Under-staffed Mayday remains accident waiting to happen

Mayday has just had its latest check-up and the local hospital is still a long way short of being given a clean bill of health, with the Chief Inspector of Hospitals expressing “very serious concerns” over staffing levels and safety at Croydon’s main hospital.

Mayday sign left to rightThe Care Quality Commission – CQC – conducted an urgent inspection of Mayday in September, with its report published tonight. Mayday – sometimes referred to by the non-sequitur “Croydon University Hospital” – was among one-quarter of NHS trusts around the country which were identified as “high risk”, with higher than expected death rates. Mayday’s scores in the national in-patient survey for 2012-2013 “were among the worst in the country”, the report says.

Today’s CQC report expresses particular concern over the referral situation between the hospital’s Accident and Emergency department and the Urgent Care Centre, which has been privatised and is run by a subsidiary of Virgin. “The A&E unit is not consistently providing safe care, mainly because of relationships with the UCC run by another provider,” the report states.

The report also found that waiting times at Mayday’s A&E, although usually meeting the NHS’s national four-hour target, had “a high number of people … being discharged just before four hours is up”.

These delays in prompt treatment are less surprising when you consider that the CQC discovered that 1-in-5 posts in A&E had previously been deliberately left unfilled. At the time of the inspection, instead of having 10 consultants, the A&E department was trying to get by with just six on their rota.

The inspectors also discovered that there were some shifts on A&E which had no permanent qualified nursing staff on duty.

One of the conclusions following the Mid-Staffs hospital scandal was that patients died because of poor staffing levels which left those on duty being too stressed and over-tired to do their jobs properly.

The 25-strong CQC inspection team included doctors, nurses, patients and senior NHS managers. The team spent several days on site observing care, talking to patients and staff, and looking at records and patient feedback. There were also unannounced visits.

What they found was an under-resourced and under-staffed hospital, often ill-equipped for dealing with such high demand, especially in out-patient departments.

The report states: “CQC found that some out-patient clinics were poorly organised and significant numbers of older people were being discharged in the evening. Inspectors were also concerned about low staffing levels affecting patient care especially in wards for older people. The poor physical environment in A&E and in some other parts of the hospital made the delivery of care difficult.”

“Failing the four-hour A&E target is endemic in the NHS, but it is rare to see the CQC shine a light on it in this way,” one senior doctor told Inside Croydon.

Mayday has been instructed to make improvement as a matter of priority in:

  • the staffing levels in older people’s wards
  • reducing discharges in the evening, especially for older people
  • improving out-patients to reduce waiting times, providing enough seating and communicating better about the reasons for and length of delays
  • improving care plans to make sure that they involve people and reflect their needs
  • arrangements between A&E and the Urgent Care Centre “as far as the trust can influence”

CQC has told Mayday’s managers that they still need to improve staffing levels and skills mix generally; to improve the care provided for “patients who are not being treated in the correct ward for their condition” (yes, really); developing a stronger attention to detail on key practices including infection control; improving the accuracy and storage of patient records; and supporting food choices for people with dementia.

There was some good news. CQC expressed satisfaction with good practice in a number of areas, such as a “sustained improvement in maternity services”, “the care of people with dementia in A&E”, and the COPD, or Chronic Obstructive Pulmonary Disease clinic, “which was working well to prevent avoidable respiratory admissions”.

Chief inspector Professor Sir Mike Richards: "

Chief inspector Professor Sir Mike Richards: “Poor patient experience was still a theme across the trust”

“While most patients praised the care they had received, poor patient experience was still a theme across the trust,” Professor Sir Mike Richards, the Chief Inspector of Hospitals for CQC, said.

“At Croydon University Hospital, we found that while most services were being delivered safely, a number of areas needed to be improved as a matter of priority. There were staffing challenges in a number of areas of the hospital – including A&E and elderly care – despite an on-going recruitment drive.”

A recurring theme with the inspectors was the state of Mayday’s A&E provision. “We had serious concerns about the way in which patients move between the Urgent Care Centre (UCC), which sees people when they first arrive, and the hospital. The UCC is run by another provider who we have inspected separately to address our concerns.

“The A&E environment was not well designed or maintained. It was cramped and lacked lines of sight between staff and patients. The observation ward was very crowded. Vacancy levels were high. Staff were, however, positive about changes to care pathways and about the training and support they were receiving. The dementia zone was singled out as an example of good practice.

nurse generic“In its current state the A&E environment is not suitably designed or adequately maintained. It was generally cramped and lacked some lines of sight between staff and patients. The general decoration was in need of attention. Much of the paintwork was chipped and plaster was crumbling in places.

“There is a 16-bed ward for observing patients who are expected to stay less than 24 hours. This observation ward was not suitable for patients. It was very cramped and the layout made it difficult to observe patients. There were no separate male and female bathrooms.

“Two patients said they found the bathroom area difficult to use. The floor was damaged in places and taped down – making cleaning more difficult and creating a risk of infection.

“Staff vacancies are high within A&E. At the time of our inspection, there were six consultants but funding was available for up to 10 consultants. This would bring the department up to the level recommended by the Royal College of Emergency Medicine. The trust was actively recruiting but had not yet been able to fill these roles,” the inspectors found.

The report says that there “is a new management team that is working to change culture (through the ‘listening into action’ programme,’ which is working well).

“It is early days but the new team is having an impact.”

With a cold winter on its way, the people of Croydon must hope so.

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News, views and analysis about the people of Croydon, their lives and political times in the diverse and most-populated borough in London. Based in Croydon and edited by Steven Downes. To contact us, please email inside.croydon@btinternet.com
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