Critical care services at Basildon and Thurrock University Hospitals Foundation Trust have been downgraded by inspectors from a “good” rating to “requires improvement” after staff shortages and discharge problems were identified.
However, overall the trust has retained its “good” rating from last year due to further improvements in other services.
The organisation was revisited by the Care Quality Commission in March following a favourable inspection last year which resulted in the organisation being moved out of special measures.
It returned this year to check certain areas of the trust that were previously highlighted as needing improvements, as well as assessing critical care due to concerns raised by patient and families.
Inspectors found the critical care’s outreach team “depleted” due to maternity leave and resignation.
“Occasionally at night there was no outreach cover and support was provided by the site nurse and medical staff”
CQC report on Basildon’s critical care services
They noted in 2014 this team had nine nurses and one vacancy, but this year there were just six registrants employed.
“Occasionally at night there was no outreach cover and support was provided by the site nurse and medical staff,” said the CQC in its report on critical care services at the trust.
The team’s aim to see patients discharged within 24 hours had become “increasingly difficult” in recent months due to the staff shortage of outreach nurses, added the report.
Meanwhile, the number of nurses who had completed accredited training in critical care – 29% - was below the national recommendation of 50%. However, inspectors noted the trust had put in place a competency framework to mitigate this issue.
The trust should continue to improve skill mix and staffing levels in critical care, with particular focus on reviewing staffing and management structures for the outreach service, said inspectors.
“Staff also told us that because there was no medication kept on CDU… at times eight patients were being cared for by a support worker only”
Elsewhere, inspectors found “significant” improvements had been made in A&E, medical care, and surgery since last year providing the trust with a “good” rating overall.
Although a new concern was highlighted within the emergency services’ clinical decision unit – designed for those unlikely to be admitted but who require additional tests - which did not have enough registered nurses to provide safe care when the CDU was used for extra beds.
Inspectors found a 1:8 ratio of nurses to patients, when in fact a senior manager confirmed it should be 1:4 based upon acuity at that time.
“Staff also told us that because there was no medication kept on CDU, the one registered nurse had to frequently leave the unit for up to 15 minutes which meant at times eight patients were being cared for by a support worker only,” said inspectors in their report.
They added: “Our concerns were heightened because some of the patients on CDU were acutely unwell patients whose condition was not stable.”
“The pace of change within critical care, although improving, required further work to ensure that patients receive a timely service”
The CQC raised this with senior staff within the department who said they would review the concerns.
CQC’s chief inspector of hospitals, sir Mike Richards, said: “We found Basildon and Thurrock University Hospitals Foundation Trust was providing a good service to its patients overall.…but improvements are needed in the critical care service.
“The pace of change within critical care, although improving, required further work to ensure that patients receive a timely service.”
The trust’s chief executive, Clare Panniker, said the organisation had developed an action plan to address these issues.
“This includes recruiting extra doctors and nurses to the unit, improving critical care training arrangements, developing the leadership team and improving how patients are managed,” she said.
She added: “Since our inspection in 2014 staff have worked incredibly hard to demonstrate that the decision to take us out of special measures was justified. This report tells us that we are continuing to move in the right direction.”