Staffing levels and skill mix within NHS hospitals have been reiterated as a concern by the Care Quality Commission in its annual report on services.
Today’s CQC report said that while there had been some improvement in recruitment, staffing shortages still remained an issue for many hospitals. In last year’s analysis, the regulator said it was a key factor affecting patient safety in hospitals.
According to the latest data, up until the end of July, 6% of the 264 NHS acute hospital trusts in England were rated “inadequate” and 52% as “requires improvement” overall. In its assessment of safety of NHS acute hospital trusts, it found 10% were inadequate and 71% required improvement.
“Staffing levels were often not determined by or adjusted to the needs or acuity of the patients”
CQC State of Care report
The 2015-16 State of Care report, published today, said providing consistently safe care “remains the single biggest challenge for hospital providers in terms of the quality of care” and again pointed to staffing as a factor.
Inspectors found that in trusts rated as requires improvement or inadequate, “staffing levels were often not determined by or adjusted to the needs or acuity of the patients”.
“In some cases, there was no tool to identify the numbers or skill mix of staff needed to deliver safe care,” added the report.
The regulator noted that its assessments were based on a rounded view of staffing levels, taking into account patient and staff views, observations, rotas, and risk registers that feature incidents relating to staffing – as well as guideline requirements in critical care.
In addition to staffing, the CQC said improved leadership was needed to address other safety concerns.
“Where patient safety was the hospital’s main priority, staff were confident in reporting incidents”
CQC State of Care report
Poor safety cultures in hospitals were being driven by a series of problems including variation in support for reporting and learning from incidents, incomplete safety audits and staff not receiving essential training or attending mandatory courses.
The CQC said inadequate management of medicines, poor management of patients at risk of deterioration, and unsatisfactory data sharing – leading to unnecessary repetition of tests and incomplete care plans – had also all been seen as poor environments for safety.
In addition, inspectors had noted insufficient record keeping and systems that were not fit for purpose, leading to clinicians creating unsafe work-arounds, said the report.
“Where we saw evidence that patient safety was the hospital’s main priority, staff were confident in reporting incidents,” said the regulator.
“Staff in trusts rated as ’good’ reported witnessing fewer potentially harmful errors, near misses and incidents than those in trusts rated ‘inadequate’, but more said that they report the ones they had witnessed,” it added.
The CQC’s annual report also highlighted trends in social care and mental health settings.