Nurse shortages at a struggling acute trust are leading to staff “burn out” and high sickness rates, the health watchdog has warned.
The Care Quality Commission (CQC) also found that not enough nurses at North Cumbria University Hospitals NHS Trust were completing mandatory training including in life support.
“We do recognise that recruitment remains a long running challenge for the trust”
Professor Ted Baker
The concerns were raised following an inspection in July and August this year.
In a report published last week (see PDF attached below), the CQC gave the trust an overall rating of “requires improvement”.
The trust runs acute services at Cumberland Infirmary in Carlisle and West Cumberland Hospital in Whitehaven as well as maternity services at Penrith Community Hospital.
During this visit, the CQC assessed urgent and emergency care, medical care, surgery, maternity and children and young people’s services.
The inspectors found “registered nurse staffing shortfalls and registered nurse vacancies” on all wards.
They warned that “several” registered nurse shifts had remained unfilled despite the trust implementing “escalation processes”.
They added: “Nursing staff sickness was also prevalent across wards with several wards having teams that were described as ‘burnt out’.”
Additional staffing support was not always available for wards with more complex patients such as those who behavioural problems or aggressive tendencies, the inspectors said.
They highlighted that the electronic systems for recording staffing levels and patient acuity was not used consistently throughout the trust.
“Our CQC report shows that we have made some significant improvements since the last inspection in 2017 despite the pressures our services are under”
Mentally unwell patients experienced long delays in the emergency department while they waited for specialists to attend from the local mental health trust.
Nursing and medical staff were failing to hit the trust’s 95% compliance target for mandatory training, with the rate for immediate life support “particularly low”.
The CQC found “serious incidents” had occurred due to delays in treatment for patients with sepsis, diabetic ketoacidosis (DKA) and stroke. While acknowledging that the trust was “aware” of the problems and had implemented new processes to deal with them, inspectors said they had not been embedded at the time of their visit.
In the trust’s maternity services, 10% of women at the time of inspection did not receive one-to-one care in labour.
The watchdog also raised concerns about patient flow in the emergency department, with a rising number of people waiting longer than four hours from decision to admit to admission.
However, on a positive note, the inspectors found that staff worked hard to deliver the best care they could for patients.
They added: “Patients were supported by staff who were kind and compassionate despite being under pressure.”
Staff were found to have understood their responsibilities in relation to reporting incidents and duty of candour.
Inspectors also noticed an improvement in staff morale within areas of the trust.
The inspectors added that midwifery and medical staff worked well together to ensure women received the best care.
The inspectors highlighted that the trust had taken “appropriate action to manage and mitigate risk” in relation to nurse staffing in children and young people’s services.
The trust was rated as “requires improvement” in the areas of safety, effectiveness, responsiveness and leadership, but was deemed “good” in caring.
Of the services inspected during the visit, the CQC rated urgent and emergency care as “requires improvement”, medical care as “requires improvement”, surgery as “good”, maternity as “good” and children and young people as “good”.
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The chief inspector of hospitals, Professor Ted Baker, said he was concerned that patients were being left for too long without treatment in Cumberland Infirmary and West Cumberland Hospital but added that staff were “clearly working hard to deliver the best care they could under pressure”.
He said: “We do recognise that recruitment remains a long running challenge for the trust and I am satisfied that the leadership team are responding to the concerns we have raised. The trust has come a long way but further improvements are needed.”
Professor Baker added the CQC would continue to monitor the trust closely and would return in due course to reinspect its services.
Stephen Eames, chief executive at North Cumbria University Hospitals NHS Trust, said: “Our CQC report shows that we have made some significant improvements since the last inspection in 2017 despite the pressures our services are under.”
He said the “good” rating for the caring domain was a “testament to our hardworking staff”.
However, he said the trust recognised that there were still areas where further improvement was required, including nurse shortages.
He said since the inspection the trust’s nursing vacancy rated had “continued to decrease” due to escalating efforts to fill gaps such as attending job fairs across the country.
A trust spokeswoman said that mandatory training issues highlighted by the CQC had since been addressed.
She added senior nursing leadership team reviewed the trust’s nurse staffing levels on a daily basis.