Regulator finds 'variable' staffing levels at big London trust
Morale is low at the biggest health trust in Britain where some staff feel bullied and unable to raise concerns while some patients complained they do not feel listened to, according to a report by England’s Chief Inspector of Hospitals.
Services at Barts Health Trust in London are safe, but patients are at risk of harm as staffing levels are variable across services and equipment is not always easily available.
The Care Quality Commission (CQC) inspected the Royal London Hospital, Whipps Cross University Hospital, Newham University Hospital, the London Chest Hospital, St Bartholomew’s Hospital, Mile End Hospital, the Barkantine Birthing Centre and the Barking Birthing Centre in November.
An inspection team, including doctors, nurses and specialists, issued 15 compliance actions to the trust - these were divided across all the hospital sites with the exception of Mile End Hospital. Three warning notices issued to Whipps Cross Hospital in June were after this inspection.
“We found that Barts Health Trust was, in the main, providing services that were safe. My team identified a number of areas of good practice and the majority of patients we met were complimentary about the way they had been treated by staff,” CQC’s chief inspector of hospitals, Professor Sir Mike Richards, said.
“On a more negative note, we found that staff morale was low. Too many members of staff of all levels and across all sites came to us to express their concerns about being bullied, and many only agreed to speak to us in confidence. The trust needs to take action to make sure people feel confident to speak up.
“Locally, the leadership of services is good, but there is a disconnect between the board and the ward. While the leadership team is well-established and cohesive, we found that it needs to be far more visible across all parts of the trust.”
In order to improve the trust must ensure that potential risks are acted upon, there are enough staff with the right skill mix on all wards to deliver safe and effective care and that equipment is readily available when needed, the CQC said.
It must also ensure that all patients get nutritious food in sufficient quantities and create better links between the executive board and the staff so they are listened to and will know that raising their concerns will make a difference. There should also be a zero tolerance approach to bullying, it added.
Learning from incidents took place on individual sites, but not always trust-wide, the inspectors noted. There were problems with patient flow through the hospitals, bed occupancy and discharge planning at both the Royal London Hospital and Whipps Cross University Hospital.
Most patients said that staff were caring and compassionate. The inspectors also noticed that people were being treated with dignity and respect but there were complaints some people did not feel listened to. Inspectors were contacted by a number of people who were dissatisfied with the trust’s response to their complaints.
The inspectors said there were strong standards in palliative care, which was compassionate and held in high regard by staff, patients and friends and family and good practice was also found in children’s services, particularly in relation to education and activities for children while in hospital.
Patients who had had a heart attack received equal treatment, whether admitted during the day or at night and there was also good support for relatives when patients were in a life-threatening situation or when difficult decisions needed to be made about continuing care.
Barts Health Trust was one of the first to be inspected under radical changes introduced by the CQC aimed at providing a more detailed picture of care in hospitals.
The CQC, which has presented its findings to the local Quality Summit, will continue to monitor the trust and is set to carry out further inspections of all of its services.
Professor Richards said: “Barts Health Trust is a very large, complex organisation, which plays a vital part in the life of many Londoners. I would encourage local people to read the individual reports on their local hospital or service as these give a detailed view of the care we saw being delivered.
As reported by Nursing Times, the trust carried out a controversial staffing review in October that proposed cutting some posts and downbanding others, which it said was in order for it to afford the introduction of a better skill mix ratio.
The trust originally proposed losing more than 300 whole time equivalent nursing posts but opted in the end for a reduction of around 150.
Royal College of Nursing London regional director Bernell Bussue said: “Today’s CQC report is right to highlight the care, compassion and commitment provided by staff at Barts Health in extremely difficult circumstances.
“However, the report repeats serious warnings about the staffing levels at Barts Health and says explicitly that problems with bullying, stress and low morale have to be addressed if the trust are to achieve their vision. It is hard to see how this is reconciled with the trust’s decision to cut 200 nursing posts before Christmas and cut pay for several hundred more.”
He added: “It is essential that nurses and other staff at Barts are now given the support and resources they need to continue providing quality care for patients in East London.”
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