A trust in London has “significant shortages” of medical, nursing and allied health professional staff in most departments, which are affecting care delivery and patient safety, according to regulators.
Major lapses in the following of hand hygiene protocol were also found by inspectors in surgery, as well as a general lack of mandatory training and poor adherence to medicine management guidance.
“There remain areas of unresolved risks and areas for significant improvement”
The Care Quality Commission visited Lewisham and Greenwich NHS Trust in March. The latest CQC inspection was sparked by complaints and concerns reported by patients, relatives and staff in 2016.
It undertook an urgent inspection of emergency and medical services at the trust’s Queen Elizabeth Hospital in Woolwich during June 2016 – prompting a warning about the need to improve dementia care – before returning to look at the rest of the trust in March this year.
Key findings highlighted by the CQC included “significant shortages of medical, nursing and allied health professional staff in most departments which were having an impact on delivery of care and patient safety”.
“Although the trust was actively trying to recruit into vacant posts there was limited evidence of success,” said the CQC in its report on the trust, published earlier this week.
The trust was told to ensure that medical and nursing staffing levels were “in line with national standards and service specifications”.
“We were not getting it right for every patient every time when the inspection was carried out”
Meanwhile, in surgery, inspectors said they observed “numerous breaches” of infection prevention and control policy, that potentially placed patients at “significant risk of infection”.
“We observed poor adherence to trust hand hygiene policy and national guidance during our inspection,” said the inspectors in their report.
“Staff did not routinely sanitise their hands between patients and on entering and leaving wards,” they said. “Across the course of our inspection, we observed 10 staff not adhering to hand hygiene policy on leaving and entering wards.”
Similarly, in medical care, the CQC warned that infection control processes, including waste management and adherence to guidance on controlling hazardous substances, was “variable”.
In maternity and gynaecology, the CQC said it found the cleanliness of the environment and some equipment to be of a “poor standard”, even where green stickers had been used to indicate that surface areas and equipment had been cleaned that day.
In addition, in some areas, safeguarding training rates and mandatory training rates “fell well below the trust’s target”, warned the regulator.
“Staff did not routinely sanitise their hands between patients and on entering and leaving wards”
The CQC highlighted that, in some areas, principally surgery, medicines management processes were found to be “not in line with hospital policy or national guidance”.
The provision of end of life care at Queen Elizabeth Hospital was also rated as “inadequate”, though it was viewed as “requires improvement” across the organisation as a whole.
The trust was told that it must ensure patients requiring end of life care received “appropriate and timely care”.
In a long list of action points, the CQC said the trust should ensure staff complied with infection prevention and control policies and procedures.
It must also ensure staff working on medical wards and in end of life care had the “values and attitude necessary” to treat patients, their relatives and visitors with dignity and respect.
In addition, it should ensure all patients have their pain assessed and receive analgesia in a timely manner, ensure there are arrangements for measuring and reporting patient satisfaction in critical care, and that patients who are at the end of their life are afforded privacy.
“There were significant shortages of medical, nursing and allied health professional staff in most departments”
It should also Improve compliance with mandatory training completion rates, review the environment and waiting times for women using the gynaecology service and provide sufficient staff to care for patients who need one to one care.
However, the CQC did note that some progress had been made since the last inspection in meeting the needs of patients living with dementia including increased activities.
Inspectors also highlighted some areas of “outstanding” practice, which included staff in the Trafalgar Clinic providing care and treatment for patients in a nearby prison.
Meanwhile, in critical care there was a “dynamic” programme of research and development enabled by the full-time appointment of a research nurse working with doctors, including consultants.
Overall, the trust was rated as “requires improvement”, the same rating given to it three years ago after its last comprehensive inspection.
The major South London trust was rated as “requires improvement” for being safe, effective, caring, responsive and well-led, but community services in Lewisham were rated as “outstanding”.
edward ted baker
CQC chief inspector of hospitals Professor Ted Baker said: “The trust has not made sufficient progress since our last comprehensive inspection.
“There remain areas of unresolved risks and areas for significant improvement,” he said. “This included the acute emergency pathway at Queen Elizabeth Hospital.
“However, we did see good and some outstanding practice in the trust’s community services, and great credit goes to the staff in these services for the quality of care they provide,” he added.
Responding to the CQC report, trust medical director Dr Elizabeth Aitken said: “The CQC report shows that we were not getting it right for every patient every time when the inspection was carried out.”
Major London trust short of nurses in ‘most departments’
“We launched a major safety and quality improvement plan immediately after the CQC inspection in March and have made significant improvements for patients,” she said in a statement.
“This is a joint plan with our health and social care partners to make the improvements needed across the whole system,” said Dr Aitken.
She added: “The CQC report also acknowledges several areas of good and outstanding practice and highlights many areas where Lewisham and Greenwich NHS Trust has improved since the last trust-wide inspection in 2014.
“We are extremely proud of our staff who work so hard, often under significant pressures,” she said.