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CQC finds over-use of agency workers at Stafford Hospital


The trust that has taken over management of Stafford Hospital has a “constant challenge” in achieving safe staffing levels and is relying heavily on temporary workers, the Care Quality Commission has found.

University Hospitals of North Midlands Trust formed in November through the integration of University Hospital of North Staffordshire Trust with Stafford Hospital, which was part of the former Mid Staffordshire NHS Foundation Trust.

Following an inspection in April, the regulator rated the new organisation as “requires improvement” overall.

“In some parts of the organisation wards were struggling with high levels of nursing vacancies and sickness was problematic”

CQC inspectors

Stafford Hospital, now renamed as the County Hospital, was highlighted as having a particular problem with the overuse of agency and bank staff.

In its report on the trust, CQC inspectors said: “The chief nurse told us the trust applied the National Institute for Health and Care Excellence guidance to nurse staffing levels…We noted that the actual staffing levels did not always reflect what was planned.”

“In some parts of the organisation wards were struggling with high levels of nursing vacancies and sickness was problematic. There was over-reliance on agency and bank staffing to make staffing levels safe,” it added.

However, at both the County Hospital and the trust’s other site, the Royal Stoke University Hospital, inspectors found all parts of the organisation to be “good” in providing caring services – with the latter highlighted as “outstanding” in how caring its services were for children and young people.

The trust has been told it must review staffing arrangements in medicine and the emergency department at the Royal Stoke to ensure there were sufficient numbers of nurses and that the planned and actual staffing levels for each shift were displayed.

Meanwhile, gaps in nurse training in gynaecology services and critical care were also identified by the inspectors.

“[23 ‘good’ ratings from the CQC for County Hospital] is proof that the changes we are making… are now bearing fruit”

Mark Hackett

Nursing staff on general surgical wards – where gynaecology patients were being cared for – told inspectors they had not received particular training for these patients and were concerned about their lack of specific skills.

The regulator found critical care services at the Royal Stoke were not meeting the requirement that at least 50% of intensive care staff have the relevant post-registration qualification. It found only 21% had the qualifications.

“The trust must review the capacity and adequacy of the critical care services at Royal Stoke to ensure that level 2 and level 3 patients are cared for in appropriate and safe environment by nursing staff with sufficient experience and qualifications as set out in the Intensive Care Core Standards,” said the CQC report.

Patient flow was noted as being problematic, with the trust persistently unable to move patients out of the emergency department and “significant challenges” in discharging people.

Stafford Hospital

Stafford Hospital

Inspectors noted that, between April 2013 and November 2014, there were more than 4,700 delayed transfers of care at the County Hospital and over 11,000 at the Royal Stoke.

Since February the trust has contracted an external care provider to help facilitate discharge for some patients.

CCQ chief inspector of hospitals Sir Mike Richards said: “During the April inspection, we found that the emergency department at the Royal Stoke was consistently failing the four-hour waiting time target.

“Other areas of concern surrounded the trust’s struggle with capacity levels across many departments…There were not enough beds for critical care patients and high numbers of patients were cared for in the recovery unit,” he said.

However, areas of outstanding practice were found at the trust by the regulator.

These included work on a specialised neurological unit at the County Hospital, a range of initiatives in services for children and young people to enhance patient experience, and a specialist one-stop clinic for pregnant women with substance misuse.

Trust chief executive Mark Hackett noted that less than a year ago there were serious concerns about the sustainability of services at County Hospital, but that the CQC had now assessed it as “good” across 23 areas.

“This is a real boost for NHS staff in Staffordshire and proof that the changes we are making on the back of an unprecedented investment of £250m are now bearing fruit,” he said.


Readers' comments (9)

  • michael stone

    There is currently a lot of stuff in the media, about nurses: mainly about permanent NHS staff versus agency nurses.

