Inspectors have raised concerns over the number of ambulances waiting outside the Royal Cornwall Hospital and the impact on its emergency department.
The Care Quality Commission (CQC) has described the length of time patients were kept waiting when it inspected the Royal Cornwall Hospital Trust in March as a "major issue".
It also says delays mean staff "do not feel that they are achieving good outcome for the patients".
In a letter to the Trust, the watchdog said the frustrations of staff showed how "dedicated and passionate" they are, adding patients themselves were "complimentary" of the care they received.
But ambulance queues were among several concerns raised by the CQC following its inspection of the emergency department and medical care at Royal Cornwall Hospital and the urgent treatment centre at West Cornwall Hospital.
In a letter to the Trust, the CQC said the emergency department felt “controlled" and was "being managed well” with staff aware of risks and responding to patients where needed.
But, it added: “The number of ambulances awaiting offload and the length of time patients are spending on ambulances and in the department is a major issue."
The Trust has had difficulty discharging patients due to a lack of social care provision has had an impact on its services, alongside high levels of demand on NHS services during the pandemic which has also seen beds closed due to infection control.
But the CQC said nurse staffing levels were an issue and highlighted “significant staff turnover”, adding staff are also not getting time to complete mandatory training.
It added: "We understand how the wider system issue is impacting on the delays at the front door.”
Inspectors also raised concerns over the mental health room, which they said was not always available for patients who needed assessments.
"We observed a patient being assessed in a cubicle and the conversation could be overheard," the letter adds.
The CQC said discharge arrangements "need to be reviewed", adding: "There is not an effective integrated discharge team and not always coordinated by the same member of staff.”
It added a new ward dedicated to helping people who are medically fit to be discharged sooner “had not completely served the purpose it was intended for”.
But staff were once again praised for their "commitment and dedication".
"They are tired but engaged and had good ideas on how to improve some things," the letter said. "There are perhaps opportunities for quick wins through staff engagement.”
West Cornwall Hospital
At the West Cornwall Hospital Urgent Treatment Centre the CQC found “a very skilled workforce" and described the team as "very dedicated and knowledgeable”.
But it adds: “The biggest risks are with acuity of patients coming to the urgent treatment centre either as ‘walk-in’ or referred by NHS 111 when the location converts to a minor injuries unit.
"There is a lack of medical support on site after 10pm. Although staff are able to access support remotely from Royal Cornwall Hospital there are long delays for patients to be transferred to the emergency department if this has been identified.”
A full report is being prepared by the CQC following the inspection and the Trust's chief executive Steve Williamson said it is expected by the end of this month.
There was no discussion of the letter at the board meeting but Mr Williamson said the final report will be provided for the board to oversee and scrutinise along with any plan to address any issues raised.
With support from the Local Democracy Reporting Service
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