Concerns over nurse staffing levels across several areas within hospitals at West Suffolk NHS Foundation Trust have been raised by the regulator following an inspection, despite services being rated “good” overall.
The Care Quality Commission’s inspection of the trust’s Bury St Edmunds and Newmarket Community Hospital revealed “numerous” nurse vacancies in the emergency department, as well as support staff being used to plug gaps in outpatients.
In addition, registered nurse and paediatric nurse staffing levels were not sufficient to ensure safe staffing in both the clinical decisions unit and the emergency department, said the CQC in its report on the hospitals.
“There were occasions, particularly overnight, in which only one registered nurse was on duty in the clinical decisions unit”
In these two areas “there were occasions, particularly overnight, in which only one registered nurse was on duty in the clinical decisions unit, as opposed to a registered nurse and a health care assistant”, said the report.
The children’s ward did not comply with best practice guidelines produced by the Royal College of Nursing, said the report, but the trust had taken actions to mitigate the risk to children in the emergency department.
Meanwhile, in outpatients services, nurse staffing levels were “not sufficient” and “staff hours regularly exceeded monthly planned levels”. Regulators noted care support staff were allocated to cover the shortfall.
Overall, more than half of the wards at the trust reported some shortage of staff, mostly among nurses. However, this was usually a small staffing gap. Only a third of the 29 affected wards said they had a shortfall greater than one member of staff.
“We are especially delighted that the dedication and compassion of our fantastic staff was recognised and commended by the inspectors”
In midwifery services, staffing guidance for maternity settings produced by the National Institute for Health and Care Excellence in 2015 had prompted a review of staffing which was being completed at the time of inspection in March.
“Following which, senior staff planned to present a business case to trust board in May 2016 for the reallocation of staff across maternity,” said CQC inspectors.
However, the trust was assessed as “good” overall, after achieving this rating for safety, effectiveness, leadership and responsiveness, as well as “outstanding” for how caring staff were.
Evidence of exceptional practice included additional support for critical care patients provided by a follow-up nurse and outreach team – who also provided a cross-department education programme – plus outstanding results from national audits, including the Sentinel Stroke National Audit Programme.
In addition, the CQC noted that in a recent major review of NHS productivity among a selection of hospitals – led by Lord Carter – the trust was assessed as the most efficient small acute provider.
CQC chief inspector of hospitals, Sir Mike Richards, said inspectors found staff at the trust were “extremely caring” and that challenges were addressed quickly and efficiently.
“We found that, from the most junior levels, staff had innovative ideas for continually ensuring improvements took place at the trust and patients and their relatives were positive about their experiences at both the trust’s hospitals,” he said.
Sir Mike Richards
“There were also some areas where improvements were needed and our inspectors highlighted these to the trust leadership. Our inspectors will return to check on progress in those areas where improvements were needed,” he added.
In a statement, trust chief executive Dr Steve Dunn said: “We are really pleased with the results of this rigorous inspection, which show that patients at West Suffolk are receiving outstanding care.
“We are especially delighted that the dedication and compassion of our fantastic staff was recognised and commended by the inspectors,” he said. “They are the lifeblood of the hospital and this rating is a testament to their hard work and enthusiasm.”
He said the trust would start to implement the CQC’s recommendations over the coming months.
A trust spokeswoman told Nursing Times the organisation monitored all of its nurse staffing levels daily and reported them to the board. She referred to recent board papers which showed the trust had on average exceeded its fill rates for night and day nurse shifts in June.