Mid Essex Hospital Services Trust has been given an official warning by the regulator after urgent care and emergency services at Broomfield Hospital in Chelmsford were yet again rated “inadequate” due to a series of problems including staff shortages.
The Care Quality Commission found the trust had failed to address concerns highlighted in previous visits with inspectors describing a struggling service with low morale and nurses “running to get their work done”.
“The medical and nursing teams in the emergency department were pressured and this caused their communication to break down”
CQC report on Broomfield’s emergency services
It issued a warning notice to the organisation after carrying out its third inspection in less than a year.
During a previous inspection, the regulator found newly-qualified staff awaiting registration badged as nurses and providing care that should be done by registered staff.
However, this time it said staff were appropriately qualified for the care they were providing, but there were nurse shortages throughout the emergency floor.
“Staff nurses were stressed and running to get their work done,” said the CQC in its report on the trust.
Concerns about skill mix were also raised as many nurses were junior staff with limited experience in emergency medicine.
While inspectors rated services “good” for caring they found morale had been affected by what emergency staff described as a “blame culture”.
Inspectors found the emergency department was disorganised with patients often experiencing delays in care and treatment.
“The flow through the emergency department, the high number of staff vacancies and the arrangements to triage urgent cases still had an impact on care”
Infection control practices were poor and there were also ongoing concerns about the care and treatment of people with mental health conditions.
“During our inspection we saw that the staff were dedicated, passionate and caring towards their patients,” said the report. “However, they were not supported, and in some instances felt blamed for target performance issues, which affected their morale.”
Inspectors also found the pressure on staff was affecting multi-disciplinary working and witnessed doctors “speaking rudely” to nurses.
“We observed that the medical and nursing teams in the emergency department were pressured and this caused their communication and working relationship to break down at times,” said inspectors. “The episodes of frustration were often witnessed by patients.”
“We have invested in the staff and teams working in the [emergency] department with enhanced leadership support”
Dr Ronan Fenton
Chief inspector of hospitals professor Sir Mike Richards said: “I am concerned the trust has not taken sufficient action to address the requirements of our previous inspections, and that patients coming in to urgent and emergency services continue to experience a poor level of care and treatment.”
“The flow through the emergency department, the high number of staff vacancies and the arrangements to triage urgent cases still had an impact on the care patients received, which in some cases was poor,” he added.
The CQC has now asked the NHS Trust Development Authority to step in and provide support at executive level to ensure the organisation addresses long-standing quality and safety issues.
Meanwhile the trust has been warned it may face further enforcement action if it fails to make progress.
The trust’s medical director Dr Ronan Fenton said the trust was implementing a “robust” plan to deliver improvements.
“We have also invested in the staff and teams working in the [emergency] department with enhanced leadership support to the emergency and medical directorates which supports improved management of care for patients,” he said.
A clinical lead for the emergency assessment unit has been appointed and training for staff has been “enhanced”, while the trust was working closely with employees to build an open and supportive culture, he added.