listened to or acted upon.

The inspectors acknowledged that while the nursing vacancy rate at Dr Gray’s Hospital has reduced since their previous inspection, there is a high level of medical vacancies with a reliance on locum medical staff.

Concerns were also raised regarding senior medical support in both orthopaedics and medicine particularly in out of hours periods with a reliance on agency locum doctors within medicine.

Inspectors also identified ongoing wear and tear to the environment and fire risk assessments identified a number of fire doors requiring repair or replacement.

‘Hard-working’ Dr Gray’s staff providing safe delivery of care

Patients and relatives that spoke with the inspectors described kind and compassionate care.

The inspectors said: “We observed that patients appeared well cared for and both relatives and patients we spoke with spoke positively of the care and the staff providing it.

“Inspectors observed caring and compassionate interactions between staff and patients with patients being treated with dignity and respect.”

Helen Chisholm, chief nurse for Dr Gray’s Hospital and Health and Social Care Moray, said that they are pleased with the recognition of areas of good practise and of the significant improvements the team have made at Dr Gray’s Hospital.

She said: “We remain fully committed to providing the best experience possible for our patients and our staff at Dr Gray’s Hospital and will continue to work hard to build on the progress already made to meet the additional recommendations and requirements in the report.

“We are working hard to reduce our reliance on agency and locum staff, not just at Dr Gray’s, but across Grampian.”

NHS Grampian has also submitted an action plan to HIS which they say “clearly lays out the work we are undertaking to meet their recommendations and requirements”.