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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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Staff should be properly trained and supervised, and have the chance to develop and improve their skills (outcome 14)

Not met this standard

We checked that people who use this service

  • Are safe and their health and welfare needs are met by competent 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

Figures for statutory, mandatory and essential training showed that across a range of areas, including adult and children safeguarding training and health and safety management attendance is low. Supervision of staff in clinical roles is variable and described as ad-hoc for some staff. The trust is also not ensuring that all staff receive an annual performance appraisal. These areas of non compliance are perceived to be the result of staffing pressure in some areas, where staff time cannot be diverted from patient care to allow them to receive appropriate support.

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

User experience

In the 2009 NHS staff survey, the trust was rated worse than average when compared to similar trusts across 22 areas related to level of work pressure and support, quality of job design, communication between senior management and staff, staff appraisal and opportunities for training. While only 5% of staff responded to the survey, a further staff safety survey conducted by the trust itself reinforced some of these findings. The staff safety survey was completed by 1786 staff (18% of the total).

The trust has an action plan in place to address the staff survey and has prioritised four key areas:

• training provision/personal development

• appraisals

• internal communications to improve staff engagement

• bullying and harassment and health and well being.

The plan is monitored through a range of relevant meetings including directorate boards and matrons’ meetings. There is evidence that the trust has made some progress against this plan.

While many of the staff interviewed had attended mandatory and other training, the figures provided by the trust show that this is not indicative of the trust as a whole. Figures for statutory, mandatory and essential training showed that across a range of areas, attendance is low. In November 2010, 56% of eligible staff had attended fire safety training, 52% had attended general health and safety training and 68% had attended manual handling. As highlighted in outcome 7, 47% of eligible staff had received level 1 safeguarding training, 29% level 2 safeguarding training and 46% of staff had attended safeguarding vulnerable adults training.

In 2009/10, 60% of staff had attended mandatory infection control training. In view of this, the infection control team are developing a new e-learning (learning via electronic media such as the internet) tool for 2010/2011. The trust has trained 25% of its staff between April and July and is on track to have 85% trained by the year end.

An internal review of governance arrangements in the trust in May 2010 reported a ‘disconnect between staff and the executive corridor’. Staff were asked how often they saw senior managers and executive staff on the wards. Some staff commented that senior staff were accessible and supportive. Others stated that were rarely seen on the wards and that they did not always have a grasp of the key issues at ward level. The trust has undertaken 27 safety ‘walkarounds’ in 2009/10. These are conducted by senior executives and aim to seek the views and experiences of staff and patients and record any issues and concerns. A wide range of concerns were raised from these visits and the trust provided resulting action plans. There was no written evidence provided to verify whether these actions have been completed.

The trust stated that it uses a range of other approaches to communicate and gain feedback from staff. This includes staffing updates via email, newsletters, team briefs and the intranet. The chief executive officer holds meetings to enable staff to come and talk with him and other senior staff. Staff at the Churchill Hospital reported that they felt they could raise issues with their managers and that they were responsive. The trust has also put a leadership development programme in place to support those employed in the new management structure. A series of workshops are being run initially for the trust management executive team, divisional directors and clinical directors.

Staff stated that clinical supervision for nurses is in place, but that it was provided on an ad-hoc basis. The trust has stated that development of an action plan to address mentorship and supervision arrangements for all staff across the trust is underway.

The trust is currently not ensuring that all staff receive an annual performance appraisal. Figures provided by the trust show that consultant appraisal rates for the past 12 months are low. The trust was divided into three divisions (this has recently changed with the reconfiguration). In divisi

Other evidence

Unspecified