Staff working in a troubled A&E unit have criticised it as “unsafe, unsupported and relentless” because its care is putting patients at such serious risk, a secret NHS report reveals.



Treatment at North Middlesex hospital’s emergency department is allegedly so poor that none of the doctors interviewed who work in it would advise their friends or relatives to seek medical help there, according to the unpublished report by Health Education England (HEE), the NHS’s workforce agency.



The report goes into extraordinary detail about the alarming responses hospital staff gave to HEE inspectors, and led the agency to warn of “numerous examples of patient safety potentially being compromised” by a list of failings at the unit, which treats 181,000 patients a year.



Inexperienced trainee doctors were reportedly left in charge at night of both the main A&E unit and a separate emergency department that looks after children, because there were no middle-grade medics or consultants to help and give advice, the inspectors were told.



“Most trainees reported having to deal with situations beyond their competence without appropriate supervision on a regular basis,” says the document, which the Guardian has seen.



The hospital, however, denied that junior doctors had been left in charge of the unit. “There is and always has been at least one and usually two or more middle-grade doctors or consultants on duty,” a spokesman said. “Junior, unqualified staff were never left in charge of the A&E department overnight or at any other time.” The discrepancy between the hospital’s denial and some staff’s detailed testimonies remained unexplained.

The report, drawn up by HEE’s quality and regulation team for London and the south-east, says: “Issues were raised about the competency of some staff. As a result of this, there were concerns about patient safety. This was exacerbated by the high volume of patients coming through the department. The department was reported to be ‘unsafe, unsupported and relentless’.”



It alleges that some junior staff were “being left unsupported in the emergency department at night with neither middle-grade nor senior on-site presence”.



The document, which is based on interviews with 24 staff , also discloses that:

Some doctors found working in the A&E unit so stressful that they cried when they finished their shifts. “Foundation doctors had been reduced to tears by the sheer volume of patients they had to deal with, for example 200 patients and a six-hour wait, and they felt that they regularly had to send children home without having discussed their case with anyone senior,” the report states. “They often finished their shift and returned home full of anxiety that they had not been able to provide care at an appropriate level.”

Some trainee medics expressed serious misgivings about the competence of some more senior colleagues, including one who misdiagnosed a patient.

They also said they had difficulty getting expert help overnight.

Handovers of patients from doctors on one shift to their replacements did not always happen, despite being standard medical practice.

Vital equipment, including some needed to resuscitate patients, was missing.

The findings have raised further alarm about an A&E unit that the Guardian revealed last week could be shut down within weeks because of fears that patients could be harmed.

MPs whose constituents use the hospital have demanded urgent changes, including a clearout of senior figures. Kate Osamor, the Labour MP whose Edmonton seat includes the hospital, said she was horrified by the report. “HEE’s findings make me very, very worried. For HEE to find that medical staff at the unit saying such things tells me that the hospital is in crisis”, she said. She also expressed fears that the unit was not safe for constituents.



“They tell me they don’t want to use it but they feel they have no choice. They are over-reliant on it because there’s a chronic shortage of GPs in the area,” she said.



The disclosure of the 18-page report comes as the General Medical Council, which regulates the medical profession and ensures the safety of hospital units where trainee doctors are working, prepares to start inspecting the unit on Monday. The Guardian disclosed last week that, in a move unprecedented in NHS history, the GMC and HEE were so worried about conditions at the A&E unit that both had threatened to withdraw junior doctors from working there, which would lead to it having to close and patients being treated elsewhere.



Osamor and the Labour MP for Enfield North, Joan Ryan, will meet the North Middlesex chief executive, Julie Lowe, on Tuesday. They want a new board and new senior management team installed at the hospital to get a grip of its problems, Osamor said. “We are going to ask her to ensure that there are changes urgently, [and if not] then she should resign,” she said.



David Lammy, the Labour MP for nearby Tottenham, said: “These revelations demonstrate an extraordinary collapse at this hospital that has been largely covered up for almost a year. There are questions to be asked about the role of NHS England, NHS Improvement, the Department of Health and the local clinical commissioning group. Why has nothing been done? My view is that heads should roll.”



The hospital spokesman said: “We apologise for the concerns about our A&E caused by the shortage of middle-grade doctors and consultants.”



The Department of Health last week said that patients had been seriously let down by the standard of care at North Middlesex. It added: “This situation must change and NHS Improvement is supporting the trust so patient care is quickly improved.”

