The body which runs Bradford Royal Infirmary has been given a formal warning to sort out staffing problems after a surprise inspection found it failed to meet four of six national standards.
A watchdog found general staffing shortages across several wards, a lack of senior medical staff at Accident & Emergency – particularly in the early hours of the morning – and overcrowding in A&E, leading to some patients having limited privacy.
One nurse on the elderly care ward told inspectors: “We are short-staffed, everyone knows that.”
A regional director for the Care Quality Commission (CQC) described issues identified at BRI as “unacceptable”. Bradford Teaching Hospitals NHS Foundation Trust has now been given an official warning and told it must improve to comply with national standards of quality and safety.
Yesterday some MPs were calling for urgent meetings with the trust, while Healthwatch Bradford and District said it was “concerned” by the failings.
The trust said it welcomed the opportunity the inspection gave to make improvements, highlighted positive comments in the report and acknowledged there were areas for improvement.
The report follows unannounced one-day and four-day inspections at BRI in September and October 2013, respectively, by the independent regulator of health and social care in England.
CQC regional director Malcolm Bower-Brown said: “The issues we identified at Bradford Royal Infirmary are unacceptable and the trust must take further action to ensure national standards are met.
“We have warned the trust that improvements must be made and we continue to monitor the situation closely, to ensure that patients receive the service they are entitled to expect.”
The CQC’s 48-page inspection report, which is published today, said the trust was failing to meet four of the six national standards – care and welfare of service users; respecting and involving people who use services; staffing; and assessing and monitoring the quality of service provision.
It said that most significantly it found staff shortages across several wards and departments particularly in A&E.
There were also concerns about the varying skills of staff in some areas with inspectors worried that it impacted directly on the trust’s ability to provide safe and effective care that fully met patient’s needs.
Areas of concern included:
- delays in triage (the process of assessing and prioritising people's injuries/illness) for patients attending the A&E due to insufficient staff numbers, and delays in moving people out of the department
- a shortage of senior level medical staff cover in the A&E, particularly during the early hours of the morning. There was also a shortfall of medical consultant doctors on the Medical Admissions Unit (MAU)
- A&E was overcrowded during busy periods and this meant that patients being attended to had limited privacy
- care records on one elderly care ward in particular were basic and did not demonstrate clearly that patients’ individual needs were adequately assessed and supported
- inspectors identified concerns regarding the trust’s governance and noted delays by the executive team in addressing problems such as staffing and patient flow in a responsive manner
- on the MAU, an eight-bedded trolley bay area designed to manage patients with moderate to low risk was at times being used to place acutely unwell patients due to limited available bed space.
A trust spokesman said: “We are pleased that the full CQC report highlights areas of good practice and we welcome the opportunities the inspection has given us to make further improvements. The inspection report is complimentary about the service we provide in many areas and includes very positive comments from our patients on the care they receive.
“However, we acknowledge there are areas for improvement and we have taken the concerns raised extremely seriously. Robust action plans have been in place since the CQC inspection in October and we took a number of immediate steps to significantly increase staffing levels. Substantial investment in staff and a sustained recruitment drive have helped us fill vacant and newly-established posts and we will continue this process throughout the next few months.
“Our plans include many actions which were already in progress prior to the CQC inspection, and others which have been implemented with immediate effect to improve the process of triage in our Accident and Emergency department and ensure patients are afforded more privacy.
“We are also working closely with our local Clinical Commissioning Groups on initiatives to ease the strain on our A&E department and reduce overcrowding during busy periods.
“We would like to reassure patients that we have taken significant steps to immediately improve standards since the CQC inspection in October and we are confident that measures have been taken which allow us to continue providing safe and effective care that meets patients’ needs.”
Philip Davies MP (Con, Shipley) said the shortcomings were “serious”.
“Clearly the service being provided is not good enough for local residents who rely on their local hospital,” he said.
“I trust that an action plan will be put in place straight away.”
Gerry Sutcliffe MP (Lab, Bradford South) said the trust had written to MPs explaining the situation and that he would stay in contact with it about developments.
“It’s still worrying. We’re being pressurised into this situation,” he said, adding that he thought the Government needed to do more to help trusts across the country, not just in Bradford.
“They [the trust] are trying to do the best they can. The problem is they’re under-resourced and under-staffed – that’s what we’re seeing, not just in this area, but others too.”
George Galloway MP (Respect, Bradford West) said he did not think local medical staff were of a lower standard than elsewhere, so there had to be stringent questioning of the management’s ability.
“But there is a wider issue here, and that is the systematic, ideological under-mining, under-funding of the NHS by this Government,” he said.
“This restructuring of the organisation to favour private medicine is a disaster.
“It’s all compounded by the austerity programme, people unable to eat properly or look after themselves and then presenting in A&E with poverty ailments.”
David Ward MP (Lib Dem, Bradford East) said it would be unfair to say too much before discussing the issue face-to-face with trust members.
“I’m disturbed by it and I shall be seeking to meet with the trust to talk it through. I always follow up these with personal meetings, rather than letters,” he said.
A spokesman for Healthwatch Bradford and District, which represents patients, said: “We know that there are some real issues at the hospital about providing enough qualified, skilled and experienced staff to meet patients’ needs, particularly in the very busy A&E department.
“Healthwatch spent time in the A&E at BRI early in October 2013 to talk to patients, carers and staff. A number of people we spoke to were positive about their experience and the clinical care they were receiving, while others talked about long waiting times, insufficient staff numbers, and overcrowding.
“The information we gathered was shared with the trust and also passed on to the Care Quality Commission who, on the basis of this information, took a closer look at the A&E during their unannounced inspection later that month.”
Healthwatch found that privacy in A&E was an issue.
“We are pleased that the trust has already taken positive steps to improve the triage process and has an action plan in place to improve privacy by assessing patients in private rooms.
“Healthwatch knows that the trust is already taking action to address many of the issues identified by the CQC and is working hard to deliver good services under significant pressure and demand. The test will be how these actions translate into excellent patient care and experience for all.”
Inspectors will return, unannounced, to BRI to check the necessary improvements have been made.
Dr Akram Khan, clinical chairman of NHS Bradford City CCG, and Dr Andy Withers, clinical chair of NHS Bradford Districts CCG, said in a joint statement: “Our two CCGs commission health services from Bradford Teaching Hospitals NHS Foundation Trust for local people. We expect these services to be of high quality, safe and effective.
“We also expect that the trust will treat all of its patients with respect, dignity and compassion. The CQC’s report, while highlighting some areas of excellent service, unfortunately shows shortcomings in the standards we expect in a number of areas.
“The trust has been open with us about the issues the CQC has raised and about its immediate plans for improvement and we have met with them to discuss these. We will continue to monitor progress very closely and to play our role in holding the trust to account. We will also be working closely with other relevant bodies such as Healthwatch, Monitor, NHS England, and the CQC itself.
“At present we are confident that the trust is taking the right actions to make improvements where they are required and will continue to work constructively to support the trust’s improvement actions over the coming months.”