The Royal College of Nursing has called for a long-term solution to staffing issues that are damaging performance at a London accident and emergency department, following a report from regulators.
The Care Quality Commission has rated North Middlesex University Hospital NHS Trust’s A&E department “inadequate”, but said it had “turned a corner” over the last few months.
“Nurses in the emergency department have been raising concerns… for some time”
The north east London trust was inspected by the CQC back in April in response to concerns raised by Health Education England, the General Medical Council, MPs and the media.
HEE had threatened to withdraw trainee medics from the trust, saying they were being asked to undertake work they were not prepared for and did not have proper supervision. North Middlesex has had difficulty recruiting middle-grade and consultant emergency department doctors.
The report released today rated the service “inadequate” – the lowest possible rating – but also said that when inspectors revisited the trust last week they found evidence of progress.
CQC chief inspector of hospitals Sir Mike Richards said: “The evidence from our latest inspection last week is that North Middlesex’s emergency department has turned a corner, but there is still much more that needs to be done. We will be watching their progress very closely.”
The latest publicly-available A&E statistics, for April, put the trust’s performance at 72.6% against the target that 95% of patients be seen within four hours. This is the lowest of any trust in the country, but an improvement on its position in February.
After the April inspection, the CQC said the A&E department had not had a clinical director for more than six months and that “trust management was seen as overbearing and unsupportive to staff. The culture meant that staff did not feel comfortable in raising concerns”.
A new clinical director was appointed to run the emergency department last week.
The Royal Free London NHS Foundation Trust signed a memorandum of understanding with North Middlesex in March to explore closer working.
Meanwhile, NHS Improvement has been working with other trusts to try and persuade them to lend emergency department staff to North Middlesex.
However, the RCN put the trust’s problems down to the downgrading of a neighbouring A&E several years ago and called on managers to listen to the concerns of staff.
RCN London regional director Bernell Bussue said: “The downgrading of Chase Farm A&E to an Urgent Care Centre in 2013 had significant knock on effects for North Middlesex University Hospital where patient demand jumped almost immediately.
“The hospital has had serious and understandable challenges with staffing the emergency department ever since,” he said.
“Nurses in the emergency department have been raising concerns about practices including medical and nursing staffing for some time,” he said. “This has been reflected in a high turnover of nursing staff.
Mr Bussue added: “The management need to listen their staff and the unions to ensure effective and safe staffing and first class patient care. A permanent answer needs to be found which keeps the service open, not a stopgap short-term fix.”