The inspection in February and March, which was part of the CQC's winter pressures programme, re-rated the service as requires improvement.

Inspectors found the system used to direct people to appropriate services once they had arrived in A&E was ‘ineffective'.

The CQC heard concerns over delays and lengthy waits and people not being monitored properly, including those with mental health needs.

People were also left on chairs and trolleys for long periods due to a lack of beds and treatment areas, with several cared for in temporary escalation spaces.

Despite the challenges, the CQC saw examples of effective multidisciplinary working, for example, physiotherapists worked hard to ensure people returned home safely with appropriate equipment and community support, reducing the need for re-admission.

NCIC said it had taken a number of immediate actions following the warning notice including:

• assigning a healthcare assistant or registered nurse to the ED waiting room to improve the oversight of patients while they wait and to identify and support any patients with deteriorating conditions
• completing works to upgrade the mental health assessment room
• processes and safeguarding measures put in place to ensure mental health risk assessments are carried out quickly when a patient arrives in the ED.

Dr Gill Findley, chief nurse at NCIC, said: ‘Some of the improvements will take time to put in place but we are determined they are resolved on a permanent basis and not just a temporary fix. As the well as the actions listed above, our colleagues in ED are attending mental health training which is being provided by the University of Cumbria. We are also undertaking a number of improvements to the facilities and environment in the ED, including painting and decluttering the cubicles and making improvements to our toilet facilities.'

Dr Findley said the ED was seeing over double the amount of patients it was designed for and had, therefore, invested £4m in urgent and emergency care services to help stream less urgent cases to the most appropriate place and free up ED for critically ill patients.