Guy’s and St Thomas’ NHS Foundation Trust has been rated “good” overall by the Care Quality Commission, with inspectors identifying many examples of excellent nursing care.
The trust, which employs more than 4,100 nursing staff, was rated “outstanding” for being caring. Services for children and young people and emergency services at the Evelina Children’s Hospital were also judged “outstanding” during a series of inspection visits in September last year.
“I am delighted the CQC has highlighted so many areas of excellent practice throughout the trust”
This was despite vacancies in all areas, with particular concern about nurse staffing levels in community services. Inspectors found staffing levels in most clinical areas were “maintained at a safe level with the use of bank, agency and locum staff”.
“Where agency staff were used there was an induction programme to help them become familiar with the environment,” said the CQC’s report.
Specific staffing issues were identified in the antenatal day assessment unit. While there had been an increase in midwifery staffing levels, inspectors found “staff at times found it difficult to keep up with the demand”.
In community services, there were a number of nursing workforce issues including difficulty recruiting and retaining staff, and the fact 70% of the workforce was aged over 45.
However, the CQC inspection team noted the trust had recently been successful in recruiting staff, particularly in community services, with more than 60 new appointments made.
Excellent nursing helps trust gain ‘good’ CQC rating
Inspectors highlighted the important role of specialist nurses in providing emotional as well as practical support for patients in areas like palliative care, stroke and diabetes.
A specialist learning disability nurse was on hand to support patients and staff and inspectors noted innovative and effective care for patients with dementia.
This included the use of the “This is Me” document to obtain information about patients, enabling staff to tailor care to their needs.
Inspectors also praised the development of dementia training film “Barbara’s Story”, which has been used by other providers.
In addition, the CQC noted efforts to improve quality and safety such as the “Safe In Our Hands” accreditation programme, which was brought in by the trust’s chief nurse and sees individual wards assessed against key standards.
Alongside this, nurses and other staff attend weekly meetings to share and discuss improvements and challenges in delivering care.
Other innovations identified by the CQC included senior nurses working on the wards during “clinical Friday”.
Examples of outstanding work in community services included employing a specialist nurse for childhood obesity in the borough of Lambeth in response to an identified need.
Meanwhile, the trust’s specialist nurse for children in care had improved the uptake of immunisation by 22% among this vulnerable group by using “opportunistic” vaccinations.
Other exemplary practice included the fact community nurses had a daily meeting to discuss patients nearing the end of life and share any changes, issues or concerns.
While inspectors found most services at the trust were safe, they identified some issues in critical care and maternity services at St Thomas’ Hospital and in surgical services at both Guy’s and St Thomas’. The trust was therefore rated “requires improvement” for safety overall.
Other areas the trust was told to look at were increasing the amount of time health visitors spent working directly with patients and reviewing school nursing provision to ensure core services were being delivered in schools.
There was individual praise for chief nurse Dame Eileen Sills, who has been in post for more than 10 years.
Staff “spoke positively about the visibility and approachability of the chief nurse”, said the CQC report.
At the start of the year Ms Sills was appointed “national guardian” for whistleblowers by the government, but soon after announced she was standing down due to difficulties juggling the role with her responsibilities at Guy’s and St Thomas’.
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She said she was pleased with the CQC’s findings. “I welcome this report, which paints a very positive picture of the compassion and dedication of our staff to deliver high quality care to patients,” she said.
“I am delighted the CQC has highlighted so many areas of excellent practice throughout the trust and has rated both our children’s and emergency services as outstanding,” she said.
She added: “The CQC report also highlights areas for improvement and I look forward to working with our staff, patients and local stakeholders to tackle these together in the weeks and months ahead.”