The “inadequate” rating given to Hinchingbrooke hospital by healthcare inspectors was a “knife in the heart” for nurses who work there, according to its director of nursing.
In an interview with Nursing Times, Deirdre Fowler stressed her deep disappointment with the Care Quality Commission’s conclusions, after Hinchingbrooke Health and Care Trust became the first NHS provider to be rated “inadequate” for how caring it was towards patients.
“When we hear the CQC has concerns about the nursing staff being caring that is a knife in the heart for any nurse or midwife”
In its report, the CQC identified examples of patients who could not reach call bells, with one telling inspectors they had soiled themselves waiting for assistance, and that drinks were also often left out of reach.
“It doesn’t reflect what I see on a day to day basis walking around the hospital,” said Ms Fowler. “The majority of our nurses are caring, committed and dedicated nurses. When we hear the CQC has concerns about the nursing staff being caring that is a knife in the heart for any nurse or midwife.
“We will use the report as an opportunity to focus our minds on the quality improvements ahead of us, but obviously we are very disappointed,” she told Nursing Times.
It subsequently recommended the Cambridgeshire trust be placed in special measures, the support scheme for failing organisations.
Just hours before, the independent provider that runs the trust, Circle Partnership, had announced it would be pulling out of its controversial 10-year contract.
Ms Fowler admitted Circle’s decision to leave was “startling”, but said there was “a spirit of resilience” at the trust that would enable it to move forward.
However, union representatives have warned the trust could face a mass exodus of staff in the light of the double whammy of the CQC’s criticisms and Circle’s unexpected decision to withdraw.
“The mood is one of shock,” said Karen Webb, regional director for the Royal College of Nursing’s Eastern region. “There’s now a lot of anxiety and worry about what the future holds for the hospital, particularly around the security of people’s jobs,” she said.
Ms Webb said nurses had told her they were “appalled” by the CQC report, but it was “tinged with anger and disappointment” over ongoing staffing issues. “They are feeling very much blamed for a situation they don’t believe is of their making,” said Ms Webb.
“They are saying in some ways the quality issues are in part due to fact there are just not enough qualified nurses who are permanent members of staff to give the care patients deserve and require,” she told Nursing Times.
Ms Fowler agreed that, like many other trusts up and down the country, the organisation had struggled to recruit to substantive posts but claimed its staffing situation was under control.
Currently the trust has about 40 whole-time equivalent nurse vacancies and a 10% turnover in nursing staff, which has come down from 13% in the last six months.
“There’s now a lot of anxiety and worry about what the future holds for the hospital, particularly around job security”
Ms Fowler said there was already a clear recruitment plan in place, following a review of existing nursing and midwifery establishments. This had identified a need for more healthcare assistants and the board had also agreed to invest £1.2m in nursing teams, which Ms Fowler said “will hopefully see us come to full recruitment in June”.
Ms Fowler, who joined the trust last May, said she did not anticipate significant staff losses as a result of recent events. “One thing I have been incredibly impressed with since I arrived is the staff loyalty in Hinchingbrooke,” she said.
She noted positive changes that had taken place since the CQC visit, including the creation of a “specialist nurse congress” – quarterly meetings between specialist nurses and the senior nursing team – and the introduction of seven-day working for senior nurse managers.
“We now have a designated senior nurse at weekends to make sure the quality agenda is maintained,” said Ms Fowler.
She highlighted that her key priorities were to raise the profile of nurses and midwives within the trust, and “maintaining morale in a period of intense activity and challenge in the NHS”.
However, the RCN has stressed the need for better communication and information during the transition to new management arrangements, while Circle completes its withdrawal. Ms Webb said there were fears the hospital could close altogether or lose its A&E.
She claimed transparency had been “completely lacking” since the start of the “whole sorry business of handing over an NHS trust to an independent provider”. However, Ms Webb said she was hopeful the relationships would improve after a positive discussion with Ms Fowler, who has committed to ensuring good communication with staff.
Circle took over the struggling hospital in early 2012, after winning the first franchise involving a private company running an NHS acute provider. It has become a totem for private sector involvement in the health service.
But on 9 January Circle chief executive Steve Melton said that “after considerable thought and with great regret” the company had concluded that its involvement in Hinchingbrooke “does not have a sustainable future in its existing form”.