A trust has been criticised by regulators after newly-qualified staff awaiting registration were found badged as nurses and providing care that should be done by registered staff.
The Care Quality Commission was so concerned by the findings that it took immediate action by imposing an urgent condition on the trust’s registration.
Mid Essex Hospital Services Trust, which runs Broomfield Hospital and Braintree Community Hospital, has been the subject of a series of inspections by the regulator, the outcome of which were published today.
The trust was rated overall as “requires improvement” by the CQC and told it needed to improve on ensuring its services were safe, effective and well-led.
“While there were some areas of good practice, we were seriously concerned at what we found during our inspections and this is why we took immediate and urgent action at the trust”
It was rated “good” for whether services were caring, but “inadequate” for their responsiveness. Its accident and emergency service was also rated inadequate.
The CQC carried out an initial inspection in late November, after which the trust was issued with a warning to make immediate improvements.
But inspectors returned in February in response to concerns brought to the CQC’s attention about the trust’s emergency assessment unit. They found staff were providing nursing care who were not yet registered with the Nursing and Midwifery Council.
“We saw that staffing levels were not sufficient to provide safe care to patients with three registered nurses on duty,” said the CQC inspector’s report.
“We found that on the EAU pre-registration staff awaiting registration with the NMC working in nurse uniform, with ‘registered nurse’ ID badges, working with responsibility with for patient caseloads without NMC registration,” it stated.
In addition, the regulator found staff in the unit consistently had “poor awareness and practice” of infection prevention and control – wearing gloves and aprons while walking around the departments.
Appropriate care was not always provided to people with deteriorating conditions, or those with mental health concerns. There was a low return of audits on sepsis and pain, and guidance on specific conditions, such as the stroke and sepsis pathway, was not always followed.
“During 2015 we will be recruiting an additional 20 midwives and over 50 trained nursing and healthcare assistants to improve nursing care”
The report also said inspectors found a “blame culture” on the emergency assessment unit, with staff saying they did not feel listened to when they raised concerns about safe staffing levels.
Another follow-up inspection, carried out at the end of last month, suggested improvements were being made. It concluded that the unit was now “appropriately staffed” with qualified nurses and that pre-registration nurses were well supported and working in supernumerary roles.
However, the CQC’s report reinforced the fact that in future the trust must ensure only registered nurses are included in the nursing numbers and staffing numbers are maintained by suitably qualified and registered staff on the EAU.
Sir Mike Richards, the CQC’s chief inspector of hospitals, said it was “seriously concerned at what we found during our inspection” of the assessment unit. “We will continue to monitor its progress, which will include further inspections,” he said.
Mid Essex is a severely financially distressed trust, and was forecast to finish 2014-15 with a £32m deficit. It is also likely to be affected by a reconfiguration of acute services across Essex.
The CQC said Mid Essex had experienced an “unstable few years” because of management changes, which had “impacted on service flows, confidence and stability”.
It noted there were over 24,000 patients on waiting lists for a follow up outpatient appointment, with no risk assessment of individuals to ensure a longer wait was acceptable.
However, the CQC also identified some areas of “outstanding practice”, including the burns service, where outcomes were “comparable with the best in the world”.
Dr Ronan Fenton, the trust’s chief medical officer, said: “We have taken immediate action to ensure EAU care is delivered by suitably qualified staff, and all new nursing staff are undertaking compulsory drug administration assessments to ensure medicines are always administered in a timely and effective way.
“During 2015 we will be recruiting an additional 20 midwives and over 50 trained nursing and healthcare assistants to improve nursing care, nursing handovers and provide the time for learning in all ward areas and our maternity unit,” he added.