Trust’s emergency care downgraded due to lack of nurses

Lack of nurses and a failure to meet mandatory training targets have prompted inspectors to lower a trust’s emergency and urgent care rating.

The Care Quality Commission (CQC) has downgraded urgent and emergency care at Aintree University Hospitals NHS Foundation Trust in Liverpool to ‘requires improvement’, despite the organisation’s overall rating of ‘good’.

This follows an unannounced visit in April, in response to concerns over safety and quality at the emergency department.

Inspectors found:

• Nurse staffing levels were not always filled to the safe staffing establishment.
• Periods of understaffing persisted for a number of days before and after the inspection.
• Staff raised concerns over nurse numbers using an internal incident reporting process.
• Poor compliance with the mandatory training target of 85%, although the trust did have a plan in place to reach this figure by March 2017.

‘Patients at risk’

The trust’s overall rating was determined by the CQC following a comprehensive inspection in May 2014, at which the emergency and urgent care was also rated ‘good’.

However, following the revist this year, CQC chief inspector of hospitals Sir Mike Richards said: ‘We were concerned on inspection that the processes in place for recognising and escalating the care of deteriorating patients were not always followed, which put people at risk.

‘We also saw that nurse staffing levels were lower than the safe recommended amount.’

‘We do acknowledge the trust was taking action to address the nurse vacancy rate, but it remained evident during our visit that the wards were not always staffed as they should be.’

Understaffed

The CQC looked at 35 day shifts in the surgical assessment unit over a seven-day period, and found 10 were not filled to establishment levels.

In response to the downgrading, trust medical director Steve Evans said: ‘We always strive to improve our services and a report such as this is helpful in pinpointing where we can do better.’

He blamed the lack of nurses on staff sickness and unfilled vacancies, but added the unit had used experienced cover when it was needed most and since the inspection had recruited new temporary and permanent nursing staff.

Mr Evans added: ‘We have a new approach to mandatory training, which includes the use of block training sessions, and this has seen an increase in compliance.’

Further information

Read the CQC report