Nursing shortages have been highlighted at Chelsea and Westminster Hospital NHS Trust in London following inspections by the Care Quality Commission, which has warned the trust overall “requires improvement”.
During its inspections in July, the regulator found the hospital trust – which employs more than 3,000 staff – had nurse shortages in the acute assessment unit, children’s services and surgery departments.
It also said some staff members reported an unresponsive culture at the trust when they tried to raise concerns about significant workforce shortages.
“While staff were caring and compassionate, some of the services we looked at required improvement in some areas”
Inspectors were told by senior staff in children’s services that 200 whole time equivalent nursing staff were in post out of a budgeted 247 posts.
They also found that in the neo-natal intensive care unit there was a 26% vacancy rate, with a reliance on agency staff to fill posts.
Staff on the wards told inspectors that beds were regularly closed due to staff shortages but nothing was being done to make changes, said the regulator. Workers also claimed that a culture of bullying existed in the neonatal care department, which the trust was taking action to address.
The CQC concluded that Chelsea Children’s Hospital should monitor nurse staffing levels so that the levels and skills mix were in line with Royal College of Nursing guidelines.
Nurse staffing levels in the acute assessment unit were also found to be below the level recommended by the RCN, said the regulator in its report on the trust.
Inspectors observed an average nurse to patient staffing ratio for acutely ill patients that required close monitoring of one to four – when the RCN requires one to two for patients with moderate dependency. Some staff reported this as being unsafe, said the CQC.
Meanwhile, midwives reported that they frequently missed breaks and had to stay late after the end of their shift.
Also of concern in the maternity department was the high proportion of junior midwives – which mothers had reported prior to inspection, and the CQC found to be higher than the national average during its visit.
However, a shortage of midwives at the trust had recently been addressed, said the CQC, noting that around 22 midwives had been recruited to be in post by the end of the year.
Overall maternity and gynaecology services were rated as “good”. Staff were caring and compassionate – something reflected across the whole trust – and women were treated with dignity and respect, said the CQC.
The inspectors added: “Women had choices during birth and were involved in decisions about their care and treatment. Staff on the unit were polite and friendly.”
One of the areas of outstanding practice within the trust was neonatal palliative care nursing, which had developed national standards, noted the regulator.
Overall, improvements at the trust should focus on a number of areas, said the CQC.
This should include ensuring nurse staffing levels are compliant with safer staffing levels guidance, patient records and care plans are accessible to all staff – including agency workers – and that regular checks of medicines are undertaken.
“We are involving staff in developing our action plan to address each recommendation”
Professor Sir Mike Richards, CQC chief inspector of hospitals, said: “When we inspected Chelsea and Westminster Hospital we found that, while staff were caring and compassionate, some of the services we looked at required improvement in some areas.
“Our overall findings highlight the level of variation that can be found within the same organisation,” he said. “We hope that the trust can quickly build on the good work that we found in most areas to consistently deliver good services across the board.”
The trust’s chief executive Tony Bell said he was disappointed with the CQC’s rating, but that the areas highlighted for improvement could be resolved swiftly.
Trust chief nurse Elizabeth McManus said: “I am sure that people using any of our services will be pleased to hear that the caring nature of our services are viewed by the CQC inspectors and patients as ‘good’.
“We can and will keep improving services for patients,” she said. “We fully take on board the CQC’s feedback on the areas in which we need to make improvements and have already actioned some of the areas highlighted in the report.
She added: “We are involving staff in developing our action plan to address each recommendation as we want to be good or outstanding across the board in our next inspection.”
Last week, a government competition inquiry was launched into Chelsea and Westminster Hospital NHS Foundation Trust over it attempts to merge with West Middlesex University Hospital NHS Trust.