South Tyneside NHS Foundation Trust has been told it still requires improvement, including on nurse staffing levels and training, after the Care Quality Commission inspected its core acute services and mental health services.
The regulator said that, while some progress had been made to address problems uncovered in its acute services during a previous inspection in 2015, concerns remained – particularly around safety – meaning the organisastion should maintain its rating of “requires improvement”.
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In November, the CQC visited South Tyneside District Hospital’s urgent and emergency care, medical care – which included services for older people – surgery, and critical care services.
The CQC also inspected wards and community services for people with a learning disability or autism that, in contrast, were given a “good” rating overall.
But within acute core services, the regulator said, despite staffing improvements, it was concerned some medical care wards did not have enough people on shift for there to be the recommended one registered nurse to eight patients.
In addition, the process of medicine reconciliation on these wards had been completed in less than 80% of cases, which was the trust’s target. In urgent and emergency services, only 56% of nursing staff had completed mandatory infection prevention control training.
“Nurses told us they did not report all out-of-hours transfers to the ward or incidents when critical care patients were cared for outside of the unit”
The CQC told the trust it should ensure there are enough healthcare assistants in the critical care ward staffing establishment to cover all night shifts. It was also concerned that not all incidents were being reported in line with standards, according to its latest report on the trust published today.
“For example, nurses told us they did not report all out-of-hours transfers to the ward or incidents when critical care patients were cared for outside of the unit in theatre recovery. This meant managers and staff did not have full oversight of the number of times such events occurred,” said the CQC in its report.
It added that, while the unit met safe nurse staffing ratios based on the Guidelines for the Provision of Intensive Care Services standards, overtime and agency staff were used to achieve this.
“Staff complained the unit was regularly short-staffed. When there were sufficient numbers of staff they were deployed elsewhere in the hospital and managers did not maintain robust oversight of this,” said the report.
“Inspectors found improvements in the responsiveness of services…which is good news for the people using them”
Meanwhile, only 19% of nurses in critical care services had completed safeguarding adults training. In surgery, safeguarding training compliance was variable between areas – ranging from 10% to 100%.
However, the trust had responded to previous concerns about a lack of educational support for nursing staff by recently appointing a clinical nurse educator.
The CQC concluded the trust should maintain its “outstanding” rating for being caring, because staff were “kind, caring and compassionate and had a good understanding of the needs of patients”.
In addition, following its visit to the trust’s services for people with a learning disability or autism, the CQC said its inspection – which looks at safety, effectiveness, caring, responsiveness and leadership – revealed all five areas of checks to be “good”.
Ellen Armistead, CQC deputy chief inspector of hospitals, said: “Inspectors found improvements in the responsiveness of services provided at South Tyneside NHS Foundation Trust on their return, which is good news for the people using them.
“Today’s CQC report recognises the tremendous efforts of our staff… I anticipate further strong progress in the year ahead”
“Since our previous inspection South Tyneside formed a partnership with a neighbouring NHS trust and established the South Tyneside and Sunderland Healthcare Group. This means they now have a single management team across both trusts, and the same senior leadership,” she said.
“The team inherited some significant challenges across many services and although the trust had taken action to address some of those issues, executive leaders acknowledged there was still more to do,” she added.
Trust chief executive Ken Bremner said: “Today’s CQC report recognises the tremendous efforts of our staff and shows where, with focussed efforts, the right support and positive local leadership, we have been able to make some significant improvements over the past year to benefit our patients.”
“It is equally important that we also now focus our efforts on the areas identified by the CQC for immediate action,” he added.
“By encouraging a positive culture of continuous quality improvement, where every member of staff feels empowered to make changes to improve the care and experience we offer our patients, I anticipate further strong progress in the year ahead,” he said.