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Staffing issues unite latest trusts criticised by CQC


Nursing shortages were at the heart of three critical inspection reports on trust standards, which were published last week by the Care Quality Commission.

Most high profile was Cambridge University Hospitals Foundation Trust, which was placed in special measures after inspectors found problems including major shortages of nurses and midwives.

“Nurse numbers haven’t kept pace with demand, and nurse training places have been cut”

Heidi Alexander

After inspecting the trust’s two main sites, Addenbrooke’s Hospital and the Rosie Hospital, the CQC rated its services as being “inadequate” overall.

Inspectors found a lack of staff in a number of areas, including critical care and maternity services. Staff were “frequently” moved to other wards to cover for the shortfall in nursing teams and due to capacity issues a number of wards were caring for patients with conditions for which their staff had little experience.

Inspectors also found a high number of nurse vacancies that was being tackled through the use of bank and agency workers. Despite this, some shifts were still not filled, added the CQC’s report.

“Substantial” shortages of midwives were noted and lack of workforce planning, which had contributed to the maternity unit being closed 37 times between July 2013 and April 2015.

Last week regulators also recommended that East Sussex Healthcare Trust be placed in special measures following a second inspection inside 12 months rated it as “inadequate”.

There was a high reliance on agency staff in surgical services. Staffing in the emergency department relied “heavily” on locums and nurse sickness levels were high.

In addition, staff were “afraid to speak out or to share their concerns openly”, with some telling the inspectors that relationships with management “had never been worse”.

Meanwhile, Gloucestershire Care Services Trust was told to address safety concerns in its minor injuries units, after healthcare assistants were found to be assessing patients beyond their skillset.

“We were concerned that some patients waited too long to be assessed by a registered nurse on arrival and that unregistered practitioners were undertaking this task without adequate training or supervision,” said inspectors. Overall the trust was rated “requires improvement” by the CQC.

Despite the various staffing issues identified, all three trusts were rated highly for how caring their clinical staff were.

In one of her first comments since becoming shadow health secretary earlier this month, Labour MP Heidi Alexander emphasised the “serious warnings” made by the CQC reports on hospital short-staffing.

“Nurse numbers haven’t kept pace with demand, and nurse training places have been cut. This has left hospitals dangerously understaffed and has put patient safety at risk,” she said.

“Hospital bosses all over the country now face a stark choice between balancing the books and delivering safe care,” she added. 


Readers' comments (8)

  • Bad managers require bank and agency nurses who are more likely to comply with poor practice if they want repeated employment at better pay rates.

    The CQC seem to me to take ages to act therefore I believe the measures will be deserved.

    Nurse vacancies are not "tackled" through the use of bank and agency nurses: desperate situations are exacerbated by the use of bank and agency nurses.

    CQC needs to act before things advance to this stage. Their rating of caring is, I believe, used to indicate that given the chance staff would do better.

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  • Nurse shortages all over the NHS are due to a combination of many things! I can't see it getting any better until there is a fundamental overhaul of the whole system!!
    I cannot work in the NHS because the wages are low compared to what I am getting in nursing home and on agency.They are going to take away enhanced rate for weekend and unsocial hours NHS pay- how is that decision going to attract nurses toward NHS work?
    Being forced to care for patients on different wards (by managers who move staff all over the place) can put PIN numbers at risk and staff could feel very 'used and abused' by this constant need to work out of their own practice area.
    Internal rotation is often required in NHS and I can't do that as a single Mum I can't leave my daughter overnight on her own, she is only 15 and that is against the Children's Act 1989.
    The NMC keep putting up their registration fees and nurses are retiring early and not renewing PIN numbers as they are fed up with it all.
    Re-validation is putting people through hoops and hasn't been properly thought through.
    Care Assistant vacancies local to me are being advertised at rates between £12-18 per hour for private or mental health work.
    Why would anyone want to re-validate their PIn, be moved all over the place by managers, lose unsocial hours pay, pay ever increasing costs just to keep registered and receive such low wages and few benefits working for an NHS Trust?
    The Health Service used to be a great place to work with a good Superannuation scheme, annual increments,steady employment and helpful extra pay for unsocial hours- so much has changed now!
    The shortages will go on and on and on until so much stuff is addressed!!

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  • they reap what they sow, treat nurse like xxxp , they leave, agency pay nurse their worth, hospitals cannot fi=unction without nurses, time for politicans to wake up

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  • I agree with both comments above. It's about time they seriously considered the Buurtzorg health care model.

    Is there not a pilot scheme on the go somewhere that is doing something similar?

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  • Isn't it wonderful how the powers that be [often not knowledge power, obviously] love to espouse market principles to care homes and hospitals, forgetting that market principles also apply to the labour market! Long live nursing agencies!

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  • All RCN members should read this blog, you don't often hear another view on the RCN, is this why nothing in nursing ever changes?

