'Overworked staff' impacting patient safety at Torbay Hospital - CQC

Torbay Weekly

The Care Quality Commission (CQC) has raised concerns about Torbay Hospital being understaffed and the impact that has had on patient safety.

The CQC has published a report following an inspection of medical care services at Torbay Hospital, run by Torbay and South Devon NHS Foundation Trust.

It carried out an unannounced focused inspection of medical care services at Torbay Hospital in December, after receiving information of concern about the service.

As this was a focused inspection, medical care was not rated on this occasion and the previous rating of requires improvement remains.

The Torbay and South Devon NHS Foundation Trust says it has taken the CQC’s findings very seriously and made immediate improvements, which the CQC have recognised.

Cath Campbell, CQC’s head of hospital inspection, said: “When we inspected medical care services at Torbay Hospital, we were mindful of the pressures that the COVID-19 pandemic had had on the trust, and aware that staff were working extremely hard during this time. However, we were concerned to find some of the wards didn’t have enough staff to meet the needs of patients, especially those on a dedicated COVID-19 ward, and the trust wasn’t able to provide us with evidence that there were enough staff on the ward to monitor patients to keep them safe.

“In addition, staff didn’t always complete risk assessments for each patient to remove or minimise risks to people’s safety. Staff also did not always identify patients at risk of deterioration and act quickly to keep them safe.

“Staff told us that they felt so overworked they didn’t have time to complete incident forms to let the trust know about the low staffing numbers, because it would mean staying behind after their shift to do so. They also told us they would have to do this so often it would not make a difference. However, the trust told us it was focused on recruitment and had allocated significant funds to increase the workforce. In the last year it had recruited additional nursing apprentices and some overseas staff, though more were needed.

“Although patients told us that staff gave them enough food and drink, we were concerned that there were no records to show if patients had eaten or drunk what they were given at mealtimes. We saw a member of staff disposing of some uneaten food and drink at breakfast time, but they didn’t know which patients these had been collected from, meaning some people could be at risk of dehydration or malnutrition. Some patients needed assistance with eating, but without completed records it wasn’t possible to tell if these patients were receiving enough support at mealtimes.

“Following the inspection, we told the trust that it needs to have more effective processes in place to manage risks better and reduce the chance of people coming to harm. I am pleased to say that trust leaders acted quickly to put an improvement plan together which they have started to action. We will continue to monitor the service to ensure that the improvements are made and fully embedded.”

Inspectors found the following:

  • Managers did not always have the skills and abilities to run the service. They did not always understand and manage the priorities and issues the service faced and were not always visible and approachable in the service for patients and staff.
  • The service did not have enough staff to keep patients safe from avoidable harm and to provide the right care and treatment.
  • Leaders and teams did not always use systems to manage performance effectively. Staff did not always identify and escalate identified nursing risks and issues or implement actions to reduce their impact.
  • Staff did not keep detailed records of patients’ care and treatment and records were not always clear and up to date.

However:

  • Staff felt respected, supported and valued and were focused on the needs of patients receiving care. The service promoted equality and diversity, provided opportunities for career development, and had an open culture where patients, their families and staff could raise concerns without fear.
  • The service provided mandatory training in key skills to all staff and made sure everyone completed it.
  • The service usually managed patient safety incidents well. Staff recognised and reported incidents and near misses. Incidents were investigated and lessons learned shared with the whole team and the wider service. When things went wrong, staff apologised and gave patients honest information and suitable support.
  • Managers ensured that actions from patient safety alerts were implemented and monitored. Managers reviewed and tried to adjust staffing levels and skill mix. Records were stored securely and easily available to all staff providing care.

In response to the CQC’s findings Liz Davenport, Chief Executive for Torbay and South Devon NHS Foundation Trust said: “We fully accept the findings detailed in the Care Quality Commission report and have acted immediately to make the improvements. During the time they visited we were challenged by increased rates of staff sickness absence due to the pandemic. However, our staffing levels are regularly reviewed and supported by the use of bank and agency staff to ensure adequate staffing arrangements.

“We took a number of actions straightaway to make the necessary improvements across not just the wards inspected but also to ensure good practice was shared across all of our wards. As a key part of this we have had an absolute focus on ensuring there is good monitoring of patient’s nutrition and hydration and that those who need support are given it.

“We have introduced six steps to patient safety on nutrition and hydration across all our wards. Within 24 hours of arrival on our wards, all patients receive a risk assessment which identifies any specialist needs that they may have in relation to eating and drinking. Every morning each patient is reviewed and we assign dedicated staff to support those patients who need help with eating or drinking.

“We have strengthened our approach to protected meal times so that we are giving patients and staff the time and space to focus on eating and drinking making sure that patients receive the right meal at the right time with the right amount of help. We have introduced meal time buddies who help to create a relaxed and friendly environment, encouraging patients to eat their meals while providing assistance and companionship.

“We also have ambitious but achievable plans to fill 95% of nursing vacancies including speeding up processes particularly for overseas recruitment while ensuring all necessary checks are completed.

“I am pleased that the CQC also found good practice around training in key skills areas and that when things did go wrong staff were open and honest with patients and that there was good learning and actions were taken.

“We are absolutely determined to make the necessary improvements and continue learning and improving. I would like to thank our staff, who CQC recognised are working extremely hard during challenging times, for taking onboard the learning and for their absolute commitment to providing the best possible care for our patients.

“As this was a focused inspection, medical care services were not rated on this occasion and the previous rating of requires improvement for medical care services remains. Our overall CQC rating remains good.

NHS Devon Clinical Commissioning Group Chief Nurse, Darryn Allcorn said: “NHS Devon Clinical Commissioning Group recognises that Torbay and South Devon NHS Trust has made some immediate changes following the CQC visit on 01 December 2021; to ensure that patients have sufficient nutrition and hydration and that additional support is provided where needed.

“The CCG will support the trust to make further improvements to ensure that patients receive the best possible care.

NHS organisations in Devon are continuing to work together to recruit more nurses and other healthcare staff, both locally and abroad, to fill vacancies.”

The reports will be published on the CQC's website on Friday, March 4.

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