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Community trust told to review 'unmanageable' nurse caseloads

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A community trust in West London has been praised for making improvements but told to review the “unmanageable” caseloads of its nurses who have complained of feeling stressed and overworked.

Inspectors from the Care Quality Commission (CQC) found one community nurse at Hounslow and Richmond Community Healthcare NHS Trust was doing the job of three people, which was labelled “unsustainable”.

The trust’s overall rating was lifted from Requires Improvements to Good following an inspection in June and July 2018.

But the CQC raised concerns about the trust’s “high” qualified nurse and health visitor vacancy rate of 22%.

In a report published on Friday (see attached), inspectors urged the trust to review the “unmanageable” caseloads of some community nurses.

It added: “Nursing staff in Hounslow said the shortage of staff resulted in a heavy caseload, which sometimes made for a stressful working environment. Staff told us the workload felt relentless.”

Responding to the report, a trust spokeswoman said it had since reduced the adult registered nurse vacancy rate to 18.2% and had recently recruited 15 new district nurses.

Despite staffing concerns, the CQC’s latest analysis of the trust was positive on the whole.

“Staff told us the workload felt relentless”

CQC report

Hounslow and Richmond Community Healthcare was rated Good in all areas of inspection, which includes whether the trust was safe, effective, caring, responsive to people’s needs, and well-led.

The watchdog highlighted areas of outstanding practice. The trust’s intravenous therapy (IV) nurses demonstrated “innovation” by developing a way of caring for patients with the skin infection, cellulitis, in their own homes, it noted.

Patients were given portable infusion pumps that they could either wear around their necks or place in their pockets and that delivered a continuous dose of antibiotics over 24 hours.

The report noted: “This pathway meant that patients received effective care [and] did not need to attend an acute care setting, supporting their independence.

“In addition, the local NHS saved costs from shorter hospital stays and a more efficient use of nursing services.

“This approach meant the IV team only had to visit each patient for 30 minutes a day and patients only had to attend hospital once a week for medical check-ups and a new supply of pre-filled pumps.”

“There has been an all-round improvement at Hounslow and Richmond Community Healthcare NHS Trust”

Ted Baker

Hounslow and Richmond Community Healthcare was also the first trust to use an “innovative” Wound Care Buddy app, the CQC said.

The trust won an award for the use of the app, which acts as an online electronic guide to help staff determine the best way to treat patients’ wounds in their homes.

“The app gave staff instant access to wound care management and treatment planning information,” the report said.

“The app enabled staff to obtain advice from senior and specialist staff, which helped them assess and identify the correct grading and possible deterioration.”

The health watchdog also praised the trust for employing link nurses with a specialist interest in dementia and learning difficulties.

Relatives of children receiving end-of-life care told inspectors that the trust’s staff were their “lifeline during periods of distress”, the CQC said.

The physical, mental and social needs of patients were “holistically assessed” and their care was delivered in line with legislation, standards and evidence-based guidance, the report added.

Multidisciplinary working was “strong” across the services and staff were “kind, caring and treated patients with dignity and respect”.

Ted Baker

edward ted baker

Ted Baker

Professor Ted Baker, chief inspector of hospitals at the CQC, said: “There has been an all-round improvement at Hounslow and Richmond Community Healthcare NHS Trust and I’m pleased to see the overall rating has now improved to Good.”

Hounslow and Richmond Community Healthcare chief executive, Patricia Wright, said trust leaders were “absolutely delighted” with the result of the inspection, adding that they were “particularly pleased” that the CQC found some examples of outstanding care.

The trust provides community healthcare services for around 515,000 people living in the London boroughs of Hounslow and Richmond-upon-Thames including inpatient rehabilitation; community district nursing; health visiting; physiotherapy; and speech and language therapy.

It works from 15 sites, including Hounslow Urgent Care Centre at West Middlesex Hospital; Teddington Memorial Hospital, which has an inpatient unit and an urgent treatment centre; and Thames House, the headquarters for a range of community services delivered at clinics and health centres across Hounslow and Richmond boroughs.

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