    Libcom blogs -

    The Royal College of Nursing (RCN) represents most of the nurses employed within the NHS and has a membership of over 400,000. It started life as a ‘professional’ organisation for nurses, promoting excellence in practice, before registering as a ‘trade union’ in 1976. Scratch the surface of this grubby, conservative, false-flag operation, and you will see it is not a ‘trade union’ by any understanding of the term.

    I have previously written about nurses and industrial action during the pension’s dispute and defeat of 2011. Not a lot has changed in the last three years. Nurses are still being targeted because they are an easy touch and lacking anything resembling meaningful trade union representation.

    The RCN congress is taking place this week, in Liverpool, with ‘pay’ and ‘taking action’ dominating the debate. Against a backdrop of the growing anger of nurses, the RCN General Secretary, Peter Carter, had this to say:


    “The RCN has not called a ballot, and the unique role of nurse’s means that they should think carefully before taking such a decision. Think what going on strike really means. For a strike to work, it has to have a real impact on someone or something. If you work in a car factory, that means stopping the production line. But if you are a nurse, it means abandoning your patients, leaving those babies in the neonatal unit, cancelling that visit to an elderly patient in the community, walking out of the emergency department, or psychiatric ward.”

    He went on to say that it was important to protest by other means, including “writing to your local MP” and asking where they stand on nurses pay. If they agree with the government’s position, then nurses should “unseat the MP by voting for someone else”

    Peter Carters deceitful and cowardly speech was so absurd, that when I first read the transcript I had to double check that I had not accidentally downloaded it from Private Eye, or a spoof website.

    Firstly, Peter Carter says ‘The RCN has not called a ballot’. Of course they haven’t, because the RCN is structured in such a way that any decision to ballot for industrial action can ONLY come from the General Secretary (Peter Carter). I would wager that the vast majority of the nearly half a million nurses in the RCN have no idea that they have zero decision making power in terms of taking industrial action.

    Historically, the RCN had a ‘no strike clause’ up until 1995, when it was dropped. It was only dropped as it was a barrier to recruitment, not because of any ideological changes within the organisation. It is crystal clear that the RCN still operates a ‘no strike policy’, but does this via smoke and mirrors, and deliberately excessive bureaucracy.

    Peter Carters use of a car factory analogy is ridiculous. Why is he suggesting that the only industrial action is that of a full scale strike? There are many ways of taking action short of a strike, which he well knows. Nurses undertake many extra responsibilities that are not part of their job descriptions, work extra unpaid hours to support their colleagues, and undertake many other activities that could be described as ‘goodwill’… Nurses could refuse to engage in those activities, particularly those activities that pertain to the meaningless bureaucracy that swamps the NHS. Furthermore, there are examples throughout the world of nurses taking actual strike action, winning disputes, whilst not impacting on direct patient care.

    Peter Carters deceitful and cynical use of emotive language and examples of who would suffer during a strike is an absolute disgrace. Only a liar would suggest that striking nurses would literally ‘walk off’ a neo-natal unit, leaving babies unattended. His speech was a nefariously planned attempt to deceive nurses, the media, and the general public, into believing a nightmare vision of what ‘nurses on strike’ would look like, and lead to. Furthermore, if you took his examples at face value, you could then argue the point of how valuable the work of nurses is, and why they deserve to be fairly paid.

    Industrial action and patient care is an interesting subject. Patient care is not just instant, here and now, at the bedside. Nurses should be taking action over the wider issues of care provision. What is the RCN doing about thousands of nurses being made redundant, what did the RCN do about the Labour Party saddling NHS with £300,000,000 of PFI debt, what are the RCN doing about mental health beds being stripped away throughout the country, resulting in people being sent hundreds of miles away from their homes, what are they doing about national terms and conditions being attacked, what are they doing about the Conservative Party privatising the NHS? The answer is ‘nothing’, all they do is ‘talk’ and ‘negotiate’. Nurses and their union should be fighting for better patient care, not just accepting what is being handed down to them…. Nurses who want to take industrial action over issues that have a direct impact on patient care, should be applauded and supported, not vilified… How dare you Peter Carter, how dare you……

    Peter Carters solution to the dispute – “Write to your local MP” is so stupendously ridiculous and insulting; I won’t bother dignifying it with a rebuttal.

    Peter Carter and the RCN are obsessed with the public perception of nurses, and how industrial action may impact of that perception. This attitude is steeped in the historical snobbery and classism that runs through the RCN’s upper echelons like a stick of Blackpool rock. The RCN, a so-called trade union would rather have its members viewed as low-paid, over-worked, servile ‘angels’, than fairly paid, nurses, with self-respect and a backbone.

