Staffing shortages at Mid Yorkshire Hospitals NHS Trust mean nurses are sometimes too hard-pressed to provide compassionate care, according to the organisation’s latest inspection report.
Inspectors found the trust did not always have enough nurses to provide safe care with staffing pressures at all three of its hospital sites.
“We noted call bells ringing for more than five minutes and patients were calling out for help”
However, they also noted a number of improvements at the trust, and said the creation of a new school of nursing was a positive step forward.
The report from the Care Quality Commission (see PDF attached below) follows visits to Dewsbury and District Hospital, Pinderfields Hospital and Pontefract Hospital during July and August this year.
While inspectors found a significant shift in the culture of the organisation, they rated the trust “requires improvement” overall again due to ongoing challenges including lack of nursing and medical staff and a backlog of patients awaiting follow-up appointments.
In particular, inspectors raised serious concerns about staffing levels and care quality at the Pontefract Medical Stroke Rehabilitation Unit (PMSRU).
They found the unit was “consistently short of nursing staff” and rated it “inadequate” for safety.
During the inspection they saw only two registered nurses on duty to cover two separate units of 30 and 12 beds.
“We saw that staff on the PMSRU did not have always time to give compassionate care to patients because nurse staff levels were low,” said the report.
“We noted call bells ringing for more than five minutes and patients were calling out for help,” it added.
“We continue to step up recruitment of new staff as well as introducing initiatives to help retain the staff we have”
Inspectors found the unit did not always have enough staff with the right qualifications, skills, experience and training “to keep patients safe from avoidable harm and abuse, and to provide them with the care and treatment they needed”.
This included at mealtimes when not all patients got the assistance they required.
“Some of the housekeeping staff worked additional hours to help with meals when nurse staffing levels were low,” the report noted.
Meanwhile, ward managers could not always match staffing levels to patient need and could not increase staffing when care demands arose.
Record-keeping was found to be poor and inspectors did not see evidence that patient risk assessments for falls, pressure damage and nutrition were updated weekly or following transfer to the unit.
Inspectors also found staffing issues in other parts of the organisation with high numbers of nurse vacancies in medical services across the board and support workers and agency staff being used to plug gaps.
“To minimise the risk to patient care, the division had over recruited to healthcare assistants and had developed new roles within the unqualified nursing staff to bridge gaps in staffing,” said the report.
Areas of improvement highlighted by the CQC included the management of deteriorating patients, especially in medical services, and when it came to sharing learning from incidents.
The trust was rated “good” for caring with examples of “outstanding care” in critical care at Pinderfields where staff had “shown a dedication to listening to and involving patients and families”.
Its Rapid Elderly Acute Care Team (REACT) based at Dewsbury and District was also singled out for praise for its work in facilitating the timely and safe discharge of patients over 80 years of age and those aged over 65 living in care homes, as well as fast-tracking discharge for patients nearing the end of life.
Ellen Armistead, the CQC’s deputy chief inspector for hospitals, said there had been a measurable improvement in culture at the trust and staff morale had benefitted as a result, but there was “more work to do”.
“We found pressure on staffing at all three hospitals,” she said. “The backlog of patients requiring follow-up appointments needs to be addressed as a priority and Pontefract Hospital’s medical care ward needs support to get back on track with its improvements.
“In the light of the staffing challenges, we welcome the trust’s new school of nursing as an important development,” Ms Armistead added.
Trust chief executive Martin Blakely said the CQC’s assessment showed the organisation was an “improving trust” with nearly 70% of services rated good or outstanding compared with just over 40% in 2014.
“We found pressure on staffing at all three hospitals”
He said the organisation was working hard to address the issues identified including around staffing and delays in appointments.
“The CQC rightly highlights ongoing challenges around numbers of nursing and medical staff and, despite national shortages, we continue to step up recruitment of new staff as well as introducing initiatives to help retain the staff we have,” he said.
He said the trust had responded “immediately” to concerns about lack of nurses at the stroke unit at Pontefract by increasing staffing levels and providing extra support.
David Melia, the trust’s director of nursing and quality, highlighted a number of steps the trust was taking to boost nurse recruitment and ensure safe staffing levels.
This included the development of its own school of nursing, flagged up by inspectors as an “outstanding” area of practice.
The school, which is based at the Dewsbury hospital site, opened its doors to its first 28 students this April – who are all guaranteed employment at the trust once they graduate.
Other developments included the introduction of trainee nursing associates with 62 due to start work at the trust in its December/January cohort.
“On completion of their training we hope that these associates will stay on at the trust and train to become fully registered nurses,” said Mr Melia.
He said the trust also ran a programme of recruitment events aimed at nurses in their final year of study.
“The events give prospective employees an opportunity to meet the team they could be working with and visit the environment they could be working in as well as have an interview and be offered a job, all on the same day,” he explained. “They are hugely successful and our event this Saturday saw us offer 37 student nurses a job.”
He highlighted that the trust had also been praised for its workforce innovations.
For example, earlier this year the trust was short-listed for seven Nursing Times awards, including three of our inaugural Workforce Awards.
This was testament to the organisation’s efforts to address “the national issue of nursing recruitment,” said Mr Melia.