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CQC raises concerns about agency nurses giving IV at trust placed in 'special measures'

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Some agency nurses on duty at an Essex hospital were observed administering intravenous care without it being known if they were competent to do so, a regulator has warned among a raft of failings that have seen the organisation recommended for entry into the support regime for struggling care providers.

The Princess Alexandra Hospital Trust, which has long struggled against key performance targets, has been rated ”inadequate” and recommended for special measures by the Care Quality Commission.

“The vision for the trust was not clearly articulated by the senior team and staff”

Mike Richards

The small Essex hospital, which last weekend declared a “black alert”, meaning no beds were available, has had serious concerns for some time and its performance against key targets has declined sharply over the last year.

NHS Improvement has now placed the hospital trust in special measures and an improvement director had already begun working with the organisation, as part of a support package offered by the regulator, the trust said in a statement.

The CQC’s latest report on the trust, which was published today, said the its leadership had been rated “inadequate” and that the hospital was also rated ”inadequate” in terms of how responsive and safe it was.

It was rated “good” for how caring the trust was, despite the overall “inadequate” rating, and ”requires improvement” on how effective the trust was.

A CQC statement released with the report said inspectors had observed a deterioration in the quality of some services since an inspection last year. “There was a lack of management oversight in some departments and staff concerns were not always escalated to board level,” it said.

“Staff across the trust provided care that was compassionate”

Mike Richards

Inspectors said the trust had “significant capacity issues and was having to reassess bed capacity at least three times a day”. Inspectors were also “concerned that some agency nurses on duty were administering intravenous care without the trust knowing if they were competent in this area of practice”.

CQC chief inspector of hospitals Professor Sir Mike Richards said: “The vision for the trust was not clearly articulated by the senior team and staff. The executive team provided us with different visions, risks and strategies for the future, which did not assure us that the team were working cohesively.”

He added: “Ambulance handover delays were also much worse than expected for the emergency department.”

Sir Mike Richards

Sir Mike Richards

Sir Mike Richards

Analysis of the quarter one accident and emergency data by Nursing Times’ sister title Health Service Journal revealed the hospital was one of a handful of trusts contributing disproportionately to the decline in national A&E performance.

The £200m turnover trust is considered unsustainable as a standalone organisation. It signed a memorandum of understanding in July with East and North Hertfordshire Trust to explore opportunities for closer working, which could eventually result in a merger.

However, Sir Mike did highlight that in “many areas staff were dedicated and committed to patient care despite the pressures of staff shortages and the building, which is ageing and in need of repair. Many of the “outstanding” areas of care were directly related to nursing.

For example, the ward manager for the Dolphin children’s ward had significantly improved the ward and performance of children’s services since our last inspection.

The tissue viability nurse in theatres produced models of pressure ulcers to support the education and prevention of pressure ulcer development in theatres, which also helped to increase reporting.

“We recognise we face considerable challenges”

Nancy Fontaine

In addition, the advanced nurse practitioner groups within the emergency department were an outstanding team, who worked to develop themselves to improve care for their patients.

Meanwhile, the CQC highlighted that the outcomes for women in the maternity service were outstanding and comparable with units in the top quartile of all trusts in England.

The lead nurse for dementia was also singled out by the CQC for being innovative in their strategy to improve the care for people living with dementia.

Sir Mike said: “We were particularly impressed by the early pregnancy and termination of pregnancy services in the maternity service, which we rated outstanding overall.

“The trust was also rated ‘good’ overall for being caring,” he said. “Staff across the trust provided care that was compassionate, involved patients in decision making and provided good emotional support to patients and those close to them.”

The trust confirmed it was now in special measures and that it was receiving “a package of support from NHS Improvement”.

Phil Morley

Phil Morley

Phil Morley

Trust chief executive Phil Morley said: “We are of course disappointed with this rating, we know that we deliver good care here and that patients have good outcomes from their treatment.

“We know that the hospital isn’t perfect, our emergency department, like many others across the country, is very busy and capacity across the hospital means that too frequently patients have unacceptable delays,” he said. “However, our patients should be in no doubt that our staff are 100% committed to delivering good care.”

Professor Nancy Fontaine, chief nurse and deputy chief executive, added: “We recognise we face considerable challenges, not least increasing demand for our services and a hospital that was not built to see the volumes of patients that now annually come through our doors.

“But this is not an excuse, we will face these challenges head on and we are confident that we have the support of our staff in our continuing efforts for improvement,” she said.

The trust provides acute hospital and specialist services for 350,000 people living in Harlow and the surrounding area.

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