A Norfolk hospital’s medical care service has been rated requires improvement by the Care Quality Commission (CQC), following an inspection undertaken in November.
CQC inspected the service, which includes older people’s care, at Norfolk and Norwich University Hospital, after receiving concerning information regarding the safety and quality of care and treatment being provided to people. This included information about a shortage of nurses and healthcare assistants.
Following the inspection, CQC rated the service requires improvement overall. This does not represent a change from its previous overall rating.
In addition to the overall rating, the service was rated requires improvement for being safe and effective, and good for being caring. It was not rated for being responsive to people’s needs or well-led as this was a focused inspection in response to specific concerns.
Ratings for Norfolk and Norwich University Hospital – and for Norfolk and Norwich University Hospitals NHS Foundation Trust, which runs the hospital and service – are unchanged following this inspection. Both remain requires improvement overall.
Antoinette Smith, CQC head of hospital inspection for the east of England, said:
“We’re very aware that many healthcare services across the country are facing significant pressure due to challenges in recruiting and retaining staff.
“Although the trust knew how this challenge affected it, and it was taking steps to reduce the risk this posed to people using its medical care, a lack of staff meant it couldn’t consistently meet people’s needs in the service.
“The pressure the service was under was increased by a lack of available places elsewhere for people to receive respite or step-down care. This meant people stayed on the service’s wards longer than they needed to, and people needing the service couldn’t be admitted without increasing the number of beds beyond what it is designed to accommodate.
“The trust is working with the wider health and social care system in Norfolk and Waveney to improve how people transfer between services. This work must continue at pace, with all parties collaborating to drive progress.
“However, despite the pressure they were under, staff collaborated well in the interests of people using the service. They also ensured infection risk was well managed, and that people were treated with compassion and respect.
“We also found the service’s leaders used good systems to manage performance and identify risks.
“We’ve reported our findings to Norfolk and Norwich University Hospitals NHS Foundation Trust, so it knows what it needs to address in the service.
“We continue to monitor the service, including through future inspections, to ensure people receive care and treatment meeting standards they have a right to expect.”
The inspection found:
- Despite a range of recruitment initiatives, the service did not have enough nurses and healthcare assistants. This undermined care and treatment people received
- Staffing shortages also affected the ability of staff to assess and respond to risks, and manage people’s nutritional, hydration and pain-relief needs
- Staff were not always able to ensure people’s needs were being monitored and recorded as required
- Staff morale was low. Staff reported feeling exhausted and stressed
- Arrangements to admit, treat and discharge people were undermined as significant numbers of people that no longer met the criteria to reside in the hospital remained because they were waiting for onward care packages. This led to beds being added to bays in December 2021 as a temporary measure, but it continued throughout 2022
- The use of additional beds in bays was impacting on the space available to provide care, and on people’s privacy and dignity
- Challenges with flow led to the service moving people between clinical areas when there was not a clear medical reason, or when it was not in their best interest.
However:
- Infection risk was controlled well
- Staff worked well together for the benefit of people using the service
- The trust was actively engaging with other agencies in Norfolk and Waveney to address challenges with flow through the health and social care system. Staff were pushing for this work to be carried out at a more urgent pace, and to encourage risk to be shared more equally by all system partners
- Staff treated people with compassion and kindness, took account of their individual needs and helped them understand their conditions. They provided emotional support to people, families and carers
- Leaders ran services well using systems to effectively manage performance. They identified and escalated relevant risks and issues, and they identified actions to reduce their impact
- The service’s culture was centred on the needs and experience of people who used it, supporting openness and honesty at all levels
- All staff were committed to continually learning and improving services.