University Hospital of South Manchester NHS Foundation Trust has been told it must make improvements to services, following an inspection by the Care Quality Commission.
As well as concerns about high nurse vacancy and sickness rates, some of the criticism centred on the trust’s recent integration of community nursing teams with social service staff into four patches.
“We were concerned at the recent increase in sickness levels amongst the nursing staff”
The move, intended to promote integrated nursing care provision, included district nursing, active case management and rapid response with a single point of access for new and urgent referrals.
However, the CQC said the integration of community nursing services had “resulted in a reduction in senior roles and experienced staff leaving the service”.
“We were not assured that staff that had been redeployed into new roles had the competencies to fulfil their role and at the time of our inspection the trust had not performed a training needs analysis to understand the gaps,” the CQC’s report warned.
Across the trust, the regulator noted that the nurse staffing vacancies rate was high as was turnover, and the sickness absence rates had increased since October 2015 to 4.29%.
Nurse staffing vacancies were raised at the time of inspection across both acute and the community services, with 250 vacancies against an expected rate of between 100 and 150, said the CQC.
Midwifery staffing was at a ratio of 1:31 at the time of the inspection, worse than the expected rate, but the trust was maintaining a 1:1 ratio in labour.
Overall, the organisation was again rated as “requires improvement”, repeating its previous inspection result.
When broken down by section, it was rated as “requires improvement” for safety, responsiveness and being well led, and as “good” for being effectiveness and caring.
Wythenshawe hospital was individually rated as “requires improvement”, and Withington hospital as “good”. Community services within the trust were rated overall as “requires improvement”.
A team of inspectors visited the trust from 26 to 29 January 2016.
Their other key findings included that the trust must ensure that equipment checks in resuscitation areas at Wythenshawe Hospital were completed daily and followed up when needed.
Meanwhile, in medicine, it must ensure that staffing levels were “appropriate to meet the needs of patients across the medical services and ensure there is an appropriate skill mix on each shift”
The trust was also warned to remove the risk of ligature from ceiling vents in the mental health room, in line with guidance from the Royal College of Emergency Medicine.
The inspectors noted that the trust was undergoing a transition in leadership, with a new executive team in place and an interim chief executive.
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “In recent months there have been a number of significant senior executive changes which had affected the long term strategy and staff morale.
“We found that nurse vacancies were high and we were concerned at the recent increase in sickness levels amongst the nursing staff,” he said.
“Although we found some improvements in urgent care services, such as in the treatment of patients with sepsis, we were less assured about the work done to follow up audits of services in other areas such as care for children suffering fits, or mental healthcare,” said Sir Mike.
Sir Mike Richards
But he added: “I am hopeful that the new executive board will translate their vision and strategy into real improvement by the time of our next inspection.”
However, the regulator found cleanliness and infection control to be “good”. Staff demonstrated good infection control and inspectors could see locations were clean, said the CQC, adding that the rate of cases of Clostridium difficile was within the expected range.
The CQC also noted there were a number of areas of outstanding practice. These included the bereavement midwife at Wythenshawe Hospital who had been nominated for the national Butterfly awards for her work providing bereavement support.
A rapid access clinic had been introduced for menstrual disorders and post-menopausal bleeding to meet demand was also commended, as was the cystic fibrosis team’s innovative use of a database that provided focussed and early intervention to prevent further patient deterioration.