A community trust in West London has been told it must reduce its nurse staffing shortages, lower its high turnover rates and ensure practitioners have sustainable caseloads, following an inspection by the Care Quality Commission.
Hounslow and Richmond Community Healthcare NHS Trust has been rated as “requires improvement” overall, after the regulator’s inspection in March.
“As a priority the trust needs to ensure that there are always enough staff to meet patients’ needs”
The CCQ found high vacancy rates, particularly in community nursing, which was placing pressure on existing staff, leading to under-reporting of incidents and a negative impact on the take-up of training.
Around 105 whole-time equivalent vacancies across nursing, health visiting and allied health professional staff were reported by the trust before the inspection, as well as 21 vacant nursing assistant posts. The annual turnover rate across the trust was 22%.
At the trust’s Teddington Memorial hospital – which provides inpatient, end of life, and urgent care services – there were “substantial” nursing vacancies that meant care was sometimes being compromised, according to the CQC’s report on the trust.
“At Teddington Memorial Hospital, risk assessments and care plans were in place. However, we noted substantial gaps in recording observations, documenting scores in the early warning system and a lack of appropriate action when changes in patients’ observations were observed,” said the report.
Inspectors said they found staff provided care in a compassionate way in the majority of instances in the community.
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However, at Teddington they noted few of the patients had any involvement in their care and treatment, and that staff were seen walking past confused patients who were exposing themselves or in distress and also ignoring call bells.
“We found that, although the majority of beds at Teddington Memorial Hospital were designated as being for patients requiring rehabilitation, an increasing number of patients living with dementia and those requiring continuing care were being admitted and were sharing the same ward space,” said the report.
“This meant that staff spent a lot of time caring for patients with challenging behaviour, and caused a great deal of distress and disruption to the rehabilitation patients,” the report added.
The CQC noted that trust’s executive team had already recognised improvements were needed in nurse leadership at the hospital and had appointed a new member of staff to address this.
Meanwhile, in the community nursing team, while staff would ask for consent from patients for treatment, inspectors found some nurses were not carrying out mental capacity assessments.
“We continue to make progress in reducing vacancy rates across the organisation”
While district nursing team leaders said they completed “best interest” assessments, there was no formal training in place for this process and some district nurses were unable to identify patients on their caseload with a diagnosis of dementia.
Professor Edward Baker, CQC deputy chief inspector of hospitals, said: “We rated Teddington Memorial Hospital, the trust’s inpatient unit, as inadequate.
“The hospital was increasingly being asked to admit patients outside of its admission criteria because of pressures on the local acute trusts,” he said. “This was proving a challenge to adequately staff and to provide positive patient experiences for all those receiving care and treatment there.
“As a priority, the trust needs to ensure that there are always enough staff to meet patients’ needs. There was evidence of pressure on existing permanent staff, delays in incident investigation and the under reporting of incidents,” he added.
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Professor Baker said there were some areas of good practice, including services for children and young people, which inspectors said were effective, caring, responsive and well-led.
Trust chief executive Patricia Wright said the organisation had already recognised improvements were needed at Teddington Memorial Hospital and action was being taken to address the problems.
“Since the inspection we have carried out immediate actions to resolve the safety issues on the wards – around staffing and equipment,” she said.
“Staffing is a key priority for the trust and we continue to make progress in reducing vacancy rates across the organisation. We know where the challenges are around recruitment and staffing – which stem from national shortages in healthcare professions such as community nursing and health visiting,” she added.