A hospital trust in Somerset has been told by regulators it must ensure that nursing and medical staffing levels are “sufficient to meet the needs of patients”.
The emergency department at Yeovil District Hospital must undertake a review of staffing levels using a recognised assessment tool, said the Care Quality Commission following its latest inspection.
“We found an emergency department which was not responsive to the needs of patients”
In addition, the CQC said Yeovil District Hospital NHS Foundation Trust “must recruit sufficient” nursing and medical staff to enable operational standards for intensive care units to be met.
Theatres remained understaffed to establishment, despite overseas recruitment, added the report.
During 2015 the vacancy rate for staff across Yeovil District Hospital was 10% for registered nurses, equating to around 52 nursing staff.
The trust had acknowledged that recruiting nursing staff had been a priority in common with other NHS trusts during 2015, with efforts to integrate new recruits and fill nurse vacancies, said the CQC.
The trust had implemented an overseas recruitment strategy and had filled 120 posts with nurses from Europe.
Despite the trust’s recruitment challenges, the inspection team found staff were “caring, respectful and considerate”, and were “proud” to work at Yeovil.
They noted that the average sickness absence rates for nursing staff across the trust during 2015 – between 3% and 4% – were below the English national average of 4-5%.
The inspectors added that staff they had spoken with told them that staff turnover appeared relatively low, with many telling us how they had worked at the hospital since qualifying as a nurse.
Overall, CQC the rated the services provided by Yeovil District Hospital as “requires improvement” following its latest inspection in March.
At the time of the visit, the hospital was on “black alert”, with services extremely busy and capacity stretched in every area. This affected the care delivered in some areas, said the regulator.
The emergency department was experiencing continued pressure and services had not kept pace with demand, said the CQC. As a result, some patients were waiting too long for initial assessment.
In addition, some patients were waiting too long for surgery – referral to treatment times did not meet national standards in four of the six surgical areas.
Most areas of the hospital were visibly clean, although equipment was not always stored in a way which reduced the risk of infection, added the CQC.
At the time of the inspection, the CQC’s team was especially concerned about arrangements to protect children on Ward 10 from the risk of abuse.
The ward includes a unit designed for young people in transition to adult services, but other patients were admitted and there was no way of preventing adults from having access to young children.
However, the CQC highlighted a number of areas of outstanding practice across the trust.
For example, to help with patient orientation, at the foot of every bed in critical care there was a clock, with the date and a clear sign stating: “You are in intensive care, you are in Yeovil Hospital”.
Meanwhile, the critical care outreach team had produced a patient assessment document to help the early recognition of sepsis. A staff badge has been introduced to acknowledge staff who had used the tool to identify and manage a patient with sepsis.
In maternity and gynaecology services, the Acorn team provide specialist care for women who are vulnerable, known to be at risk of domestic abuse, who smoke or are prone to substance abuse.
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Professor Edward Baker, CQC deputy chief inspector of hospitals, said the trust needed to ensure that there were “enough staff to meet the needs of patients at periods of high demand”.
He said it was for the trust’s board to determine whether this was best achieved through additional recruitment or through changes to the existing model of care.
But he added: “We found a highly committed workforce who put their patients at the centre of care.
“We saw some examples of very good practice which included the stroke buddying group and the ways in which maternity staff were involving vulnerable young women in maternity care,” he said.
“However, we also found an emergency department which was not responsive to the needs of patients when it was under pressure,” noted Professor Baker.
“We were also concerned to find that young adult patients were placed on a young persons’ unit within the children’s ward – so much so that we needed to raise this during the inspection,” he said.