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CQC rates London trust 'good', but community nurse vacancies 'at 20%'

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A south London trust has been rated as “good” overall by the Care Quality Commission, although an inspection revealed community nurse vacancy rates as high as 20%.

A visit to both the Royal Marsden NHS Foundation Trust’s acute cancer services and community health services in April led CQC inspectors to rate it as being “good” for safety, effectiveness, being well-led and responsive, and “outstanding” for providing caring services.

In its assessment of how safe the trust was, the CQC found it had robust processes for incident reporting, in which employees largely received feedback.

“Staff were seen to be proactively prioritising community patients to ensure that those with the most complex needs were seen first”

CQC report on Royal Marsden  FT

It also found staff understood the need to be open when mistakes happen – to comply with duty of candour regulations – and that the trust had appropriate safeguarding policies in place, supported by training for the vast majority of professionals.

But its assessment of safety also found community services “consistently” flagged staffing as a problem, with recent turnover rates reaching 16%.

The overall nurse vacancy rate for the trust stood at 11% in March, the month before the inspection, but in community services had reached a high of 20%.

“Staff were seen to be proactively prioritising community patients to ensure that those with the most complex needs were seen first and by the most experienced members of staff,” noted inspectors in their report on the trust when they visited in April.

Inspectors also found the organisation was in the worst fifth of trusts nationally for the proportion of staff working extra hours.

The majority of staff in adult community services said they would rather work additional time to ensure that patients were seen and treated within expected time frames, said inspectors.

“[The Royal Marsden must] review the staff compliment for community adult services to ensure there are sufficient numbers of appropriately skilled staff”

CQC report on Royal Marsden  FT

The trust’s executive team believed the high vacancy rates in the community were in part due to the transfer of some of its services, in Merton, to another provider at the end of March 2016, said the CQC report.

The CQC said the trust must “review the staff compliment for community adult services to ensure there are sufficient numbers of appropriately skilled staff to meet patient’s needs”.

It also said improvements must be made to ensure staff use the Mental Capacity Act regulations properly when adult patients are unable to consent to care.

“[Nursing staff had the] commitment and time to provide person-centred care [and] often went out of their way for their patients”

CQC report on Royal Marsden FT

This was after it found staff were not always recording decisions made in the best interests of patients.

Overall, inspectors found investment by the trust to ensure staff were highly trained, with many having completed master degrees and specialist courses in cancer.

Nursing and therapy staff had the “commitment and time to provide person-centred care [and] often went out of their way for their patients,”said CQC chief inspector of hospitals, Professor Sir Mike Richards.

Wellbeing and relaxation activities such as tai chi and meditation services were promoted by senior staff, he said, noting that the trust was also clean and organised in a way that reduced infection risk. He recognised the organisation was a leader in the field of cancer care.

A spokeswoman for Royal Marsden FT told Nursing Times the overall nurse vacancy rate across the trust in April 2016 - when the inspectors actually visited the organisation - was 9%, and among community services it was down to 14%.

 

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