Shropshire Community Health NHS Trust has been told to review its nurse staffing levels to ensure they “meet patients’ needs” by the Care Quality Commission.
The CQC has this week rated the trust overall as “requires improvement”, noting four key areas in need of attention, including staffing.
“There were insufficient numbers of suitably qualified, competent, skilled and experienced staff”
Staffing levels and skill mix must be reviewed in community adult nursing, child and adolescent mental health services and minor injury services, said the CQC in its report on the trust, which was published on Wednesday.
It becomes the second community trust this week to be warned about staffing levels by the regulator, along with Hounslow and Richmond Community Healthcare NHS Trust in London.
In addition to staffing, the trust was told it must develop and implement an overall vision and strategy for end of life care services, and review its admission criteria for community hospitals.
The trust was also warned to ensure that when local social care arrangements were required for a patient’s discharge, further collaborative working was required.
”We will use this report to continue to drive that improvement”
Shropshire Community Health was inspected in March. It was rated as “good” for being caring but as “requires improvement” for being safe, effective, responsive and well-led.
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “There were insufficient numbers of suitably qualified, competent, skilled and experienced staff to meet the needs of people using the service within the children and adolescent mental health service’s learning disability team.
“Increased patient acuity in the community hospitals was not considered when staffing levels were planned so patients requiring support and assistance did not always receive this appropriately,” he said.
“Staffing and skill mix levels within each community nursing team were not reviewed systematically and at regular intervals to ensure that patients’ needs were met,” said Sir Mike.
Sir Mike Richards
He added that the trust had no strategy for end of life care, with governance systems and processes insufficient to “assess, monitor and improve the quality and safety”.
“In addition, some staff’s understanding of the arrangements to enable quick identification of a deteriorating patient especially children in the minor injuries unit were not consistently in place across all four units,” he said.
However, the inspectors noted that they witnessed some good practice across the trust, especially around tissue viability.
For example, photographs of pressure ulcer and skin damage were reviewed, which enabled tissue viability nurses to provide timely advice on treatment required to prevent further harm.
The tissue viability service had also demonstrated that changes to two-layer compression bandaging did not compromise wound healing, meaning patient comfort increased and provided cost savings to the trust.
Meanwhile, the inspectors highlighted that the trust effectively used telemedicine to help patients living in very rural areas remain at home, and that its diabetes patient education programme provided “excellent” outcomes for the management of the condition.
Sir Mike also highlighted that staff across all services treated patients with “kindness, dignity and respect”. In addition, he praised the trust’s Admiral nurses in Telford who ran workshops for carers of people living with dementia.
“They provided opportunities for carers to share their experiences and offered training on areas such as communication and nutrition,” he said. “The workshops also featured guest speakers giving advice on legal and practical issues.”
CQC warns community provider over staffing
Trust chief executive Jan Ditheridge “We know there is more work to do to achieve at least ‘good’ in some of our other services and we will use this report to continue to drive that improvement.
“We must not forget we have highly skilled, committed staff working in challenging environments, doing amazing things every day,” she said.
“Our 1,600 members of staff deliver services that have 750,000 patient contacts every year from more than 110 sites spread across an area of nearly 1,350 square miles, which is a significant challenge for a small NHS trust,” she added.
Shropshire Community Health NHS Trust provides a range of community-based health services to around 455,000 adults and children in Shropshire, Telford and Wrekin.