Leeds Community Healthcare Trust has been rated as “requires improvement” by the Care Quality Commission, after inspectors raised concerns about insufficient staffing levels and a “high reliance” on temporary staff.
The regulator said it was concerned about staffing levels across a number of services, but that the trust’s rehabilitation unit – the South Leeds Independence Centre (SLIC) – had particular problems with agency workers.
“Many of the staffing rotas we reviewed indicated that actual staff numbers per shift were less than the number required and planned for”
When it inspected the unit in November, the CQC found the care assistant workforce, which is employed by another organisation, was down by around a third from what it should have been.
“Although bank and agency staff were being used, this was affecting the continuity of care, and workload of the permanent staff that had to support the agency staff,” stated the CQC’s report on the trust.
Inspectors also found the trust’s child and adolescent mental health services had seen a reduction in staff due to budget cuts, changes in commissioning, and an increase in urgent referrals from local accident and emergency services.
This was resulting in increasing caseloads and an inability to deliver all the necessary services, they said.
Meanwhile, district nurses were found to be visiting a larger number of cases every day than was recommended, with twilight services in the community also “stretched”.
“We saw services where more needed to be done to make sure that care and treatment consistently met the required standard”
Inspectors found some district nurse were carrying out between 26 and 28 visits of 15 minutes face-to-face contact with a patient per day. The recommended amount is 16 to 22.
“Many of the staffing rotas we reviewed indicated that actual staff numbers per shift were less than the number required and planned for,” said the CQC report.
“In the twilight service, recent changes to neighbourhood teams had meant that teams were stretched and there was variation in caseload. In some cases up to 50% of shifts were being covered by bank staff,” it warned.
The trust’s children’s and family services were expected to recruit the number of health visitors they required to meet the government’s health visitor implementation plan.
But caseloads were “still above those recommended by Lord Laming [who conducted a review after the Baby P care failings] and the Community Practitioner and Health Visitor Association,” said the report.
“We are working hard on the two areas the inspectors found that we ‘require improvement’ “
However, school nurse levels were found to be sufficient for the local area.
Overall, inspectors found staff treated patients with compassion, kindness, dignity and respect and that there was a good incident reporting culture.
The CQC has called for the trust to review staffing levels in adult community teams and to ensure the suitable levels and skill mix are provided in the SLIC.
Ellen Armistead, CQC deputy chief inspector of hospitals and lead for community health services, said: “When we inspected the services run by Leeds Community NHS Foundation Trust, we saw a variation in the safety and quality of treatment and care provided.
“There were several examples of good practice in services which were really going the extra mile to improve the support that they provided to people,” she said. “However, we also saw other services where more needed to be done to make sure that care and treatment consistently met the required standard.”
Thea Stein, chief executive of Leeds Community Healthcare Trust, said there was “ongoing work” to recruit staff to the organisation and reduce the use of agency and bank staff, adding that this was a national problem.
“We were very pleased that the CQC inspection report highlights our services are rated as ‘good’ in three areas – caring, effective and well-led – and are working hard on the two areas the inspectors found that we ‘require improvement’ – safe and responsive,” she said.