Solent NHS Trust has been told to address staffing shortages in its community nursing teams that are putting patients at risk, according to inspectors.
The trust, which provides a range of community services including community nursing, specialist nurses, health visiting and school nursing, was rated “requires improvement” overall, following visits by the Care Quality Commission in June and July this year.
“We have experienced challenges in ensuring adequate and timely recruitment of nurses”
CQC inspectors said they had identified many good areas of care. However, they found staff vacancies were affecting quality and “many services were experiencing difficulties in coping with demand”.
At the time of the inspection, there were significant vacancies in community nursing teams, especially in Portsmouth where rates of medication errors and pressure ulcers were getting worse.
In 2015, the trust reported 151 serious incidents with the majority – 57.6% – in community nursing and linked to pressure ulcers.
“Although bank and agency staff were requested, not all shifts were covered,” said the CQC’s inspection report.
“This affected the safety of patients waiting for visits, and staff who were concerned that their workload was too high to care for patients properly,” it said.
The lack of staff meant visits were being missed and often rescheduled several times, added the regulator’s report.
“This contravened information governance principles, and the NMC code of practice”
Meanwhile, the Portsmouth community nursing team was identified by managers as being among “highest risk” on the trust’s corporate risk register.
Inspectors also found vacancies in children and young people’s services had led to “higher than recommended health visitor caseloads in deprived areas”.
Their report called for a staffing review to ensure there are enough staff to deliver the healthy child programme, health visiting and school nursing services.
Other concerns included the fact staff did not always follow policies and procedures to safely manage medicines, and did not always assess and manage risks to patients.
One issue highlighted by inspectors was that most bank nurses did not have the password to electronic patient records and were dependent on substantive nursing staff to gain access to this important information.
“This contravened information governance principles, and the nursing and midwifery code of practice,” stated the CQC report.
The trust was rated “requires improvement” for providing services that are safe, effective and well-led. However, it achieved a “good” rating for being caring and responsive to people’s needs.
“Throughout the inspection, we witnessed many examples of kindness towards patients and their relatives, from well-motivated, committed staff,” said the report.
“We observed, for example, community nurses treated their patients with sensitivity, kindness, dignity and respect,” it said. “Patients and carers felt emotionally supported and reassured by the community nursing visits.”
Inspectors also praised strong multi-disciplinary working and the fact the trust was working well with other agencies to reduce hospital admissions and promote integrated care in the community.
In response, the trust said it was working hard to deal with vacancies and had successfully closed its “vacancy gap” from 40% to 7% in a short period of time.
“Like many other healthcare providers across the country, we have experienced challenges in ensuring adequate and timely recruitment of nurses and therapists,” said chief nurse Mandy Rayani.
“Considerable work continues to be undertaken in partnership with local universities and other providers to ensure that we are able to recruit, retain and train staff to respond to the care needs of the local communities we serve,” she said.
The trust’s recruitment efforts have included staging open days at trust sites and using social media to reach out to potential nursing staff.
“We have also strengthened our relationship with Portsmouth University as they launch their nursing degree and are working in partnership with local colleges for apprenticeships,” said Ms Rayani.
South coast community trust warned over staffing levels
The trust has recently recruited six “educators in practice” to work with nursing and allied health professional students on placements, with a view to attracting them into community roles.
“We have also created a dedicated role to establish work experience processes and work with the local job centre, voluntary agencies, schools and colleges to promote community roles,” said Ms Rayani.
She highlighted that the bank service had been “particularly effective” in helping cover staffing gaps, and the trust had been working with a number of agencies “to ensure sufficient numbers of staff are engaged to quickly respond to demand”.
Ms Rayani added that the trust had looked into the issue relating to bank staff’s access to clinical records following the inspection.
“We have determined the issue was primarily to do with established policies not being followed consistently in some services to enable bank staff to access records,” she said. “We are taking steps to bring the policies to the attention of staff and support timely access to key records.”