Care regulator identifies concerns over staffing levels and waiting times at Oxford Radcliffe Hospitals NHS Trust

28 January 2011

The Care Quality Commission has told the Oxford Radcliffe Hospitals NHS Trust that it must take action to address shortages of staff at its three main hospitals.

Reports on each of the hospitals, published today by CQC, identify four breaches in essential standards of care, covering staffing levels, care and welfare of patients, staff training and systems for assessing and monitoring the quality of it services.

The Oxford Radcliffe Hospitals NHS Trust has been given until 25 February to produce plans within 28 days to show how it intends to achieve compliance. By law, providers of care services have a legal responsibility to make sure they are meeting the essential standards of quality and safety.

Inspectors will review progress with the trusts plans to address the breaches, including making unannounced visits to the hospitals, in coming months.

CQC conducted the review of the John Radcliffe Hospital, the Churchill Hospital and the Horton General Hospital as part of their routine schedule of planned reviews of all health and social care provision. Inspectors visited all three hospitals in September, speaking to patients and staff, and reviewing a wide range of information on all 16 essential standards.

The trust’s own data showed there were shortages of staff in parts of the trust, including the maternity unit at the John Radcliffe Hospital, where there were vacancies for midwives and obstetricians. While staff levels varied between wards, there were shortages of nurses, physiotherapists and pharmacists.

The reports say that the shortage of staff had affected attendance at training. Staff said that the surgical emergency unit in particular had been under significant pressure, although there has been some recent progress to recruit more nursing staff.

CQC says that the trust’s performance on waiting times varied, with a significant number of patients waiting over 18 weeks after referral for treatment, and the trust was not meeting all waiting times for urgent cancer cases.

Roxy Boyce, Regional Director of CQC in the South East, met the chief executive of the Oxford Radcliffe Hospitals NHS Trust in December to discuss the concerns.

She said: “Patients who we met were generally very positive about their experience at all three hospitals. The trust provides a vital service to a largely appreciative population.

“But the shortages of clinical staff on some wards are worrying. Staff on the surgical emergency unit in particular told us that staffing shortages were affecting their ability to attend to patients in the way they would like.

“Several staff commented that they felt they did not have enough time to talk to patients or enough time to give detailed explanations of care. Staffing pressures are also affecting some staff’s ability to attend training, fulfil specialist roles and support new starters.

“Some patients are also waiting too long for their treatment and this of particular concern for some cancer patients who need to be seen urgently by a specialist after referral by their GP.

“It may be that when the trust has addressed the staffing issues that these other matters, such as poor attendance at training, will also fall into place.

“In the short term the trust is using agency or bank staff to care for patients. But that is only a temporary solution. We will be returning to the trust later in the year to look again at these issues.”

The inspectors concluded that the Oxford Radcliffe Hospitals NHS Trust was meeting 12 essential standards, with non compliance in four:

Care and welfare of people who use services

• The inspectors note that there have been substantial improvements in stroke care for patients and a reduction in the time taken to produce radiology reports.
• But waiting times for people with cancer were too long, and there were too many patients waiting to be transferred from hospital to their own homes or to care homes.
• The trust also needs to ensure that its clinical staff are following guidelines issued by the National Institute for Health and Clinical Excellence (NICE)

Staffing

• The trust's own data showed that there were not enough staff in parts of the trust, including the John Radcliffe Hospital. This includes shortages of obstetricians and midwifes, and a shortage of nursing staff in the surgical emergency unit.
• On some wards, there was an urgent need to supplement shortfalls caused by vacancies, maternity leave and sickness. There was a high use of agency and bank staff in some areas to support wards and ensure patient safety.
• The trust was working with Oxfordshire Primary Care Trust and partner agencies to reduce the pressure on hospital beds.

Supporting workers

• Inspectors said that staff shortages meant that attendance was too low at essential training, including safeguarding training and health and safety management.
• The level of supervision of clinical staff varied, and many staff did not receive an annual performance appraisal.

Assessing and monitoring the quality of service provision

• The trust has a range of measures to assess and monitor the quality of its patient care, with improvements in the information made available to members of the trust board. Serious incidents are also investigated thoroughly.
• While the trust had introduced a new monitoring and governance structure, it was not yet clear that there was a systematic process in place to show how changes were implemented, followed-up and monitored. Inspectors said that since these changes needed time to embed, the trust was not yet able to demonstrate that the systems were working effectively.

Ends

For further information please contact the CQC press office on 0207 448 9401 or out of hours on 07917 232 143.

Notes to editors