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CQC criticises trust for letting unregistered staff do nurse tasks


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”

Mike Richards

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”

Ronan Fenton

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. 


Readers' comments (24)

  • michael stone

    Well done, CQC.

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  • So, who is going to do the necessary work of caring for patients.
    Who is going to do the washing of patients, the hydration of patients, the general, run of the mill, looking after the patients - the highly qualified nurses will be too busy saving lives.
    Who should we get to simply nurse the patients ?

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  • At last the CQC have teeth, now we can look forward to the Public and Private Sectors being dealt with more evenly. Although I do not think that a Nursing Home would have got away with a warning. I also think the media (BBC) should be more even in its approach so that the Public can get a balanced view point . If this was a Nursing home it would have been shut down immeadiately , no doubt about it.

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  • Washing dressing and general care of the needs of the patients is a vital nursing skill, and can be done by HCA's and nurses. However i understand where this article is coming from as i am a HCA and was approached several times by nurses asking to do BM's, something i had no 'proper' training on. I knew exactly how to do it from personal experience but i was looked down upon for not proceeding with the task at the time as i did not know if i was legally covered to do them. I also come across HCA's completing obs, which yes again they can physically carry out the tasks they are not difficult practically, but if these obs are not fully understood by the staff and/or they are not reported back to staff nurses, then gaps in communication occurs and even the possibility of delayed diagnosis/treatment. Without HCA's nurses could not fully perform their jobs BUT people should only work within their trained and/or legal limits and this covers students being given too much workload (so they are an extra pair of hands instead of learning) and post-graduate nurses being on the nursing team when they are not covered by the NMC.

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  • I have been qualified for 34 years. Due to family health problems I have chosen to work on the nurse bank. I have always accepted that for the convenience of choosing my working hours I will never earn more than the lower scale of Band 5.

    I always give 150% often not taking breaks and going home late. This past year I have worked more and more with agency staff who are not as loyal but earn over twice as much as I do and often more than the regular ward staff.

    Recently I worked with an agency HCA who was earning per hour a third more than I was. I had responsibility for the patients and for all the documentation associated with patient care. Pleasant as the person was I didn't feel her heart was in her work, she couldn't do observations,(I fully appreciate this should be a trained nurses task ) didn't seem concerned about pressure care or encouraging the patients with diet and fluids.

    I agree with the previous post, but there is something badly wrong in a system that is quite happy to pay temporary, unqualified staff more than registered nurses in order to tick boxes on safer staffing documents.

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  • Pussy

    Good God what kept them?

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  • Power to the CQC! Unregistered staff are preferable to disreputable employers. They cannot be held to account by the NMC simply because they are not registered with the NMC. So Corner-cutting, employers can use them to deliver substandard, unlawful care without fear of retribution - until now. Mid Essex is not alone in this practice. My only criticism of the CQC is that they do not have enough inspectors and so things are way too slow. Politicians listen up!

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  • As a HCA in the community (band 3) we do BMs, administer insulin, change male and female catheters, change medication patches, bowel management, wound care, continence assessments, manual Bps, venepunture, pac assessments, we make referrals to OTs, Social Care, complete sskin bundles, waterlows etc. We are all trained to do the above and I think some of the HCAs in hospitals would love the opportunity to do more interesting and nurse related jobs.

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  • It begs the question what is the point of RGN training?

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  • I'd have thought the bigger question is what on earth takes the NMC so long to process a registration on completion? It's not as if these new staff nurses are sneaking up on them for three years.

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