Whipps Cross University Hospital in east London has been rated as inadequate by the Care Quality Commission, which noted “serious concerns” about poor leadership, culture of bullying and low staffing levels.
The majority of the hospital’s services – including urgent and emergency care, care for older people, children and young people, and outpatients – require “significant improvements”, said the regulator in a report published today.
“Barts Health Trust has not given sufficient priority to safety. We found frequent staff shortages and a reliance on agency and locum staff that increased the risk to patients”
The hospital is run by Barts Health NHS Trust, which confirmed it has been put into special measures, meaning it will receive support from regulators to turn its service around.
It is the largest trust in England – running six hospitals and employing 14,000 staff – but has recently struggled with finances and performance, and now has a planned deficit of £93m. A raft of senior managers, including its chief executive, chair and chief nurse – Professor Kay Riley – recently resigned.
The CQC noted more than 200 posts were cut across the trust in 2013 and several hundred more nursing staff were down-banded, which has had a “significant” impact on morale at the hospital.
However, on a positive note, staff were found to be caring in half of its eight services, and in particular the maternity and gynaecology services were highlighted for committed staff and examples of good practice.
But a high usage of agency nurses in Whipps Cross hospital’s emergency service in particular were noted, with day shifts frequently seeing 66% of nursing cover provided in this way.
A trust merger in 2012 had seen a significant number of experienced nurses leave. They had either not been replaced or their posts had been filled with more junior nurses, which had resulted in a negative culture within the department, said the CQC.
Most of the workers inspectors spoke to in the emergency department said they rarely took a break in a 12-hour shift due to time constraints.
“The trust must get a grip on what is happening here and on the low staff morale”
The CQC spoke with four patients who had been in the emergency department during at least one mealtime – with some having been there for more than 10 hours – and said they had not been offered anything to eat or drink, despite there being no medical reason for this.
A lack of skills due to the high use of temporary nurses was also noted by some staff – who reported some agency staff being unable to triage patients or give IVs .
Surgical wards were found to be experiencing similar problems, with three out of six not having a ward manager for up to three months and one had just one band 5 nurse covering 15 beds. Band 2 healthcare assistants were also found to be carrying out complex work, including care of tracheostomies and complex dressings.
Meanwhile, in the children’s service, there was a 40% vacancy rate for qualified nurses and 16% for unqualified nurses. An external review on the neonatal unit was conducted in October 2014, following a whistleblower raising concerns regarding staffing experience, knowledge and skills and action plan has been put in place.
Meanwhile, mandatory training for nurses fell far below the 90% target in many wards, with one having a completion rate of just 33% in infection control and basic life support.
In its assessment of older people’s care, the CQC found there was a high referral rate for patients with dementia to the specialist nurse, however many were not being screened for the condition.
Problems around capacity assessments for these patients – such as long waits for psychological assessments or them not taking place at all – were noted.
Issues with incident reporting were highlighted, with some staff saying they did not have time to report incidents and would not escalate inappropriate skills mix issues, due to fears of repercussions from senior staff.
“This report describes services that fall a long way short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross”
Professor Sir Mike Richards, CQC chief inspector of hospitals, said: “I note that many of the failings which we found on inspection in November 2013 are still not resolved. In some areas there has been little progress – and this has been affecting the quality and safety of patient care.
“We found frequent staff shortages and a reliance on agency and locum staff that increased the risk to patients,” he said. “The trust must get a grip on what is happening here and on the low staff morale.”
Barts chief exectuive Peter Morris said the trust had already taken steps to strengthen leadership at Whipps Cross, adding: “Barts Health is committed to ensuring the safety and welfare of every one of its patients.
“This report describes services that fall a long way short of what we aspire to. We are very sorry for the failings identified by the CQC in some of our services at Whipps Cross and we know the trust has a big challenge ahead.”
Responding to the decision by the NHS Trust Development Authority to place the trust into special measures, the Royal College of Nursing said organisations must “never again” see cuts to jobs and wages as a “safe or sustainable way to fix funding shortages in the NHS”.
It said the CQC report showed the extent of the pressures on staff working at Whipps Cross and that an “urgent” long term plan was required for the hospital, which should address a “historic culture of bullying”.