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Nurse and midwife shortages factor in 'elite' FT entering NHS failure regime


Cambridge University Hospitals NHS Foundation Trust, one of the largest in the country, has been been placed in special measures after inspectors found a range of problems, including major shortages of nurses and midwives.

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

CQC inspectors found a lack of staff in a number of areas, including critical care and maternity services.

“In some services staff were caring for people in areas unfamiliar to them, meaning patient safety and welfare was placed at risk”

Mike Richards

Staff were “frequently” moved to other wards to cover for the shortfall in nursing teams, said the CQC in its report on the trust, and due to capacity issues a number of wards were caring for patients with conditions for which the staff had little experience.

At the time of inspection – in April and May – inspectors 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, which was published today.

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

Within maternity services, inspectors noted guidelines provided by the National Institute for Health and Care Excellence and royal colleges were not being followed, including those for foetal heart rate monitoring, venous thromboembolism and early warning scores.

“Staff were competent and understood the guidelines they were required to follow but outcomes of people’s care and treatment was not robustly collected or monitored. For example, there was no complete maternity dashboard available for the last four months,” said inspectors.

“Staff were hard working, passionate and caring throughout the trust…but having to swim upstream against the pressures they faced”

Mike Richards

Meanwhile, high levels of nitrous oxide were detected in the birthing centre at the Rosie Hospital, which senior managers had been aware of for over two years but had so far only addressed by advising staff to open windows.

The regulator noted staff satisfaction at the trust was poor and there were no robust plans in place to improve the culture within the organisation.

“Staff on the wards did not always feel actively engaged or empowered. There were teams working in silos and there was a disconnect between the senior clinical division management and the senior managers of the trust,” said the report.

Despite this, inspectors rated the trust as “outstanding” for being a caring service. They also found areas of excellent practice such as virtual clinics being run by multidisciplinary teams including nurses to review diagnostic tests and arrange treatment without patients attending an appointment.

CQC chief inspector of hospitals Sir Mike Richards said: “We found a number of serious problems…I have made a recommendation to Monitor that the trust should be placed into special measures.”

He added: “We were concerned that in some services, staff were caring for people in areas unfamiliar to them, meaning patient safety and welfare was placed at risk.

“However, staff were hard working, passionate and caring throughout the trust, prepared to go the extra mile for patients, but having to swim upstream against the pressures they faced.”

“We have already taken action, including recruiting more staff and ensuring an effective nitrous oxide extraction system is in place”

Jane Ramsey

Fellow regulator Monitor today immediately accepted the CQC’s recommendation to place the trust into the support scheme for failing trusts.

Cambridge University Hospitals Foundation Trust is the first organisation from the elite Shelford Group – the unofficial network of top 10 teaching hospitals – to be placed in special measures.

In response, the trust’s chair Jane Ramsey issued an apology to patients for its “lack of effective systems and processes”, which it said had led to problems.

“We will take rapid action to address these concerns and maintain our record of safety and high-quality care,” she said. 

“We have already taken action to address some of these concerns, including recruiting more staff and ensuring an effective nitrous oxide extraction system is in place by the end of the year,” she added.

“I would like to thank all our staff for their continued dedication and hard work, in often very demanding circumstances. We know our patients expect safe, kind and excellent care here, and that’s what we aim to provide every day,” added Ms Ramsey.




Readers' comments (2)

  • Great, where are all these extra nurses and midwives to come from? Those other trusts which are all overflowing with staff? Even if the current method of training, which puts a lot of possible nurses off, were changed back to a more sensible system, those new nurses would still not be available for years.

    This problem has not appeared overnight. Successive governments and training bodies should have seen it coming.

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  • Well! A trust where staff are "swimming upstream against the pressures they faced" but at the same time prepared to "go the extra mile" in an excellent service for care? A trust where there are some services which are not as good as they need to be, and where there are gaps in communication? Major shortages of nurses, and the CQC answer is special measures? Perhaps the whole NHS needs to be in special measures, as the kind of pressures that put Addenbrookes there are in play across the health economy (see the Kings Fund submission to the Spending Review) - it is like sitting on an island that used to be a hill and watching the sea come up to our knees. If it can happen to a trust of this standing, everyone is treading water.

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