    Every year the RCN has its congress, nurses are said to be angry about pay, pensions, conditions, service provision, and patient care. Yet all Peter Carter and his lackeys can offer their 400,000 members whose work is absolutely key to the NHS, is ‘negotiation’. Anyone with a shred of analysis can see that ‘negotiation’ not underpinned by a meaningful threat of action is little more than a begging exercise, that has NHS bosses and the government laughing into their board meeting buffet.

    The cowardice and inaction of the RCN is not a new phenomenon. Since the day it became a trade union in 1976, it has operated as little more than a ‘corral’ or ‘holding pen’ in order to keep nurses on their knees, away from genuine trade unions. The RCN has proven itself to be perfect bedfellows for successive governments of all stripes.

    The RCN’s primary tool of recruitment is to gather up student members at University when they commence their nurse training. Students are offered a greatly reduced subscription rates, free pens, and diaries, if they sign-up. Once they have completed their training they inevitably maintain their membership for the rest of the career. For many, it is their first and only experience of being a member of a trade union, so expectations of the organisation are low or non-existent. Recruitment of students is not difficult. They either join the RCN or UNISON whilst at University, with many opting for the snobbery and elitism of the RCN, as they wish to distance themselves from ‘Healthcare Assistants’, who generally join UNISON.

    As part of the RCN’s campaign to dampen down any militancy within nursing, they produce the ‘Nursing Standard’, which sells 70,000 copies each week - with a much bigger actual readership. They also produce a series of monthly ‘specialty’ journals, which are aimed at nurses working within a variety of clinical specialities. Via their range of carefully produced publications, the RCN are able to drip their squalid propaganda into the homes and workplaces of hundreds of thousands of nurses each and every month.

    For the size of its membership, the RCN has relatively few stewards. I once worked in an organisation that had 1,000 RCN members, yet had no stewards whatsoever. The RCN are not troubled by this, as those members paid nearly £200,000 a year into the organisations coffers, for zero in return. The RCN are more than happy for the Unison mafia to run the staff side committees, and toady their way through embarrassing partnership arrangements, with their own members as passive passengers.

    Member involvement at branch and regional level is not much different. Some RCN branches are enormous, yet meetings are made up of five reps, who have never consulted their members on any issue. When I challenged an RCN full-timer about lack of internal democracy and general activity, I was told that:


    “The members are to blame if they cannot be arsed to get in touch or turn up to branch meetings”

    That particular individual never made any attempt to advertise branch meetings, encourage people to get involved etc… he, and others like him were more concerned about maintaining their own position of influence within the pecking order, than assisting rank and file members in becoming more involved. They ran the branch as their own personal fiefdom, wielding the influence of such a large branch membership for their own aims. Whilst they wax lyrical about ‘internal democracy’, in reality it is just a meaningless phrase, as the organisation relies on the apathy and historically ingrained passivity of its membership in order to function.

    If there ever was a situation in which the RCN politburo would sanction industrial action, then you have the nursing equivalent to the House of Lords, (NMC) to contend with. The NMC (Nursing & Midwifery Council) is the professional body responsible for the registration of all nurses and midwives in the UK. With its disingenuous strapline ‘Run by nurses for nurses’, the NMC threatened to ‘strike off from the register’ nurses who took part in industrial action (during the pensions dispute of 2011) as they would have been in violation the NMC code of professional conduct…. In response to this outrageous state sponsored threat, Unison made the token threat of legal action, whereas the RCN said and did nothing. A quick look at the crossover of personnel at the top of the RCN and NMC would reveal why.

    The RCN, without a smidgen of sarcasm, calls itself ‘The Voice of Nursing’. It is nothing of the sort. It is the voice of the establishment that thinks slow clapping a health minister at congress is ‘taking action’. The sooner nurses wake up to this state sponsored false-flag, drop the snobbery and elitism, and see the RCN for the scab staff association it is, the better….. Join another union, any union……

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  • Not to worry, we are now coming to the obvious endpoint.

    After 5years of real term pay cuts nurses are choosing to exercise market forces and work for agencies. Hunt will soon tell us that Trusts must be able to set their own pay rates - the *national* health service is no longer keeping pace with the real world. The only answer is more private companies running hospitals who will be in a position to offer nurses pay rates competitive with local market forces.
    The Tories do not have a mandate for breaking up and selling the NHS - we are letting them. I hear what Anon is saying about our union but the union can only have teeth if the members support it.

    To my shame, I have only seen evidence of political apathy of the nursing profession. We will get what we deserve.

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  • Every hospital up and down the country must be struggling. So the CQC are going to find fault with every hospital they go into. What annoys me is when they return for another inspection of a failing hospital at a set date....everything looks good...but what did that hospital do drafted in extra staff on those days...that must be fraudulent and putting patient safety at risk after they've gone. The government needs to take note of all of the above posts and start saving what was the best healthcare in the world. And charge those who have not paid a penny to our country as well. They also need to recruit nurses who trained here and train them up.

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