The Care Quality Commission (CQC) has told Northern Devon Healthcare NHS Trust to improve staffing levels in the medical care service at North Devon District Hospital, to ensure the safe care and treatment of patients.
CQC carried out a comprehensive inspection of medical care at North Devon District Hospital in July, after receiving information of concern about medical staffing levels.
Following the inspection, the overall rating for medical care services went down from good to requires improvement and the ratings for safe, effective and well-led also went down from good to requires improvement. However, the service retained its rating of outstanding for being caring, and the rating for responsive also remained as good. This inspection did not change the overall rating for the hospital, which is requires improvement.
Cath Campbell, CQC’s head of hospital inspection, said:
“When we inspected the medical care services at North Devon District Hospital, we found a high number of vacancies with a reliance on agency staff, and not addressing issues around the availability and responsiveness of medical staff for deteriorating patients. This put patients at risk of harm.
“Although nursing staff were quick to identify and act when they spotted patients who were at risk of deteriorating, medical staff did not always attend to these patients quickly. We saw two patients waiting an hour or more for the doctor to assess them and administer appropriate treatment.
“There were also occasions when doctors did not respond when paged by the nursing staff, forcing them to contact the intensive care unit to request one of their doctors to urgently review a patient who had deteriorated.
“It was also very concerning to hear a few staff were labelled negatively by their managers for reporting too many incidents. This was preventing other staff from coming forward to report incidents, especially in relation to being short staffed. Staff told us they were sometimes too busy to report incidents and felt little was done about them anyway.
“That said, the medical care services team is thoroughly deserving of its outstanding rating for being caring, which it retained following this inspection. The service introduced a number of commendable new initiatives to reduce patients’ anxiety during the COVID-19 pandemic.
“We have told the trust it must address the medical staffing issues as a priority, and it has assured us it is working hard to do so. As well as recruiting new staff, it has been working with another neighbouring trust to support care provision at the hospital.
“We have also told the trust to ensure the service responds appropriately and quickly when patients are deteriorating, and that staff are encouraged to report all incidents, including near misses. We will keep a close eye on progress and will return to ensure the required improvements are made.”
Inspectors found the following during this inspection:
- There was a shortage of medical and nursing staff which meant patient safety was not always maintained
- Staff identified patients at risk of deterioration, but they did not always provide care in a timely manner. The system of allocation of patients to doctors in some areas was not clear and led to confusion for nursing and medical staff when patients needed urgent medical review
- In some cases, patients were admitted onto medical wards which were not designed or equipped to deal with their specific illness or needs. There was a shortage of medical staff and the arrangements to cover this shortage were not always effective and did not ensure continuity of care for some patients. For example, there was a serious incident which occurred when a patient who needed specialist feeding care did not receive this over a weekend, due to a lack of available medical staff
- Sometimes staff did not report near misses, as they were not aware it was their responsibility to do so. This meant that the opportunity to learn from incidents and near misses was often lost
- There was no dedicated service for frail patients and ward staff did not always have the relevant skills and capacity to provide appropriate care to these patients. This meant that consultants found it difficult to review all frail patients which could sometimes delay their discharge from hospital. One patient attended the emergency department for a wounded finger, then stayed in hospital for 24 days when they could have been discharged after two to three days. Muscle loss is accelerated in older adults during bed rest, so patients who were frail often had poorer outcomes in terms of their mobility levels, resulting in an increase in risk of falls
- Staff did not always have access to all the training they required to carry out their day to day jobs. Mandatory training was below the trust compliance target of 85%
- Processes to oversee locum doctors’ activities were not established
- Care records were not always complete and/or legible. Medicines were not always well managed.
However:
- There was a new leadership team and while they were yet to be fully established, they understood risks to patients and shared the same vision and strategy to improve care
- Staff felt pride in their role and the work they undertook and felt respected, supported and valued. They were clear about their roles and accountabilities and were focused on the needs of patients receiving care
- The service engaged well with patients and the community to plan and manage services and all staff were committed to continually improving services
- Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers and advised patients how to lead healthier lives and supported them to make decisions about their care
- Staff understood how to protect patients from abuse. Infection risks were controlled well, and staff kept equipment and the premises visibly clean. Staff managed clinical waste well. Staff completed and updated risk assessments for each patient and removed or minimised risks when possible
- The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback
- The service introduced a number of new initiatives to reduce patients’ anxiety during the COVID-19 pandemic. For example, ‘Hello, my name is….’ photo cards for staff, so patients could see who was treating them when the staff member’s face was covered by a mask. A drive-through service was also set up to assess patients who were anxious about coming into the hospital during the pandemic. Families were able to drop off essential items and home comforts for patients and they could also send messages to their loved ones and contact them via tablet devices which were purchased by the trust for people who did not have their own equipment to use
- Patients were complimentary about the meals and availability of food and drinks. Staff ensured patients had enough to eat and drink and gave them pain relief when they needed it
- The hospital sought the views of patients and relatives by using the NHS Friends and Family Test. The results for June 2021 showed that 99.7% of patients would recommend the medicine service. There was evidence of changes being made as a result of patient feedback
- Funding had been approved to increase the resuscitation and outreach team’s availability to seven days a week by the end of October.
Full details of the inspection are given in the report published on our website.
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