A range of continuing nursing and workforce issues have been raised by regulators during a visit to Hull and East Yorkshire Hospitals NHS Trust.
Inspectors found most staff were caring and efforts had been made to tackle perceptions of a bullying culture, but improvements were still needed across a range of areas, including recruitment, communication and basic care systems.
“There had also been significant progress made by the trust with their work to address the issue of the bullying culture identified at our February 2014 inspection”
As a result, the trust has retained its rating of “requires improvement”, following the latest inspection by the Care Quality Commission.
The visit, which took place at Hull Royal Infirmary and Castle Hill Hospital in May, followed-up a previous check in February 2014 when the trust was also rated as requiring improvement.
During the May visit inspectors focused on areas where concerns had been raised in February – surgery, outpatients and diagnostics at both sites, as well as urgent and emergency care, medical care, maternity and services for children and young people at Hull.
They concluded that staff were caring and compassionate, and treated people with dignity and respect.
However, some patients and relatives on the elderly care wards raised concerns about a lack of communication between the nursing staff and patients, particularly around discharge planning.
The trust had appointed an internal anti-bullying “tsar” and had introduced a number of schemes focussed on empowering staff and instigating positive cultural changes.
The trust had responded to previous staffing concerns and was actively recruiting to fill posts.
“While issues such as culture cannot be resolved straight away, many staff now feel this is a better place to work, which is essential in making lasting improvements”
Inspectors found there had been a significant increase in the recruitment of midwives, with the birth to midwife ratio having increased from 1:35 to 1:32 since the last inspection in February 2014.
However, there remained a shortage of nursing staff on some medical and surgical wards, and this was impacting on patient care and treatment, said the CQC. There were also staffing pressures in the electrocardiography department at Castle Hill.
Systems and processes for the management of medicines and the checking of resuscitation equipment on some wards did not always comply with trust policy and guidance, but most patients were receiving a good standard of care.
However, on the elderly care wards, patients were waiting for staff to assist them with their basic needs. Call bells were not always in reach of patients and there was inconsistent use of the “red top” water jug system for patients requiring assistance with hydration.
There continued to be delays in discharge, patient bed moves out of hours and, patients being cared for on non-specialty or other specialty wards due to inpatient capacity issues.
In addition, there were a number of infection control issues across surgical services and in the emergency department at Hull Royal Infirmary.
Inspectors identified potential risks of contamination caused by inappropriate storage and ineffective cleaning protocols and hand-washing facilities for clinical procedures were poor.
The CQC’s chief inspector of hospitals Professor Sir Mike Richards described the quality of services provided by the trust as “mixed”.
“Generally we found services to be caring and saw staff being respectful and compassionate when interacting with patients,” she said.
“There had also been significant progress made by the trust with their work to address the issue of the bullying culture identified at our February 2014 inspection,” added Sir Mike.
“But clearly the trust is under pressure,” he said. “Some people have to wait too long for their treatment.
“Bed occupancy has been very high, with poor patient flow through both hospitals, and too many patients having to be accommodated on the non-specialist wards, or simply waiting to be discharged.”
Trust chief executive Chris Long said the original inspection in February had occurred “at a very difficult time” and that the trust had “moved on significantly since then in many areas”.
“The number of both nurse and consultant vacancies has reduced, the number of incidents not investigated within 14 days has fallen dramatically between May and August,” he said.
Mr Long said he was encouraged the CQC had acknowledged efforts to improve the trust’s culture.
“The original report noted a high incidence of bullying and harassment back in 2014 and, again, whilst issues such as culture cannot be resolved straight away, many staff now feel this is a better place to work, which is essential in making lasting improvements to the care we provide,” he said.
He added: “We know we still have much to do, but we can still take some positives from the reports published today. In the five months since the re-inspection, we have either resolved or continued to make in-roads into many of the areas the report identifies for improvement.
“We’re making the trust a more attractive place to work, and the reduction in the number of vacancies we’re carrying is testament to this.”