Northern Devon Healthcare NHS Trust's accident and emergency department is one of 95 units requiring improvement nationwide, with 22 of 184 units nationally rated as 'inadequate'.
Last year the North Devon District Hospital (NDDH) was inspected by the Care Quality Commision (CQC) and the A&E department was rated "requires improvement". The "effectiveness" of the hospital was also deemed to be "inadequate".
However, information from Trinity Mirror's national data unit says that this year NDDH's A&E was the only trust in Devon and Cornwall to hit target (95% of patients waiting less than four hours from arrival to discharge, admission or transfer) in August. The A&E unit is currently under review and could close.
Dr Alison Diamond, chief executive of Northern Devon Healthcare NHS Trust, said the Trust's accident and emergency department was now a top performer nationally.
A national CQC State of Care review said emergency care was one of the poorest-performing parts of the national NHS system.
The report cited safety as a major weakness due to underfunding of council care services, with 22 of 184 units rated inadequate and another 95 requiring improvement - including Barnstaple's A&E department.
The State of Care report highlighted how elderly and frail people are ending up in A&E because there is a shortage of the right support in the community.
In the report, David Behan, chief executive of the Care Quality Commission, said: "Unless the health and social care system finds a better way to work together, I have no doubt that next year there will be more people whose needs aren't met, less improvement and more deterioration."
The NHS NEW Devon Clinical Commissioning Group (CCG) said every day in north, east and west Devon, up to 600 people are in hospitals (100 of these in community hospitals) who no longer have a medical need to be there.
Representatives for the success Regime made a presentation to the health and well being scrutiny committee at a meeting earlier in the month and spoke about the overall purpose, scope and process for consultation on a 'Your Future Care' model.
The CCG's aim with the Your Future Care programme is to provide effective and easily-accessible care and support in the community so people are not being sent to hospital just because services are not available to look after them at home.
GP David Jenner, chair of CCG's Eastern locality, said: "In Your Future Care, the aim is to provide effective and easily-accessible care and support in the community so people are not being sent to hospital just because services are not available to look after them at home.
"People tell us they prefer to be treated in their own homes if it is safe and appropriate to do so. If however they need hospital admission we should aim for them to return home quickly as soon as their condition allows."
Dr Alison Diamond, chief executive of Northern Devon Healthcare NHS Trust, said the Trust had worked hard to improve their rating since last year's inspection.
She said: "Since our last CQC inspection, we have worked hard to improve the way patients flow through our hospitals, from admission to discharge. In 2015/16, we were in the top 10 for our performance against the four-hour waiting time target and we met our referral to treatment target throughout the entire period. We remain in the top 10 for our flow performance.
"Our teams in A&E work extremely hard to make sure they see patients quickly and provide high quality care. However, our top performance for patient flow depends on more than just our teams in A&E.
"The whole system needs to be working correctly so we can move people through the hospital and make sure they are treated in the best possible place for them, and this includes making sure we can get people home again from hospital with the right support.
"We have integrated health and social care teams who provide care to keep people safe at home, reducing the chance of them needing to be admitted to hospital. This year, we also became the first NHS trust to enter the domiciliary care market, by launching Devon Cares, which acts as a bridge between health and social care.
"We are an open and transparent trust and we welcome visits from our regulators. We were pleased that the report published in November 2015 demonstrated we had made improvements since the previous report. The Trust is always striving to improve services and this report identified many areas we were already working on."
Responding to the latest A&E performance figures, Dr Anthea Mowat, British Medical Association representative body chair, said: "These figures show the worrying reality of an overstretched NHS where the government has failed to meet the unprecedented pressure and demand with appropriate funding or resources.
"Behind every statistic are patients waiting anxiously for care, and delays in care – which are getting worse all year round - are simply not acceptable.
"Staff across the NHS continue to work flat-out but the system cannot keep up with demand. We can only address the problem by looking at the health and social care system as a whole.
"We can only get to grips with pressure on A&Es if every part of the system – from our GP surgeries, to hospitals, to community care – is fully supported and working well, which includes urgently addressing the workforce crisis facing our health service.
"To protect the future of the NHS, the government must produce a long term strategy that addresses the fundamental workload, staffing and funding challenges that are currently overwhelming services."
Following the results of the CQC's inspection, rating the effectiveness of the hospital "inadequate" the Journal spoke to Dr Alison Diamond, chief executive of Northern Devon Healthcare NHS Trust.
After the inspection, it was noted that there were not enough registered children's nurses and so children were highest on the list of the CQC's concerns. Has this been addressed?
We have a linked children's nurse to every shift who can come immediately from the paediatric ward to support.
Why was it the case that there were not enough children's nurses?
We do not see children coming through A&E frequently enough to maintain the competency of children's nurses if we were to have one on every shift. However, we have always had access to a children's nurse on the paediatric ward and this has now been formalised so there is a named nurse to call at all times.
There were some 'gaps in some care records', specifically regarding the recording of peoples' allergies and pain scores. Why did this gap exist?
Sometimes this was down to being very busy and staff not recording what they asked the patients. We have since changed the paperwork and provided on-going education to staff, and we audit our results.
The underfunding of council care services has been listed as the main contributor to underperforming A&E departments by CQC inspectors. Is this something that you would agree with?
This is not an issue for us. We have an excellent collaborative working relationship with the Council. Recently we have taken on the role of prime provider for home care services in the north Devon, Torridge and mid Devon area. This is working well and there are very few unfilled home care packages.
The regulator said rationing of council care, including access to home help for daily tasks such as washing and dressing and care homes, was pushing more old and frail people into hospital. Has there been an increase in elderly people receiving treatment at NDDH?
We have seen an increase in referrals to the hospital year on year, but we cannot directly link this to home care.
How worried are NDHT about the State of Care report?
The State of Care report highlights the importance of having the right support in the community. As a Trust, we have been moving towards this model of care for a number of years and we already provide a high level of support in the community, to prevent people from needing to come into hospital and to help them to go home as soon as possible.
Work is also underway to enhance the support provided in the community across the health and social care system. The Your Future Care consultation, which is led by NHS NEW Devon CCG, is addressing this issue, as it aims to provide effective and easily-accessible care and support in the community, so people are not being sent to hospital just because services are not available to look after them at home.