School nurses working for Buckinghamshire Healthcare NHS Trust said they were “bullied” when they tried to raise concerns about services, an inspection report has revealed.
Care Quality Commission inspectors noted that the trust, which recently came out of special measures and was at the centre of the revelations regarding Jimmy Saville, had made significant progress in many areas since a new management team had come in.
But they also highlighted a range of concerns, especially on staffing, and rated the trust as “requires improvement” overall.
In particular, inspectors found leadership of services for children, young people and families to be “inadequate”, with nurses feeling under pressure and sometimes “bullied”.
“Staff within the school nursing team told us that they were discouraged or not heard when they raised concerns about being able to deliver services safely,” said the CQC’s report.
“There had been a lack of management support, and staff were dissuaded and bullied if they raised concerns,” it said.
School nurses reported they were being asked to take part in child protection work “beyond their competencies” and the report also flagged up heavy caseloads.
“Staff within health visiting and school nursing teams told us that they were unable to perform certain aspects of their role due to workload pressures,” said the report.
“The family nurse partnership could only fulfil 40% of its programme because of staffing capacity,” it added, referring to the national programme of home support for young mothers from disadvantaged backgrounds.
Inspectors visited the trust’s two main sites – Stoke Mandeville Hospital and Wycombe Hospital – as part of an unannounced inspection of urgent and emergency care and end of life services.
“There had been a lack of management support, and staff were dissuaded and bullied if they raised concerns”
In addition, the team inspected community health services at the trust during visits in March this year.
They also found staffing was an issue in community inpatient services, with “little evidence of monitoring of appropriateness of admissions or the current model of medical and nursing staffing, and the skill base to meet the needs of patients”.
Inspectors found nursing and therapy staffing vacancies had led to staff shortages and high use of agency staff, particularly at Buckingham Community Hospital.
However, there was also much to praise at the improving trust, said the CQC. It was rated “good” overall for providing caring services, with patients and relatives giving plenty of examples of “compassionate nursing care”, said the report.
Inspectors concluded the trust had made significant improvements in end of life care and both nursing and medical care had also improved with patients getting better pain relief.
They also identified several areas of outstanding practice including consistent, round the clock support from various nursing teams.
This included the fact community adult health services were available to patients 24-hours-a-day, seven-days-a-week, with nurses caring for some patients in their homes at night.
“It is particularly heartening that our patients overwhelmingly praised staff for the care, compassion, empathy and kindness they showed”
Specialist nursing services for people with respiratory problems were also praised, with patients, GPs, community nurses and hospital staff able to access their expertise, advice and support via a dedicated phone line seven-days-a-week.
Specialist palliative care nurses were on hand during the day, with telephone advice and support available out of hours, as was face-to-face support from the district nursing team.
Trust chief executive Neil Dardis described the report as a “helpful checkpoint” for new managers striving to make improvements, including addressing some of the leadership and staffing issues raised.
“It is particularly heartening that our patients overwhelmingly praised staff for the care, compassion, empathy and kindness they showed,” he said.
He added that the trust was working with staff to develop an action plan to address concerns raised by the CQC, though Mr Dardis did not directly mention the issue of bullying raised in the report.
The organisation would continue to invest in the recruitment and retention of clinical staff including nurses, he said, and address the leadership and support for staff in some departments.
“This is an area in which the trust’s new leadership team has already begun to take action with senor leader spending time working out on the frontline and establishing a new development programme for all team leaders and line managers,” he said.
Inspectors said many staff had commented on the “accessibility and visibility of the chief executive and director of nursing”.