Staffing shortfalls have been identified as a key factor affecting patient safety in hospitals and care homes, according to a report from the Care Quality Commission.
Poor staff numbers and skill mix and a tendency to rely on agency staff were a common factor in services rated “inadequate” by the regulator, it said today in its State of Health Care and Adult Social Care in England 2014-15 report.
The regulator’s annual analysis on service quality, published today, stressed that “quality depends on getting staffing right”.
However, the regulator found that safe care at some of the top-rated organisations was also being hampered by staffing issues.
“A key concern has been the safety of care – a failure to learn from mistakes or not having the right number of staff in place at the right time”
While the CQC found the majority of health and social care services in England were “good” or “outstanding”, it also found big variations in quality with safety still the biggest concern.
More than one in 10 hospitals – 13% – checked so far under the CQC’s new inspection regime were rated “inadequate” for safety. This was true of 10% of adult social care providers and 8% of primary care services.
Hospital ratings snapshot
As of Monday 12 October, CQC had rated 175 acute NHS hospitals:
- Outstanding – 2
- Good – 49
- Requires Improvement – 114
- Inadequate – 16
(Source: figures supplied to Nursing Times by CQC)
In its wide-ranging report, the CQC stressed that having the right number and mix of staff was crucial to delivering the best care.
Insufficient staffing number and skills mix were among key factors putting safety at risk across all sectors, the regulator said.
Other key issues identified by the CQC as affecting safety included failure to investigate and learn from mistakes, failure to do vital safety checks and staff not being able to raise concerns.
“The health and social care sector is facing an unprecedented level of challenge so it is encouraging that our findings show the majority of people are receiving good or outstanding care,” said CQC chief executive David Behan.
“We have found dedicated staff working hard to treat people with care, compassion and dignity,” he said.
But he added: “A key concern has been the safety of care – a failure to learn from mistakes or not having the right number of staff in place at the right time.”
The regulator said staffing had been a “core factor” in safety ratings awarded by inspectors, but highlighted that it was “about much more than just having the right numbers”.
“Having the right number and mix of staff, with the right skills, at all times is integral to providing safe, high-quality care,” stated the report.
“We are conscious that there can be difficulties getting staffing right, and that there are specific challenges in some sectors, such as ensuring sufficient nurses in adult social care,” it said. “In addition, there is a leadership challenge to ensure the right staff resources are in place to meet the challenges across the system.”
“One of the most concerning findings in the report is that problems in staffing levels were found even in acute trusts that were rated ‘good’ or ‘outstanding’”
The regulator acknowledged nationwide recruitment difficulties in both the NHS and adult social care and expressed particular concern about staffing levels in mental health wards, with a drop in the number of psychiatric nurses and a surge in the use of bank and agency staff by mental health trusts.
It found even the best services were services struggling to fill vacancies and this was true when it came to NHS hospital trusts.
“Our inspectors found problems with staffing levels in services rated good and outstanding as well as those rated requires improvement or inadequate, although they were more common in services rated inadequate,” said the report.
Trusts rated “good” and “outstanding” were more likely to have well-planned staffing rotas and rely less on agency nurses. But there were still times when staffing levels and skill mix fell below the levels needed to properly care for patients.
“When this happened, a number of our inspection reports showed that risks to patient safety grew and there were often more medication incidents, even in trusts rated good and outstanding,” said the report.
“However, these trusts prioritised measure to meet patient demand such as seven-day support,” it said.
As well as emphasising the importance of getting staffing and skills mix right, the CQC also highlighted the key role of staff training and development.
“In outstanding trusts, staff tend to feel well-supported from many different sources – for example, consultants taking the extra time to explain a particular situation to junior doctors or nurses, alongside training, assessment of competencies and feedback on performance,” noted the report.
“Too many senior nursing posts have been cut and the effects are now being felt”
Nigel Edwards, chief executive of the Nuffield Trust health think-tank, said: “One of the most concerning findings in the report is that problems in staffing levels were found even in acute trusts that were rated ‘good’ or ‘outstanding’. This suggests that these problems are systemic across the whole acute hospital sector, as well as social care.”
Janet Davies, chief executive and general secretary of the Royal College of Nursing, said the report had highlighted a “clear link between good care and good workforce planning”.
“Effective workforce planning isn’t just a numbers game – it’s about having the right level of skills, seniority and experience to improve care,” she said. “Too many senior nursing posts have been cut and the effects are now being felt.
“Whether nursing care is delivered, in hospitals, care homes, or the community, it depends on having the right number of staff with the right skills and support. There must be more investment in training nurses, keeping nurses and listening to nurses,” said Ms Davies.
“This report is stark but the issues it raises are not new – there needs to be a concerted effort from government, the NHS and local managers to ensure that there is enough staff to get through the coming winter and the years to come,” she added.
Heidi Alexander, Labour’s shadow health secretary, said: “Jeremy Hunt cannot keep ignoring these serious warnings about unsafe and understaffed hospitals.”