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Trust criticised for filling rotas with HCAs and call bell delays

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Norfolk and Norwich University Hospitals NHS Foundation Trust has been told to address serious nursing staff shortages, after inspectors found poor staffing levels were affecting patient care.

They found gaps in nursing rotas were being filled by healthcare assistants and delays in answering call bells, with staffing levels in some areas falling “significantly below national standards”.

“The main issue arising from the report is one of pressure”

Mark Davies

The trust, which was inspected by the Care Quality Commission in November last year, was told to take urgent action to address staffing shortfalls.

At the time of the inspection, the trust, which runs Norfolk and Norwich University Hospital and Cromer Hospital, employed 1,877 nursing staff against an establishment of 2,189.

Inspectors raised concerns nurse staffing levels did not match the acuity of patients on the wards.

“There were a high number of vacancies and registered nurse gaps were frequently filled with healthcare assistant hours,” said their report. “Some areas of nurse staffing were significantly below the national standard.”

This included the fact the trust was not fulfilling a ratio of one midwife to every 34 births and had inadequate staffing levels within the specialist palliative care team

The CQC’s report said inspectors found nurses were deterred from using official systems to report staffing concerns.

“Nursing staff reported being discouraged from using the electronic incident system to raise concerns about staffing shortages due to the time taken to investigate these incidents,” noted the CQC’s report.

Norfolk and Norwich University Hospitals NHS Foundation Trust

CQC finds poor nursing staffing levels at Norfolk trust

Main entrance to Cromer Hospital, which opened in 2012

The trust reported 111 serious incidents between August 2014 and July 2015, of which 40% were pressure ulcers, and a further 30% were slips, trips or falls.

Meanwhile, the trust was among the worst 20% in England for call button response times.

Data gathered by the trust showed daytime response to call bells in several wards were above the organisation’s target of 2.5 minutes in July last year. On some wards the wait was longer than five minutes.

Patients on three wards told inspectors there were delays in answering bells because staff were “busy”. “This was worse at night time when patients noted that there was a shortage of staff,” said the report.

While the trust was rated “requires improvement” overall by the CQC, it was judged “good” for whether services were caring.

Inspectors also identified areas of excellent care. For example, they praised the nursing team within the emergency department for demonstrating “outstanding care, leadership and treatment of patients”.

Inspectors also noted good joint work between doctors and nurses to ensure a smooth discharge process for patients, with nurse-led discharge taking place in some departments like trauma and orthopaedics.

Meanwhile, they also highlighted efforts to strengthen nursing leadership. Changes under way at the time of the inspection included a new “clinically-led” structure comprising four divisions, each with a nursing, medical and service manager.

“Divisional nurse director roles were new to provide a stronger nurse input,” stated the report.

Mark Davies

Mark Davies

Mark Davies

In response, trust chief executive Mark Davies said the organisation was on a “journey of continuous improvement”.

“The main issue arising from the report is one of pressure; pressure on staff and pressure on our buildings,” he said. “That is why we are rapidly developing plans to increase capacity on site – the hospital is just too small to cope with the huge demands on our services.”

“Other improvement projects are already underway in the areas identified by the inspection team including further recruitment and streamlining recruitment processes, plans for refinements to patient records and looking at developing staff training to help with incident investigation,” said Mr Davies.

He added: “I would like to personally thank our fantastic staff to whom this report rightly pays tribute. The CQC has highlighted many areas of outstanding practice throughout the hospital and found that the staff in all the services they inspected were ’overwhelmingly caring’.

In response to a request for more information, a spokeswoman told Nursing Times: “Our registered nurse vacancy percentage is 9% out of an establishment of 2123, although this is offset through use of bank and agency staff.”

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Readers' comments (1)

  • Hi Mark, when the linguistic language of 'continuous improvement' is used it strongly suggests one thing 'more of the same method' and look where it has got you. Many hospitals are making this mistake in reference to processes, and the language used by many CEOs is identifying the influence of the typical tayloristic American method being utilised. We noted your recent advertisement of a business manager, which mentions skills that refer to methods that are a concern, which may strongly suggest you're going in the wrong direction. A lack of staff seems to be a recent common theme identified by the CQC and there is a concern that many hospitals are awaiting parameter changes enforced by the government Carter approach so these issues inhibit the CQC and so further go under the carpet. The fact there are concerns staff are persuaded from not reporting issues is yet further evidence to how the concerning method is utilised nationwide and perhaps elsewhere. Can you tell me Mark how effective is your Speaking Up Safely approach utilised rather what is in place?

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