North Bristol NHS Trust has been told to review staffing levels and training following an inspection by the Care Quality Commission, which identified “serious performance and financial issues”.
The trust, which operates from five main site and provides a range of community services, was given an overall rating of “requires improvement” after a series of inspection visits in November last year.
Inspectors found staffing levels varied across the organisation and called for an urgent review.
“As well as shortages in some areas there were also issues, particularly in theatres and critical care, with regard to the skill mix of staff as a high proportion of staff were new and inexperienced in those areas,” said their report.
They highlighted gaps in training with less than half of nursing staff in critical care holding a post-registration qualification in critical care.
Meanwhile just 55% of nursing sister had completed mandatory safeguarding training.
Other issues included overcrowding in the emergency department where staff were “struggling to manage”.
“There was no support from specialist nurses such as the diabetic and cancer nurse specialists or the palliative care team at weekends”
Nevertheless inspectors praised the “dedication and commitment” of the emergency team who “displayed excellent teamwork despite the significant demands on their service”.
While inspectors rated the trust “good” overall for caring they also identified gaps in emotional support for patients.
“Patients generally received the support they needed to cope emotionally with their care, treatment and condition, however there was no support from specialist nurses such as the diabetic and cancer nurse specialists or the palliative care team at weekends,” said the report.
The report also flagged up a lack of support for the director of nursing – who was officially appointed to the role in December 2013 having been on secondment to the trust as interim director since 2012.
At the time of the inspection a number of posts supporting the nursing director were vacant although a deputy was due to start and inspectors concluded “her capacity to deliver in all the areas she covered was a challenge”.
Inspectors visited the trust just months after Southmead Hospital moved to a new site and said they were impressed with the way the move had been handled.
However, there were some concerns about the privacy and dignity of patients in the new Brunel building.
Inspectors praised the involvement of patients in services with maternity services at Crossham Hospital and community health services both rated “outstanding”.
“The question of capacity requires a response from the whole of the local health and social care community”
The trust said it was working to address issues highlighted by the CQC but said some – such as overcrowding in A&E – were linked to wider problems in the health and social care system.
“As the CQC notes, the solution to our challenges of under-capacity and over-crowding lies in the whole health and social care system in Bristol working together. We are addressing some of the important issues raised by the CQC but the question of capacity requires a response from the whole of the local health and social care community,” said trust chief executive Andrea Young.
“It’s also important to remember that this inspection took place in the run up to Christmas, the busiest period in the history of the NHS not just here in Bristol but across the country.”
She said the trust was working towards more rapid assessment of patients when they arrive at the emergency department. Changes being made as part of efforts to reduce pressure on A&E included a new GP assessment area and four more cubicles for initial assessments.
“I am confident that, with our action plans already progressing and having now settled in to our new hospital, we can expect to see further benefits that will enable us to provide quality care that achieves the best possible outcomes for all our patients,” added Ms Young.