Inspectors have voiced concerns about staffing levels in the Royal United Hospital's A&E and patients waiting out of view of medical staff.

The Care Quality Commission rated the emergency department as "requires improvement" after a focused inspection in January to assess its handling of winter pressures on the NHS.

A report published today (March 10) said social distancing was difficult and could lead to overcrowding, while demand on services meant some patients had to wait in ambulances before they could get a bed.

However, the hospital controlled the infection risk well, it was better than the national average for patients waiting more than four hours, and no one waited more than 12 hours for a bed.

Amanda Williams, the CQC's head of hospital inspection for the south, said: "During our inspection of Royal United Hospital Bath we found a team that was focused on safety and protecting patients from infection during a very difficult and challenging time.

"However, high levels of demand on the emergency department were impacting on patient waiting times and we had concerns about staffing levels, particularly at night, and in the paediatric department.

"Yet despite these pressures, there were many examples of good practice. Leaders were aware of current challenges and were in the process of making improvements. We continue to monitor the trust and will return in due course to check on the progress of improvements we've told them to make."

The CQC said the emergency department did not always have enough staff with the right training to keep patients safe from avoidable harm and at times they did not always provide the right care and treatment. Due to a national shortage of paediatric nurses, the treatment of children was not always undertaken by nurse with the relevant training, although the trust has its own in-house training programme to address this.

The inspection report said the layout of the department and narrow dimensions of corridors made social distancing difficult. At busy times some patients were asked to wait in an area where they could not be seen by staff, but they were told to return to the department if their condition worsened.

The inspectors were also concerned about the complex layout's impact on senior medics' ability to see patients. These issues are set to be addressed through a £2.5million building programme.

The CQC said trust leaders understood the issues the hospital faced and the additional pressures of the Covid-19 pandemic and the infection risk was well controlled.

An RUH Trust spokesperson said: "The trust welcomes the CQC's report. We are encouraged by the commission's favourable and positive comments, praising our team in particular as focused on safety and protecting patients from infection, and citing many examples of good practice.

"However, we and the CQC recognise the impact of heavy demand on services. We also share their concerns about staffing levels at what was a particularly busy time of the coronavirus pandemic.

"We note and will address the CQC findings. Work is already well underway on a £2.5million building project that will further improve our emergency care facilities. This will increase capacity, enable patients to be seen quicker, and speed the flow of patients from ambulance to emergency department treatment."

Updating councillors on the latest coronavirus position in Bath and North East Somerset at a scrutiny panel meeting yesterday, Dr Bryn Bird said: "The seven-day diagnosis rate is now around 30 per 100,000. That's approximately halved in the last month. It's around 10 per cent of what it was at the turn of the year.

"To put that into context that's about three-quarters of the South West as a whole, and comfortably less than half the national rate. That's not a message to change any of our behaviours at this stage.

"In the RUH as of yesterday there was no new diagnoses in the previous 48 hours and no patients on non-invasive ventilation, nor deaths in the hospital.

"There were 20 cases still present in the hospital.

"In Bath and North East Somerset over three-quarters of the cohort population vaccinated. We're looking at increasing the rate over the coming month in line with the national increase in vaccination delivery.

"We're still on schedule and doing a lot of work to help deliver that programme effectively. We're moving onto second doses soon.

"We're looking at where it's delivered, between the primary care network delivery sites, alongside the mass vaccination sites. Some of the mass vaccination centre sites will have to potentially carry out business as usual in the future."

There is a mass vaccination centre at Bath Racecourse. The RUH tweeted that appointments had been cancelled on April 6 and 16, May 3, 12 and 21, and June 4, 12, 23 and 30 – days when races are scheduled.