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Inspection report

Date of Inspection: 14 September 2010 and 11 July 2011
Date of Publication: 3 February 2011
Inspection Report published 3 February 2011 PDF | 320.95 KB

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There should be enough members of staff to keep people safe and meet their health and welfare needs (outcome 13)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

How this check was done

We reviewed all the information we hold about this provider, carried out a visit on 14/09/2010, 11/07/2011, observed how people were being cared for, looked at records of people who use services, talked to staff and talked to people who use services.

Our judgement

The trust has provided a substantial amount of data which shows that there are insufficient numbers and types of staff in many parts of the trust, including the Churchill Hospital. Some ward areas were rated red this year indicating an urgent need to supplement shortfalls in available substantive staff due to vacancy, maternity leave and sickness. There has been a high use of agency and bank staff in some areas in order to support wards. While this is a positive temporary response, the underlying staffing shortages need to be addressed.

Overall, we found that the Churchill Hospital was not meeting this essential standard and action needs to be taken to become compliant.

User experience

The inpatient staff survey (2009) contains a number of questions that indicate whether patients’ needs are being addressed in a timely way. Overall, the trust scored similarly to other trusts. There were a number of questions that related to how busy staff are and whether they had time to address patients’ care needs. The trust scored 6.1 out of 10 in relation to the question, ‘how many minutes after you used the call button did it usually take before you got the help you needed’. The trust scored 7.1 out of 10 in terms of whether patients received enough help from staff with their meals.

Other evidence

NHS trusts were registered under the new Health and Social Care Act (2008) in April 2010. The trust declared non-compliance for this outcome at the time of registration and provided an action plan. This stated that all actions would be complete by 31 March 2010. The trust has provided a substantial amount of data which shows that there are insufficient numbers and type of staff in some parts of the trust.

The trust provided evidence that it monitors staff levels and the skill mix required to adequately treat patients with different levels of need. The weekly detailed workforce report demonstrates that the trust monitors the total number of staff used including contracted, bank and agency staff. On some wards at the Churchill Hospital, there has been a high usage of bank and agency staff.

Figures provided for nursing care showed that as of July 2010, each of the three divisions was rated amber using the safer care matrix, which assess if there is adequate staffing provision. There is a 5% vacancy for physiotherapists and concerns have been identified for pharmacists in terms of the days lost due to sickness.

At the Churchill Hospital, staff on the wards we visited generally commented that staffing levels were adequate. On two wards, staff commented that levels of patient dependency changed and that they used bank staff if they needed more staff urgently.

The impact of staffing pressures on attendance at training is reported generally as an issue in the minutes of a number of key committees. The trust’s own safety survey was conducted across the whole trust and completed by 1786 staff. It found that 26%, of those who returned the survey, disagreed with the following statement: ‘we have enough staff to handle the workload’. Thirty one percent of staff disagreed with the following statement: ‘we work in ‘crisis mode’ trying to do too much, too quickly’.

An analysis of the evidence held by Care Quality Commission and further evidence provided by the trust shows some correlation between staff shortages and the standard of patient care. Of all the submitted accident and incident forms in the previous year, 158 (2.6% of the total) specifically mention nurse staffing and/or workload as a contributing factor. A review of the 31 serious incidents that occurred between 1 October 2009 to 31 March 2010 shows that staffing was identified as a contributing factor in the root cause analysis of three serious incidents. In two other serious incidents, one action plan states that staffing of the unit was under pressure and in the second highlights issues with staffing levels.

The trust is working to improve staffing levels. Senior managers stated that they are now recruiting to substantive posts. More systems-wide work is also being carried out with Oxfordshire Primary Care Trust in an effort to reduce the pressure on hospital beds. The trust has also appointed a director of intensive support who is working closely with the human resources team to improve workforce and capacity planning. It is too early yet to assess whether this work has led to improvements.