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Greater Manchester district nurse shortfall needs ‘focused attention’, says CQC

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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”

Ellen Armistead

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.

Ellen Armistead

Ellen Armistead

Ellen Armistead

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.

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Readers' comments (1)

  • Greater Manchester! My observations of the District Nurses plight in an area in Greater Manchester are this.

    The GP care home practice doctors were slow and, for whatever reasons, inadequate. Some of it looked downright stupid but I do not know the ins and outs of that. Elderly people in residential care had medical conditions which could and should have been limited and healed up quickly, but they became massive problems, very labour intensive for the district nurse and very painful for the resident through not getting the right care at the right time.

    Notably, I observed problems with the supply and use of creams to prevent ulcers which once established are notoriously difficult to heal and so expensive to treat. I observed district nurses so pushed, and some seemingly unaware that older people may need longer for their brains to process verbal communication, that they used any excuse to reduce their workload. Obviously someone with infection, maybe sepsis, is going to be irritable. Ulcers hurt a lot so if the patient is below par, and the district nurse has to call into the care home daily anyway, it may be sensible to clean and dress one leg each day instead of both legs which can cause aggression by pushing the patient beyond their endurance limits, with the occasional result of physical aggression from those who might already be more disinhibited and then costly emergency hospital admission, sometimes several admissions. What a waste of resources!

    But my empathy still lies with the district nurse because a hospital nurse can be taking on a new job in the community with the promise of training on the job which never materialises. So I observed one nurse in that position trying to move back into hospital work. She got re-appointed to the hospital job but then there were longstanding problems getting the necessary reference from the manager of the district nurse team. I don't know the outcome.

    General good will is lost. Potentially helpful involvement from relatives becomes sour input from relatives. Nurses end up continuously combatting a problem that should never have existed in the first instance, and that will have ramifications on the already severe problems in Manchester of nurse retention. Patients suffer needlessly. Daft! Just daft! For a ha'peth of tar the ship was lost.

    One horrendous problem in the Manchester area that I observed was the incredible amount of time and effort spent sucking up to relatives instead of taking care of the service user. As one seeing neglect of my relative whilst staff tried to spend a load of time and effort sucking up to me, I can only say I found it misguided and sickly. If you feel bad about something, report it anonymously to the CQC. Your first duty is to your patient (and a duty of care to yourself so keep it anonymous if you whistleblow especially in the Manchester area.)

    But the biggest waste of time, money, resources and health came from the NHS Funded Nursing Team. I observed that they were absolutely intent on withholding Nurse Funded Care money from the care homes, which then resulted in the need to award Continuing Health Care funding to those who actually had enough money to fund themselves if their real needs had been addresses and dealt with in the first instance.

    You'll notice I only said "intent on withholding Nurse Funded Care money from the care home." I did not say "intent on not allotting Nurse Funded Care money to the care home."

    Is it possible, do you think, that money may in theory be allotted for people needing nursing care that is beyond the scope of the district nursing team, but that this money never actually arrives at the care home? Maybe it could be redirected into other NHS areas...NHS toys for the boys, feathers in the cap, keeping up with Jones' or something? And all the while, for a ha'peth of tar the ship is lost.

    If such thing were happening and homes were to resist, there would be ways and means available to local authorities of ensuring that there will be adverse effects on homes that could tipple them over in already difficult financial times.

    In other areas, Continuing Health Care funding is as rare as hen's teeth but the Funded Nursing Care is allotted and actually arrives at the care home. Prevention not cure, you see? (Cure being much less common than ending up expensively managing a chronic condition anyway).

    All the knock on effects of bad management... guilty feelings; distasteful sucking up; costly meetings of numerous professionals which fail to bring about any satisfactory outcome for the service user and all who care about the service user; the harmful"pally institutionalisation" against justifiably upset outsiders of those ineffective social service and health professionals; the undermining longing to get out of the job you are in which you imagined would bring job satisfaction to most of your waking hours; corruption of systems (instead of officially changing a system to suit); corruption and institutionalisation; frustration; disengagement; staff retention problems; extra money to pay for agency staff and travel fares for staff enticed from abroad because we have disenfranchised the staff we have now; expensive in-depth involvement of other organisations -like the CQC. the Police, the PHSO. all the organisations - more than 50 of them - which handle NHS complaints, the Court of Protection, the Coroners Court, Pathologists, the Office of the Public Guardian... the ramifications are endless.

    Bad management and short termism. Such foolishness.

    The NICE report says about 44,000 people a year die of sepsis, 10,000 of these deaths are avoidable. I wonder what the statistics are for the Manchester area?? But don't bother redirecting time and resources from the service user to find this out Managers in the Manchester area because after my experience of you, I just wouldn't believe you anyway.

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