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Trust nurse shortages impacting on end-of-life care, CQC finds

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Nursing shortages mean dying patients at a London trust do not always get the best care, Care Quality Commission inspectors have warned.

They raised concerns about staffing problems at Lewisham and Greenwich NHS Trust following an inspection in September 2018.

“There has been some improvement in the quality of care in some areas”

Ted Baker

The CQC gave the trust an overall rating of “requires improvement” – unchanged since its last visit in March 2017.

As part of the inspection, the watchdog assessed end-of-life care at the trust’s two hospital sites – Queen Elizabeth Hospital and University Hospital Lewisham.

Both hospitals were given a rating of “requires improvement” for their services for terminally ill patients. At University Hospital Lewisham, shortfalls in nursing staff were affecting patient care, the CQC found.

“Some staff told CQC inspectors that shortages of nursing staff on certain wards sometimes affected good end-of-life patient care,” the CQC said in a report of its findings published this month (see PDF attached below).

It noted that at the time of the visit, only half of wards had an end-of-life care link nurse in place. Members of the specialist palliative care team (SPCT) told the CQC that general workforce problems meant it was “difficult” to get staff released to become link nurses.

“They said that there are positive signs that we are addressing the challenges we face”

Ben Travis

The report said: “The absence of link nurses reduced the day to day monitoring of standards and implementation of information distributed by the SPCT.”

A pilot study showed that 43% of end-of-life patients at the hospital did not receive their pain relief medication on time and there was “no plan in place for how to improve upon this”, the watchdog highlighted.

However, the trust was praised for increasing the number of clinical nurse specialists in the palliative care team from 2.8 WTE posts at the previous inspection, to six now.

At Queen Elizabeth Hospital, the CQC found that there was insufficient staff available in the SPCT to achieve the trust’s ambition of providing a seven-day-a-week service.

Inspectors also found “inconsistences” in the recording of pain scores, administration of pain relief medication and food and fluid intake.

However, the CQC noted evidence of good multi-disciplinary team working in the end-of-life services across both hospitals. Staff were also found to be providing compassionate and sensitive care.

In addition, the watchdog said there was “improved representation” of end-of-life care at the board level of the trust and that a separate end-of-life care risk register had been introduced.

Members of the SPCT told inspectors that there was an increased recognition from staff at the trust that end-of-life care was “everybody’s responsibility”.

On the other hand, the CQC noted that there had been no succession planning for the completion of the trust’s current end-of-life care strategy for 2016-19.

End-of-life care was assessed as part of a wider inspection of Lewisham and Greenwich NHS Trust.

The CQC inspected services that had been deemed ‘inadequate’ or “requires improvement” following its 2017 visit. As a result of the latest inspection, the trust retained its overall “requires improvement” rating.

In the five domains that the CQC looks at, Lewisham and Greenwich was given “requires improvement” in safe, effective, responsive and well-led, and “good” in caring.

The regulator found there had been some improvement in most of the services inspected, but that “many challenges” remained.

A new chief executive and chief nurse were appointed in April 2018 and the watchdog noted that staff at all levels were “positive about these appointments” and had noticed better communication and engagement.

The CQC told trust leaders that they must take action to ensure there was “sufficient staff with appropriate skills and experience” in place in all services to meet the needs of patients and provide safe care.

Ted Baker

edward ted baker

Professor Ted Baker

Professor Ted Baker, the CQC’s chief inspector of hospitals, said: “There has been some improvement in the quality of care in some areas at Lewisham and Greenwich NHS Trust.

“The strengthened leadership team needs to drive marked improvement in the trust’s ratings in the future and with that in mind we will continue to monitor the trust’s progress carefully,” he added.

Following the publication of the inspection report, the trust highlighted that it had reduced its staff vacancy rate from 17.5% to 13.9%.

Thanks to an international recruitment drive, the trust had also offered positions to a further 91 qualified nurses.

Ben Travis

Ben Travis

Ben Travis, chief executive of Lewisham and Greenwich, said: “While the trust’s overall rating from the inspection remains ‘requires improvement’, the CQC found many improvements since their previous inspection.

“The CQC also commented on how caring they found our staff, with the trust’s rating in the caring domain improving to ‘good’,” he said.

“While the CQC noted there is more to do, they said that there are positive signs that we are addressing the challenges we face,” he added.

Mr Travis said the report showed the trust was “moving in the right direction” and he expressed his thanks to staff for their ”ongoing hard work and commitment to patient care”.

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