There has been positive progress in the running of the emergency department at The Grange Hospital, although it is still facing significant challenges including an overcrowded waiting room and patients not receiving pain relief in a’timely manner’, a new report by the Healthcare Inspectorate for Wales (HIW) has concluded.

Inspectors for HIW carried out an unannounced inspection of the Emergency Department of The Grange Hospital in Cwmbran, which is run by Aneurin Bevan University Health Board.

The inspection, which took place over two days in October 2024, identified ongoing systemic challenges affecting the ability to provide consistent safe care, but also noted positive progress since the department's previous inspection in 2022.

The report said it was disappointing to note that the crowded waiting room and reception area continued to infringe on patients' privacy and dignity and their ability to access timely care. Delays in patient flow added to this, mainly caused by system-wide discharge challenges affecting the department.

Inspectors were concerned about inadequate staff supervision in the waiting areas, delays in completing risk assessments, and cases where patients had not received pain relief medication in a timely manner. HIW requested that improvements be made immediately in relation to risk assessments, medication management, and equipment checks.

Improvements had been made since HIW’s previous inspection, including the introduction of an electronic triage system that has helped improve the efficiency of patient triage processes, and the ongoing work to build an extended stay area, with the aim of preventing overcrowding and improving staff visibility.

While there are still pressures on nursing staff levels, these have stabilised since the previous inspection, with reduced reliance on agency staff and improved retention rates. Inspectors identified the impact of increased training and support initiatives, including a designated practice development nurse. Over 85 per cent of staff have completed mandatory training, and systems to collect feedback from patients, such as QR codes, are now in place to help improve services.

Despite these improvements, there is still systemic pressure. Inspectors said there was a continued high escalation status across the health board at the time of the inspection, with delays in discharging up to 400 patientsand while renovations are underway in the department's waiting area these will not be completed until spring 2025, meaning the pressure will not be relieved immediately.

Inspectors praised staff's professionalism, compassion and commitment to providing care under challenging conditions. However, the department remains under pressure, and systemic issues within the health board and the wider NHS continue to affect the ability to provide consistent care.

Alun Jones, Chief Executive of Healthcare Inspectorate Wales, said: "This inspection demonstrates the dedication of staff working under enormous pressure and the significant challenges still faced in providing safe, timely and dignified care. It is encouraging to see the progress the department is making, but further improvements are urgently needed to address the systemic issues affecting patient flow and care delivery. HIW will continue to work closely with the health board to ensure the necessary changes are made, so that patients receive the high quality care they deserve."