CQC asks for urgent report from trust on nurse-to-patient ratios

The Care Quality Commission has used its legal powers to request urgent clarification from Buckinghamshire Healthcare NHS Trust about its nurse staffing levels.

“We are fully aware of the challenges that lie before us”

Neil Macdonald

The demand comes after a CQC visit during February and March uncovered concerns about staffing problems in the community inpatient wards at Amersham and Buckinghamshire hospitals.

In a report published today, the watchdog said: “In the community health inpatients areas, the service did not always have enough staff with the right qualifications, skills, training and experience to keep people safe from avoidable harm and to provide the right care and treatment.

“Safer staffing levels were not always met which impacted on patient safety,” it said. “Patients could not always have their needs met in a timely way and this impacted on their length of stay.”

Following the inspection, the CQC asked the trust to produce a report outlining the planned and actual nurse staffing levels, including nurse-to-patient ratios for each shift in a 24-hour period for every community health inpatient ward.

Where nurse staffing levels had fallen below standards, the trust was told it must detail what action it had taken to ensure patients were kept safe.

However, the CQC noted in its report that the trust was “working hard to recruit and retain staff across all areas”.

The trust’s community health inpatient services were rated as “requires improvement” by the CQC.

“Safer staffing levels were not always met which impacted on patient safety”

CQC report 

Meanwhile, in contrast, end-of-life care services at Buckinghamshire Healthcare were rated as “outstanding”.

The CQC commended the trust for introducing “the purple rose” model of care, in which a rose was placed on a patient’s door or curtain if they were approaching death to allow families further privacy.

Purple rose resource boxes were placed on each ward and contained practical resources and information to help staff to provide the best end-of-life care for patients and their loved ones.

“End-of-life care was a priority for the trust as a whole and was seen as being important by all the staff we spoke with,” said the CQC report.

“There was a culture that spoke about death and dying and acknowledged the support that staff needed to care for those at the end of life,” it added.

The CQC also noted how the introduction of patient flow co-ordinators in Stoke Mandeville Hospital emergency department had freed up time for doctors and nurses to concentrate on clinical duties.

Overall, the CQC gave Buckinghamshire Healthcare a rating of ‘good’ and recognised that great strides had been made since its last visit in 2016, when it was rated ‘requires improvement’.

Broken down into the categories of inspection, the CQC rated the trust ‘outstanding’ for care; ‘good’ for being safe, effective and responsive; and ‘requires improvement’ for leadership.

“There remains plenty of scope for further improvement”

Nigel Acheson

In addition, the trust was rated ‘requires improvement’ for using its resources productively based on a separate assessment undertaken by NHS Improvement.

Dr Nigel Acheson, CQC’s deputy chief inspector of hospitals, said: “While I am encouraged by the progress that has been made, there remains plenty of scope for further improvement in relation to ensuring sufficient oversight of staffing in the community services.

“We have placed conditions on the trust’s registration to ensure the trust implements improvements we require for staffing – otherwise what had been achieved to date may not be sustainable,” he added. 

“Even so, our inspectors found a strong patient-centred culture with staff putting patients first to keep them safe and involving them in decisions which affected their treatment and care,” noted Dr Acheson. 

The CQC would continue to monitor the trust’s performance, said Dr Acheson.

Buckinghamshire Healthcare chief executive Neil Macdonald said the improved rating was a testament to the hard work of the trust’s staff. volunteers, partners and supporters. 

“We are looking forward to building on our achievements and maintaining the pace of change to transform our culture, workforce and tackle inequalities – for both patients and staff,” he said. 

“We are fully aware of the challenges that lie before us, particularly in regards to sustaining safe staffing in our community inpatient ward,” said Mr Macdonald.

“We are looking at a number of options to ensure we can continue to deliver the best possible outcomes and experiences for our patients,” he added.