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”
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”
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.
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.