District nurses working beyond contracted hours has become “almost a daily occurrence” in parts of Greater Manchester due to staffing shortfalls, Care Quality Commission inspectors have concluded following a trust inspection.
In addition, problems with nurse staffing levels at Stepping Hill Hospital were uncovered by the regulator in paediatric, urgent care and maternity services, with midwifery staffing in particular described as a “day-to-day challenge”.
“[District] nurses’ working beyond their contracted hours was not an exception but an almost daily occurrence”
CQC report on Stockport Foundation Trust
The inspection of Stockport NHS Foundation Trust’s Stepping Hill Hospital and its community services in January has led to the trust being rated as “requires improvement” overall by the CQC.
Previous reviews by NHS England and the trust itself had revealed district nursing services were operating with reduced staffing and that they had not been planned to meet the needs of the local population, stated the CQC in its report on the trust.
“[District] nurses’ working beyond their contracted hours was not an exception but an almost daily occurrence. This was a matter that required focused action,” said the report.
The CQC told the organisation that it must have sufficient numbers of “suitably qualified, competent, skilled and experienced staff” for its district nursing service to ensure patients are cared for in a “timely and appropriate way”.
“Staffing levels and skill mix must be reviewed continuously to respond to the changing needs of people using the service”
It said skill mix and staffing levels must be reviewed continuously to respond to the changing needs of patients.
At Stepping Hill Hospital, 96 incidents involving low midwifery staffing numbers affecting patient care had been reported between November 2014 and October 2015.
But in its report, the regulator noted the organisation had taken some action – including recruiting an additional five full-time midwives on 12-month contracts to cover maternity leave and long-term sickness absence.
In the emergency department – which was rated as “inadequate” in terms of safety – there were times when the services did not meet its expected staffing requirement of 12 nurses and three healthcare assistants for a day shift, the CQC inspectors found.
This resulted in additional pressures on an “already very busy” department, said their report, which also raised concerns about long patient waits in A&E, routine overcrowding in the department and ambulance crews queuing in corridors to admit patients.
Problems with bed availability meant patients were often placed on the wrong ward for their specialty, added the report. Concerns were also raised about the number of times patients were moved during their stay, with 632 people being moved more than three times between October 2014 and September 2015.
However, inspectors said the trust was aware of its challenges and noted it had taken action on staffing by recruiting both locally and abroad, which had led to a reduction in the use of agency workers.
In addition, it found patients were looked after by caring staff and were on the whole treated with dignity and respect.
Ellen Armistead, CQC deputy chief inspector of hospitals, said: “There have been longstanding issues with the urgent and emergency services provided at Stepping Hill Hospital, and the trust must improve this as a priority.”
“Staffing levels and skill mix must be reviewed continuously to respond to the changing needs of people using the service. More focused work is required to ensure that patients are seen and treated promptly,” she added.
“The trust has assured us it is taking action to improve its services, and our inspectors will return to the hospital in due course to check that the required improvements have been made,” said Ms Armistead.
A spokesman for the trust said: ”It is disappointing to not have received a ‘good’ rating, but the immense challenges that we have faced with urgent care was always going to make this difficult.
“We have been unable to achieve meeting the four-hour wait A&E target for some time now, which was the CQC’s biggest cause for concern in this report,” he said.
However, he noted that the CQC had rated many of its services as being high quality and that staff were dedicated and caring.
The trust was taking actions to address the regulator’s concerns, he said, and the organisation continued to work with health and social care partners to ensure patients in A&E were treated as quickly as possible.