An unannounced inspection of a hospital emergency department has found ongoing issues with overcrowding and patient care.
Healthcare Inspectorate Wales (HIW) visited the emergency department at The Grange University Hospital in Cwmbran, run by Aneurin Bevan University Health Board, in October 2024.
The inspection identified ‘ongoing systemic challenges’ affecting the ‘consistent delivery of safe care,’ but also noted positive progress since the department’s previous inspection in 2022.
HIW said it was ‘disappointing’ to find that overcrowding in the waiting room and reception area continues to compromise patient privacy, dignity, and access to timely care.
This was down to delays in patient flow, largely driven by system-wide discharge challenges that have a knock-on effect on the department.
Insufficient staff oversight in waiting areas, delays in completing risk assessments, and instances where patients did not receive timely pain relief were all concerns for the inspectors.
HIW asked for immediate improvements to be made in relation to the above and equipment checks.
It was noted that improvements had been made since the previous inspection, including the introduction of an electronic triage system which has helped improve the efficiency of patient triage processes, and ongoing construction of an extended waiting area, which aims to alleviate overcrowding and improve staff visibility.
While nurse staffing levels remain under pressure, these have stabilised compared to the previous inspection, with less reliance on agency staff and improved retention.
Inspectors noted the impact of enhanced training and support initiatives, including a dedicated practice development nurse.
More than 85 per cent of staff have completed mandatory training, and systems to capture patient feedback are now in place to help improve services.
Despite these improvements, systemic pressures persist.
There was a persistent high escalation status across the health board at the time of the inspection, with delays in discharging up to 400 patients.
Renovation work on the department’s waiting area is progressing but will not be completed until spring 2025, delaying any immediate relief.
Inspectors commended staff for their professionalism, compassion, and commitment to delivering care under challenging conditions.
However, the department remains under pressure, and systemic issues within the health board and the wider NHS continue to impact the consistent delivery of timely care.
Alun Jones, chief executive of Healthcare Inspectorate Wales, said: “This inspection highlights both the dedication of staff working under immense pressure and the significant challenges that remain in delivering safe, timely, and dignified care.
“We are encouraged by the progress the department is making, but further improvements are urgently needed to address systemic issues affecting patient flow and care delivery.
“HIW will continue to work closely with the health board to ensure the necessary changes are implemented, so that patients receive the high-quality care they deserve.”
A spokesperson for Aneurin Bevan University Health Board said: “We welcome this report into our emergency department at The Grange University Hospital, which recognises the professionalism, compassion, and dedication of our staff, as well as progress made in several key areas.
“The report highlights the sustained pressures on our hospital system, as seen across other areas of the UK, including the high number and complexity of patients attending the department and the impact of pressure on social services leading to some patients spending longer in hospital than their medical condition requires.
“HIW identified areas requiring ‘immediate assurance,’ which were addressed promptly, and we have an action plan for the other recommendations.
“Work is also underway to help address the challenges around waiting times, capacity, and patient flow, with an extension of the waiting area due to be completed this spring, and a new discharge lounge due in March.
“We expect both of these initiatives to significantly improve patient experience in our critical care centre.
“We value HIW’s independent assessments, which help us learn and develop our services further.
“We apologise to patients whose care has fallen below the standards we strive for and to those experiencing delays.
“We remain incredibly grateful to our staff, who continue to work tirelessly under significant and sustained pressure.”