There are still too few nurses at Mid Staffordshire hospital and a need to change its culture to improve care, according to a review by the government’s top emergency care advisor.
Sir George Alberti, the government’s national clinical director for emergency access, carried out the review following a highly critical investigation by the Healthcare Commission.
The commission found emergency care was unsafe at the hospital, run by Mid Staffordshire Hospital NHS Foundation Trust, because of a lack of staff and equipment.
Sir George’s review says that there have been significant improvements since the original investigation, which began in 2007 and care is now safe.
There is a nurse triage every day at the unit from 9am to 10pm, with eight emergency nurse practitioners and a matron in charge.
However Sir George said that nurse staffing levels were still ‘unsatisfactory’ in the accident and emergency department.
There are still problems at the trust’s Emergency Assessment Unit for medical admissions, Sir George said.
A lack of beds means the unit is always full and there are insufficient nurses to manage an increased bed capacity from 37 to 49.
Referrals from GPs always go through the A&E unit, Sir George says, contrary to good practice that allows them to be referred straight to the unit to speed the patients’ journey through hospital.
Patients still remain longer than necessary in EAU and Sir George recommends a 48-hour time limit, with 60% of patients going home and the remainder being transferred to the appropriate medical ward.
Adverse publicity from the Healthcare Commission’s report has deterred qualified staff from working on the hospital’s medical wards 10,11 and 12.
Sickness absence and unfilled vacancies result in a 50:50 ratio of qualified to unqualified staff, lower than the 60:40 ratio recommended by Sir George.
He writes: ‘There continues to be a major need for improvement with regard to nursing at the trust.
‘Many of the problems I heard about relate directly to bedside care.
‘I heard several harrowing patient experiences that had occurred in the last three months. My view is that this relates in part to poor staffing numbers.’
Morale was poor and staff said they were unable to do a good job because of a lack of time and training.
‘In my view, they have been under pressure for so long that “adequate” care is seen to be good enough. ‘Overall there needs to be a swift change from a “make do” culture to a “can do” culture, particularly on the wards.’