An interim review of Noble’s Hospital’s emergency department has come to some shocking conclusions.

It highlights ‘toxic’ relationships and a ‘bullying and blame culture’.

Last year the UK’s Care Quality Commission was asked by the government to examine hospital departments.

Results of the review showed that the handling of medication in the emergency department was sometimes shown to put patients’ lives at risk.

‘The quality dashboard showed there had been there medicine errors which resulted in moderate to severe harm to death. Two of these incidents happened in December 2021 and one in April 2022.’

The CQC identified two areas of particular concern within the emergency department that were escalated to the DHSC – culture and leadership.

The commission said: ‘We found lack of support for staff health and wellbeing, relationships were “toxic” and there was a bullying and blame culture.’

Some staff described the behaviour of some senior medical staff as ‘feral’.

The commission was told that there was an ‘eight- to 12-week wait’ for staff support within the department.

The governance processes of the emergency department were ‘not robust’.

‘The department leaders had limited oversight and were unable to be assured they were providing safe care and treatment,’ the report said. ‘There was a significant disconnect between the nursing and medical staffing in the department which could have the potential to cause or contribute to patient harm.

‘Relationships amongst some staff groups had deteriorated and there appeared to be conflict between them.’

The emergency department failed to perform checks to provide assurance that the service was up to standards or to identify problem areas.

The report said: ‘The results of a controlled drugs audit in December 2021, provided several actions in relation to the safe and secure management of medicines. However, during our visit, staff had not implemented the actions.’

The commission added: ‘The service did not provide the required mandatory training, including life support training, to all staff and did not make sure everyone completed it.’

They found that no staff had undertaken safeguarding adults and children training to the appropriate level.

‘Staff did not always have the skills to identify or action a safeguarding concern,’ the report concludes.

However, some staff understood how to protect patients from abuse while it was found that the service ‘did not work well’ with the other agencies to achieve this.

The review also investigated areas such as incident reporting, which is to hold doctors accountable for their actions and help improve the quality of care. The report said this was ‘discouraged’.

The commission also found that the reporting system was described as ‘weaponised’ by some employees.

‘Some staff said they could not access the system. They had to request that someone else input any incidents on their behalf but this was frequently denied,’ it said.

In regards to medical staffing the CQC said: ‘The service did not have enough medical staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and to provide the right care and treatment.

‘However, there was a reliance on bank and agency staff to fill gaps in the roster.’

Bank staff are workers who are hired out temporarily to fill shifts on a freelance basis.

The commission also found that some staff ‘did not give pain relief in a timely way’ according to the commission.

Staff assessed pain on a scale of one to 10, with one being no pain and 10 being the ‘worst pain ever experienced’.

Two patients assessed at having pain levels of five to eight were not prescribed or given any pain relief.

According to the report, the facilities, premises and equipment ‘did not always keep people safe’.

They included incidents when loose tablets were found in a clinical bin, which can be accessed by patients. This presents a danger to children and at-risk patients.

There was also an overfilled sharps disposal bin with ‘no temporary closure in place’.

The report said: ‘This posed a risk of harm to patients, especially children or people at risk of self-harming.’

The commission also found that clinical waste was sometimes not managed well.

The commission saw that there was ‘several’ hospital policies out of date and ‘had not been reviewed’ to make sure they were in line with guidance at the time.

The commission said: ‘The service did not have a documented vision for what it wanted to achieve or any strategies.’

The report did however say that the service was caring in accordance with CQC’s inspection framework.

The patients were seen to be treated with compassion and kindness.

Staff spoke about ‘wanting to make a difference for patients and their families’ and wanting ‘to care for people in the same way they would want their own families to be cared for’.

From April 2021 to December 2021, 60% of patients surveyed rated their experience in the emergency department as ‘very good’, 24% rated it ‘good’ and the remaining 16% rated it as satisfactory.

The department was also praised for the emotional support it provided to patients and their families. The commission said: ‘They understood patients’ personal, cultural and religious needs.’

The Department of Health and Social Care released a statement to say: ‘Once finalised the full reports will be published on the department webpage, alongside action plans – detailing how any identified issues will be addressed. The department and Manx Care will be directly discussing the content of the reports once the inspections have been completed.’

Health Minister Lawrie Hooper said that the department received this report last month.

‘We have no timescale of when they did that report, whether there has been any substantial change, new issues developing or whether the steps that Manx Care has already taken are starting to bare fruit,’ he said.

The CQC visited the emergency department between June 13 and June 16 this year.

Executive director Paul Moore told the Manx Independent: ‘In many ways they (the issues) were not a surprise to us, we explained these issues to the CQC in an open, honest and transparent way.’

When asked about grievance procedures in the emergency department, Moore said: ‘Those procedures are in place and can be used by colleagues.’

Mr Moore could not provide any data on grievance reports.

This review is due to finish in October and the government said reports will be published ‘in due course’.

The CQC told the Manx Independent: ‘Any reports CQC produces as part of its work in the island are passed to the Isle of Man’s Department for Health and Social Care and not published by CQC.

‘CQC reports are subject to a thorough quality assurance process prior to publication, so we cannot comment on unpublished reports.’

Commissioning the review was one of 26 recommendations made by Sir John Michael in his independent review of the Isle of Man’s health and social care system.

On Tuesday, the Isle of Man Examiner reported that waiting lists at the emergency department had got much longer in the past few years.