A “significant” shortage of nurses, which saw one member of staff caring for 20 patients on one ward, has been exposed at Hillingdon Hospitals NHS Foundation Trust, following an inspection.
The trust was rated as “requires improvement” overall by the Care Quality Commission, but inspectors highlighted the safety of its services as being “inadequate” due to problems including staffing levels.
During visits to the London trust in October, inspectors found the trust had a “committed” workforce but said the organisation must address the risks associated with the “numerous staffing establishment shortages” across the trust’s two hospitals, Mount Vernon and Hillingdon.
In its report on Hillingdon’s medical care services, published today, the CQC found a ward with one qualified nurse covering 20 patients before two nurses eventually joined after being requested from other wards.
It also noted a ward with two nurses on it that was being staffed purely by temporary workers.
“The trust had failed to take sufficient action on a number of matters of patient safety which they had already identified as presenting a risk”
Sir Mike Richards
Meanwhile, the accident and emergency department was down on nursing staff by around 25%, said the CQC report.
Inspectors also found that “until recently, the paediatric emergency department had only two paediatric trained nurses”. However, the trust has now ensured paediatric-trained staff were available on every shift.
At Mount Vernon, a reliance on non-permanent workers was also identified – with two thirds of nursing staff on the elderly care ward being agency employees, said the report.
It concluded the trust should confirm its permanent bed capacity and establish projected staffing levels based on that figure to ensure safe and effective care.
The CQC was also concerned by the trust’s failure to comply with infection prevention and control standards.
It observed equipment that was labelled as being cleaned when it was not – such as a urine-stained commode in the clinical decisions unit – and a failure by staff to intervene when a parent washed a child who had diarrhoea in a hand-wash sink beside a cubicle in the paediatric emergency department.
Training in infection control and on other standards was also found to be poor in some services.
However, the regulator did note areas of good practice from staff such as nurse practitioners in the minor injuries unit, who made direct referrals to specialities both internally and externally, including to specialists.
“Inspectors praised our staff for their commitment, compassion and desire to provide high standards of care”
Hillingdon Hospitals FT
Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “When we inspected the hospitals run by the Hillingdon Hospitals NHS Foundation Trust, we saw that the trust had failed to take sufficient action on a number of matters of patient safety which they had already identified as presenting a risk.
“We saw that the workforce at the trust was committed and we saw some examples of good practice,” he said. “The trust must build on these areas and work harder on managing risks to patients effectively.”
The trust said that following the inspection it had raised standards around infection control and cleanliness, and had stepped up its ongoing recruitment drive to increase permanent staff.
It said it believed it ran safe hospitals, but was “determined” to improve.
Chief executive Shane DeGaris said: “We aim to provide the highest standards of care to all our patients and we will use this report to help us make improvements wherever they are needed.
“The inspectors recognised and praised our staff for their commitment, compassion and desire to provide high standards of care to patients…This is a solid foundation for us to make the improvements that need to be made,” he said.