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CQC issues hospital trust with warning over 60% nurse vacancy rate

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Severe nursing shortages at an Essex hospital are putting patients at risk, inspectors have warned.

They found that almost 60% of nurse posts in the medical division at Broomfield Hospital in Chelmsford were empty when they visited in September and October last year.

“Having to rely on agency nurses costs us millions of pounds a year”

Clare Panniker

The department, therefore, needed to rely on agency nurses but failed to properly vet them before allowing them to care for patients, the Care Quality Commission inspectors said.

In a report published yesterday, the CQC told Mid Essex Hospital Service NHS Trust that it must take urgent action to address the nurse staffing challenges on medical wards in order to meet legal requirements.

The nurse shortage along with other problems meant inspectors rated medical care at the trust “inadequate”.

The trust received an overall rating of “requires improvement” – a deterioration from its previous score of “good” in 2016, when nurse vacancies were also identified as an issue.

“Nurse staffing levels were not always safe”

CQC report 

Under the assessment of medical care, the CQC report said: “Nurse staffing levels were not always safe to ensure patient needs were met, with vacancies of up to 59.8%. Staff across wards including service leads confirmed this was their main risk.

“The service covered gaps as far as possible by transferring staff from other wards and using agency staff, but this meant staff were often not familiar with the ward,” the report said. “On all wards, staff felt pressured due to the acuity of the patients and staffing levels.”  

The watchdog found that the service had a “high reliance” on agency nurses to fill gaps and that some medical wards were frequently staffed only by agency nurses, especially at night.

In addition, the CQC warned that it was “not assured” that processes were in place to ensure that temporary staff were competent to carry out their roles.

Clare Panniker

Clare Panniker

Clare Panniker

The service relied on competency checks of nursing staff from the agency rather than carrying out its own, which was “not in line with the trust policy”, said the report.

This was a “concern” because there had been issues with the competencies and behaviours of some agency nurses, it added.

The CQC also found that low nurse staffing had affected discharge planning of patients in the medical division, and also meant nurse leaders were not able to do their jobs properly.

“Nursing leads on the wards struggled to fulfil their managerial and support responsibilities due to staffing and capacity issues,” the regulator’s report noted.

Clare Panniker, chief executive of Mid Essex Hospital Service NHS Trust, said the organisation had worked quickly to improve medical care since the inspection, including opening new dementia-friendly ward.

“The trust’s leadership knows what it must do to ensure it improves its services”

Ted Baker 

She recognised that the trust’s reliance on agency nurses was an issue and assured that it was taking a multi-pronged approach to fill vacancies.

“We know that having teams of permanent staff leads to improved care and a better working environment,” she said. “That is what we want for our staff and patients.

“Having to rely on agency nurses not only impacts on care, but also costs us millions of pounds a year,” she added. 

Ms Panniker said the trust had introduced a host of initiatives to tackle the problem, including an overseas recruitment campaign, offering student nurses permanent roles, and encouraging healthcare assistants to engage in apprenticeships to become registered nurses. 

Mid Essex is planning to merge with neighbours Basildon and Thurrock University Hospitals NHS Foundation Trust and Southend University Hospital NHS Foundation Trust.

“We are well-sighted on the issues we are facing here at Mid Essex, and understand the scale of the improvements needed,” said Ms Panniker, who is chief executive of all three organisations.

“As we continue to prepare for the planned merger with Basildon and Southend hospitals, we are determined to rise to the challenge, and have already started to see real change,” she said.

Ted Baker

edward ted baker

Ted Baker

Overall, the trust was considered to be “requires improvement” in the domains of effectiveness, responsiveness, safety and leadership, but “good” in caring.

Professor Ted Baker, CQC’s chief inspector of hospitals, said changes in the trust’s management had “affected its ability to sustain improvements”.

He added: “The trust’s leadership knows what it must do to ensure it improves its services and we will continue to monitor its progress, which will include further inspections.”

Inspectors found some areas of outstanding practice across the trust, including a roll out following a trial of “enhanced support workers” to work alongside nursing staff to care for patients with complex needs in the surgery division.

The trust also funded staff in the neonatal unit to complete post-registration speciality training, the CQC noted.

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