Nurses and midwives have been pushed to “breaking point” at a hospital trust found to have overstretched staff and exposed patients to “significant risks”, unions have told Nursing Times.
Three separate independent reviews have reported a catalogue of governance and leadership failures at University Hospitals of Morecambe Bay Foundation Trust.
A review of maternity and paediatric services at Morecambe Bay found “significant risks for the safety of mothers and babies” at its Furness General Hospital, despite promised improvements after a warning last September from the Care Quality Commission (see timeline below).
The maternity services review found a lack of leadership to be “of major concern”. In some cases, there were “no strong role models” for staff and, while there were “a number of professionals who had the desire to provide an excellent service”, they did not have the “experience or guidance” to do so.
At Furness hospital, despite a “recent number of serious untoward incidents”, the team found no senior presence above the level of a band 8a midwifery matron, with the executive team and divisional management based elsewhere.
It was not possible for nurses to take a break at the six-cot neonatal unit without leaving just one staff member on duty. “Some of the staff work long days of more than 12 hours without a break,” the report stated. “Senior nurses and managers are aware of this but no contingency plans appear to be in place.”
At the time of the review, one third of the neonatal unit’s employees were absent through sickness. The review report added: “The nurses interviewed appeared to be very conscientious, but were extremely concerned about the situation.”
“That’s the type of pressure staff are working under,” said Sean Gibson, Unison regional organiser for health in Cumbria. “They’re working at breaking point.”
He added: “They can’t switch off and say ‘the European Working Time Directive says I’m taking my break, so bugger the babies’.
They won’t do that, and the trust knows they won’t do that – and now that’s backfired.”
Mr Gibson added: “What we’re seeing in Morecambe Bay I think we’re going to see more and more throughout the NHS in the UK.
“As these austerity measures hit and trusts are made to make these savings, services will crack or come under extreme pressure and there may be fatalities.”
Two other review teams reported that the trust’s governance processes and systems were “inadequate”, and it had built up a backlog of 14,000 patients with overdue follow-up appointments without recognising it was a “serious clinical problem”.
Two of the investigations were ordered by the regulator Monitor and the third by the trust itself.
The reports come a week after the CQC issued another warning to Morecambe Bay, this time calling for an urgent increase in staffing in the accident and emergency department at the trust’s other main hospital the Royal Lancaster Infirmary.
The CQC said it had told the trust in “very clear terms” to make sure the department was “safe going forward”.
Royal College of Nursing north west regional director Steve Flanagan said the foundation trust had to “get a grip and act quickly”.
“The board needs to be much more open and transparent and properly scrutinise risk, quality and patient care – not just the financial bottom line,” he told Nursing Times.
Monitor had told the board to consider its approach to staff communication, he added. “Staff feel besieged and morale is at rock bottom – we want to see the trust urgently address its ‘disconnect’ and meaningfully engage with staff,” Mr Flanagan said.
Trust chief executive Tony Halsall said the reports made “uncomfortable reading”, but the trust accepted the findings.
“Everyone has been working hard to make the changes needed and considerable progress has already been made,” he said.
|Trust’s descent into trouble:|
June 2010: Care Quality Commission undertakes unannounced review of Furness General Hospital maternity unit, in response to concerns. Regulator finds unit compliant with all standards investigated, including staffing and assessment and monitoring of care quality
October 2010: Morecambe Bay authorised as foundation trust.
June 2011: Inquest into death of baby Joshua Titcombe at FGH in 2008 rules he died of natural causes but midwives had missed repeated opportunities to spot a serious infection
July 2011: CQC and Nursing and Midwifery Council undertake joint unannounced inspection of maternity services in response to inquest
September 2011: CQC reports “major concerns” about safety and suitability of premises at FGH maternity unit, staffing and foundation’s assessment and monitoring of care quality
October 2011: Trust withdraws bid to take over nearby North Cumbria University Hospitals when Monitor finds Morecambe Bay in “significant breach” of its terms of authorisation as FT
November 2011: Trust claims there have been “significant improvements” to its maternity services, as Monitor sends in independent teams to review the services and overall governance
December 2011: Unannounced CQC inspection of the trust’s Royal Lancaster Infirmary A&E department told staffing is “often at crisis level”
17 January 2012: CQC announces in-depth investigation into trust’s emergency care
2 February 2012: CQC orders trust to urgently increase A&E staffing at Royal Lancaster
6 February 2012: Monitor replaces Morecambe Bay chair and orders trust to appoint turnaround director and chief operating officer
7 February 2012: Monitor publishes damning reports from three separate independent reviews of foundation