Staffing levels at troubled Mid Staffordshire Foundation Trust are barely adequate and could quickly become unsafe, according to the chief inspector of hospitals.
His warning follows an inspection of the trust’s clinical services at both Stafford and Cannock Chase hospitals by the Care Quality Commission this summer, which found staff were “fatigued” and fragile amid ongoing pressure on the organisation and uncertainty about its future.
“If recruitment or retention fell by even one or two people in some key posts, services would become unsafe”
At the time of the visit, services were judged to be safe but inspectors concluded staffing levels were “only just adequate” in some areas with senior managers scrabbling to fill nursing shifts and the situation hanging on a knife edge.
“Inspection teams were unanimous in their view that services would be unsustainable should any degree of winter pressures arise,” said Professor Sir Mike Richards.
“If recruitment or retention fell by even one or two people in some key posts, services would become unsafe,” he warned.
The CQC’s inspection report found the organisation, which was at the centre of a major inquiry into care failings, was struggling to recruit and retain staff because of its previous poor reputation and uncertainty about plans to transfer services to other providers.
In particular, the trust was “extremely challenged” when it came to nursing staff levels with just three quarters of its substantive registered nurses available to work, said the report.
The remaining 25% were not available due to vacancies, long-term sickness, maternity leave or suspension.
As a result, the trust had been forced to rely on bank and agency nurses “which potentially impacts on the quality and continuity of care”.
The trust’s agency spend was £9.4m between April 2011 and March 2012 – more than double other NHS organisations.
The report flags up the efforts the trust has been making to fill vacancies including offering financial incentives, running recruitment days and advertising in the local press, supermarkets and other public places.
In February the University Hospitals of North Staffordshire Trust (UHNS), which is due to take over the running of Stafford Hospital provided 20 experienced nurses of band six and above to help run wards for three months. But when this three-month period ended in May, 10 of these nurses were replaced “but not like for like”.
“So the trust feel they do not have the extra help in the areas where it is really needed,” says the report. “Although this support has been helpful the trust were disappointed that the initial support could not be sustained.”
Despite pressures on staffing, the report says the trust’s matrons have maintained a supernumerary role to reduce risks associated with significant levels of temporary staff, provide support and supervision and training.
Inspectors found “the commitment of all the staff we met was evident” and observed care delivered in a “compassionate, respectful and kind manner”.
“This report is a tribute to the commitment of our staff who remain dedicated to providing safe and compassionate care for all our patients”
Services at the trust are due to transfer from November when Cannock Chase will be taken over by the Royal Wolverhampton Hospital Trust and Stafford Hospital will go to UHNS.
But the CQC said it was “surprised and concerned” that a clear transition plan had yet to be put in place.
“The current uncertainty is contributing to the fatigue and fragility amongst staff,” says the report.
Lack of communication about the future and what would happen to their ward or department was a “source of frustration for many staff”, said the report.
However, while staff did not always understand communication from trust leaders the report found director of nursing Suzanne Banks “had developed positive and supportive relationships with nursing staff”.
Maggie Oldham, chief executive of Mid Staffordshire NHS Foundation Trust, said: “This report is a tribute to the commitment of our staff who remain dedicated to providing safe and compassionate care for all our patients, no matter how challenging their working environment becomes.
“I would like to thank them again for everything they continue to do,” she said.
Ms Oldham added: “The CQC has supported our frequently expressed view that through a huge effort we are maintaining safe services – but continuing difficulties in recruiting and retaining enough staff, and the impossibility of balancing our books means those services do not have a sustainable future within Mid Staffordshire NHS Foundation Trust.”