    Three points seem a good place to start: one is that the nurses who work permanently on-staff in a hospital, will 'get to understand it as a working enviroment'; the second, is that agency nurses are in a way 'potentially less useful' because sometimes they do not properly understand the hospital; the third, is that there is a view that some nurses find agency work easier to fit into their life, because permanent NHS staffing rotas/etc 'are too inflexible'.

    Almost everyone agrees at the moment, that the NHS needs to get to a position of having more on-staff nurses and less agency nurses: and there is work on staffing ratios under way.

    How about this, for a wild idea: why not 'nudge' hospitals towards employing more on-staff nurses where that is possible, by under-weighting an agency nurse, relative to an on-staff nurse, when 'counting the nursing ratios' ? Perhaps when working out long-term staffing ratios, hospitals could be told to count an hour worked by an on-staff nurse with a value of 1, but an hour worked by an agency nurse with a value of, for example, 0.9 ?

    Probably another of my barmy ideas.

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  • Most certainly

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  • There is one resource that hospitals use but they do not appreciate their value.
    That is your Bank Staff.
    Normally experienced, flexible, local staff, covering shifts at the last minute, but the most important factor is they are one of the cheapest to employ.
    But hearing the stories from your local "Bank" Staff I am not surprised they look for agency work instead.
    As a patient listening to your work force from the bed of a few hospitals in the UK Bank Nurses telling me they want to be flexible but are pushed for shifts they can't really do, but frightened if they turn the work down then they find themselves at the bottom of the list (It goes for your HCA's too!).
    In my eyes they should be the first on the rota to do what they want to do, then your part time, & full time staff to fill in the rest of the shifts.
    Look for incentives for them, an extra bonus for completing X amount of hours, other incentives to make it attractive (Free parking for them).
    Another area I have noticed that I find a bit odd is newly qualified staff both nursing & HCA's. There seems to sometimes be a lack of wanting to employ them.
    Why not guarantee 2 or 3 years of full time employment for them once they qualify (with no strings attached) instead of what I have seen, nurses waiting for a few months to a year before they get a job (& sometimes not in their first choice hospital).
    If you treat your work force poorly expect them to join the agencies. Treat them well & they will be a loyal employee for the future of the NHS.

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  • Over 75% of agency nurses hold substantive NHS posts, agency nurses are NHS nurses just working for different trusts. Until there is an honest debate about workforce there will be no change.

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  • I did a RTP course last year and am working on the bank of a large local care home (no permanent jobs on offer). I also joined an agency recently, but working as a band 2 for a while to 'get the feel' of the 2 places they have contracts with. Applied for a job end of last year in an area I had lots of experience, visited the place and never heard anything from them again. What chance do I have? The jobs advertised are not flexible enough - not everyone wants or needs a fulltime job. There seem to be very few part-time or job-share vacancies around.

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  • Damned if you do, damned if you don't.

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  • Why every one is after agency nurses. i work as an agency nurse and has more experience and skills probably from most of the nurses I go and work with. Why I choose to work is the issue? if nhs solve there problem with poor management andtoo many un-necessary bosses, unfair recruitment to higher posts, who knows who policies then yes people like me consider getting into nhs to progress on career path.
    So, please treat agency nurses like human and they are trained nurses and most of them experience (not all in some cases) but still need respect and show them round they there for help.

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  • I note the media don't condemn bankers for getting obscene bonuses paid for my tax payers, some of those will be nurses. the government just begrudge nurses being paid a penny

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  • Until staff are paid appropriate remuneration, appropriate overtime rates and same for full time staff working extra bank hours people will opt to work as Agency.
    Some are full time agency staff, most are NHS staff topping up years of pay freezes to make ends meet.
    Hunt can't use the threat that paying nurses appropriately will cost more nursing jobs, as nursing has been understaffed across the board for years, and that's why demand for agency staff is so high.
    Wouldn't hear same complaints if it is bankers + consultants.
    Agency rate probably reflects more accurately what substantive NHS staff should be paid. Noting that it isn't as much as what some media claims it to be. The very high pay is most likely for very skilled staff that a trust had trouble locating cover for.

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