Junior nursing staff at Norfolk and Norwich University Hospital felt “bullied” into accepting patients onto their wards at night, according to a report by the Care Quality Commission.
The regulator inspected the hospital, run by Norfolk and Norwich University Hospitals NHS Foundation Trust, “after a number of whistleblowing contacts” in relation to staffing issues.
“A number of staff told us that they felt ‘bullied’ to take patients that they felt were not appropriate for their area”
These included regular movement of staff between wards to fill gaps in rotas, insufficient staff in some areas including medical wards, maternity and children’s services, and allegations of bullying, noted Edward Baker, the CQC’s chief inspector of hospitals in a letter summarising the visit.
During their visit in April, CQC inspectors concluded that some of the concerns previously raised by whistleblowers remained, with staffing at night being a particular challenge.
Wards had less nursing cover than planned with “frequent movement of staff between wards to manage shortfalls of shifts”, said their report, which was published by the regulator on 10 August.
“Staff also raised concerns regarding skill mix, particularly when staff were moved to other wards at night,” said the report.
Meanwhile, there was some evidence that staff were being pressured into accepting patients onto wards when they did not think it was appropriate.
“A number of staff told us that they felt ‘bullied’ to take patients that they felt were not appropriate for their area,” said the CQC inspectors in their report.
“This was predominantly out of hours,” said the CQC. “Matrons were able to advocate for junior staff during the day but when not available, staff felt under increased pressure to take these patients.”
“We recognise that there are areas that still require improvement”
However, inspectors went on to state that they held a “positive discussion” with the trust on what the organisation was doing to address the issues raised by the whistleblowers.
They also found the hospital, which is rated “requires improvement” overall by the CQC, had made progress in recruiting extra nursing staff and deploying other staff to reduce risks to patients.
However, the organisation was told it still needed to ensure sufficient staffing and skill mix at all times.
The report noted that, at the point of inspection, it employed 1,935 nursing staff against an establishment of 2,221.
In addition, some safety concerns were highlighted, including that the proportion of staff completing essential training, including safeguarding training, was “well below” target in some areas.
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Inspectors also found surgical safety checks were not being done, despite four “never events” in surgery – two involving “wrong site” surgery.
In addition, the report noted that “almost all” staff who inspectors spoke to were unaware of the trust’s “speak up guardians”, whose role was to support staff to raise concerns.
But the inspectors – who focused on medicine, surgery, children’s and young people services, maternity and gynaecology – also found much to praise at the trust.
This included good examples of multi-disciplinary working and the “excellent” attitude of staff. “All staff were helpful, open and caring in their manner. We found staff to be very ‘upbeat’ locally within ward and clinical teams,” said the report.
Junior nurses in the trust’s medical division described it as a good place to start their career and said they got good support and felt valued by managers. Meanwhile, inspectors also noted a “positive and calm feeling within the team, even during busy periods”.
Other areas of “outstanding” practice highlighted by the CQC included the amount of active clinical research taking place throughout the children and young people’s service, placing it “at the forefront of clinical innovation”.
Inspectors also flagged up innovative training for midwives and others using simulation technology that can replicate changes in a baby’s heartbeat during labour.
Responding to the CQC document, Mark Davies, the trust’s chief executive, said the report documented “significant progress” at the organisation.
“Our staff are amazing and the good progress we are making on our journey of improvement is because of their dedication and professionalism,” he said.
“Of course, we recognise that there are areas that still require improvement and we are committed to working together with teams to make this happen,” he said.
Regarding the highlighting of bullying claims in the summary of the CQC report, a trust spokeswoman said: “In the CQC report’s 87 pages bullying is hardly mentioned.
“The CQC last year recognised the improvement in culture after the leadership changes, and in this current report made very positive comments in paediatrics, source of some initial concerns,” she said.
“We recognise that the hospital is working under significant daily operational pressure, and we are committed to ensuring that staff and are equipped with the right skills and training to deal with this by further encouraging a culture of respect and resilience,” she told Nursing Times.
She added: “Staff are doing a great job operationally – cancelled operations are down 50% compared with last year, the number of patients admitted as emergencies has drastically reduced, and therefore patient flow is much better and staff should be congratulated on all their efforts.”
The hospital opened in late 2001, having been built under a private finance initiative. It has 913 acute beds and 210 day-case beds.
The trust’s last comprehensive inspection by the CQC was carried out in November 2015 when it was rated as “requires improvement”.