Emergency Care Under Pressure: Staff praised despite ongoing challenges at Ysbyty Gwynedd

The inspection took place over three days in April 2025 and assessed the quality and safety of care provided to patients attending the department. As with most EDs across Wales, the inspection identified ongoing systemic challenges affecting the department, impacted by poor patient flow through the hospital, due to delays in discharging patients. Regardless of these challenges, inspectors observed several positive improvements since the previous inspection in August 2023, and clear examples of learning from the issues identified previously.

Inspectors found a committed and resilient team striving to deliver safe and compassionate care. The department was found to be clean and well-maintained, with good infection prevention and control practices in place. However, it was concerning that patients with weakened immune systems were sometimes cared for in open areas, increasing their risk of infection. 

Staff were seen to communicate clearly with patients and made every effort to treat them with dignity and compassion and maintain their privacy to the best of their ability. However, this was more challenging for those cared for on trolleys in areas not designed to provide patient care, such as corridors. Most patients were generally positive about their interactions with staff, although many expressed frustrations with long waiting times.

The department demonstrated areas of good practice, including effective communication between staff, a designated pharmacist, occupational therapy and physiotherapy support, and proactive escalation of unwell patients. The ED leadership team was visible and supportive, with the senior nurse leader regularly assisting staff during busy periods. Although, staff reported feeling unsupported by senior management outside the department.

The key findings from the inspection revealed several patient safety concerns that required immediate assurance. Issues included medication storage temperatures exceeding safe thresholds, expired or improperly stored items on the resuscitation trolley, and inadequate staffing and oversight in the paediatric area. Additionally, it was noted that not all patients were triaged within the recommended 15-minute window, leading to delays in specialty reviews and ambulance patient transfers into the department, which impacted patient flow and safety.

Inspectors found that a positive team culture within the ED was described by the staff, though concerns were raised about violence and aggression from patients, lack of breaks, and inconsistent access to training and development. 

Despite the overall challenges, inspectors found evidence of a committed and professional team working hard to deliver safe and compassionate care in a high-pressure environment. Staff also described the culture within ED as positive, inclusive and team-oriented, with strong camaraderie and mutual respect across roles. Many staff expressed pride in their work and confidence in their immediate managers, who were seen as approachable and hands-on. The visible leadership and willingness to support on the floor during peak times was particularly valued. 

A total of 28 areas for improvement were identified, and the health board has submitted a comprehensive improvement plan, which HIW has accepted. Progress on these improvements will be monitored as part of HIW’s ongoing assurance work.

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

The pressures seen in this department reflect a wider national picture, where patient flow and overcrowding continue to challenge emergency care services across Wales. This inspection highlights the dedication of staff at Ysbyty Gwynedd Emergency Department in delivering compassionate care under pressure. However, it also identifies concerns that must be addressed to improve patient safety and staff wellbeing.  We will continue to engage with Betsi Cadwaladr University Health Board to ensure progress against our findings.

April 2025 - Hospital Inspection - Emergency Department - Ysbyty Gwynedd, Bangor