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Bradford Teaching Hospitals Foundation Trust

Yorkshire trust under investigation after CQC inspection

Monitor has launched an investigation into Bradford Teaching Hospitals Foundation Trust, following concerns raised by the Care Quality Commission about accident and emergency staffing levels.

The CQC identified problems with A&E staffing at the trust’s Bradford Royal Infirmary site during an unannounced inspection carried out in September and October last year. Its concerns were sufficiently serious for it to serve the hospital with a formal warning notice.

In its inspection report, the CQC said staffing levels within the department were “significantly low, particularly in relation to nursing staff and senior medical cover; especially midnight and throughout the night”.

The department was sometimes “significantly overcrowded”, meaning “people’s privacy and dignity were regularly compromised”, and triage and treatment were on occasion subject to unsafe delays.

When looking at the duty rota for nursing staff over a four-week period, the inspectors found there were shortfalls every day. In one week 18 shifts were not covered by a registered nurse and nine shifts not covered by a healthcare assistant.

Similarly, when they looked at the medical rota for 21 days, they found that on 17 days there was only one senior grade doctor on duty from midnight until 8am, which the inspectors thought could compromise care.

In light of the CQC’s findings, Monitor is investigating the trust to see if they are “symptomatic of wider issues with how the trust is run”.

In a statement the trust said it acknowledged the areas for improvement and took the CQC’s concerns “extremely seriously”.

It added: “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.”

Readers' comments (7)

  • Why in a healthcare system, in the 21st century, a system that is usually respected around the world, do such fundamental shortcomings keep re-occurring? Is it financial pressures that force management to constantly 'take a chance' that things will probably be OK? Or is it that management feel uncomfortable that there may very occasionally be times when A&E departments are not as busy and staff will be paid for not doing too much? In the past when I have observed statistical process control information regarding A&E, demand fluctuation is predictable but there are obviously peaks and troughs in demand that mean staffing cannot be totally "flexed" to fit perfectly with these peaks and troughs, but departments should be staffed sufficiently to meet demand within the acceptable 2 standard deviations from the average demand level. It cannot be a lack of staff available to recruit, as after these visits those Trusts concerned always seem to have a plan which involves recruiting, and existing and new posts are suddenly filled, and establishment is increased to an acceptable level. Why didn't the Trust know what its safe level was and recruit to this level in the first place? I realise I am not in possession of all the facts, but I see this so often I am left totally bemused by the risk patients are put at yet again, not to mention the stress on the staff left in the department who are obviously going to feel the strain. Can the Trust 'risk share' with primary care to proactively manage the 'frequent attenders' and tackling this and staffing the department to appropriate levels would surely help to avoid such findings on inspection?

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  • i suggest you have a look at the current financial position of all of the 'Keogh' trusts and see how tricky it is to meet all of the quality expectations within the constraints of tariff - particularly in emergecny care.

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  • Well said above. The simple but unpalatable truth is that increasing numbers of organisations do not have the funding they require to enable them to meet the constantly inflating expectations of patients and regulators. to qoute Chris Hopson of the FTN 'We can't go on pretending that high quality care and patient safety can be delivered without a realistic budget'

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  • I like the suggestion from Anon. 11.12am " Trust 'risk share' with primary care to proactively manage the 'frequent attenders' and tackling this and staffing the department to appropriate levels. This is exactly the type of creative yet practical solutions which should be explored. Budget restrictions and tightening is'nt going away in the medium term, simply bleating about cuts does'nt help anybody, including the patients.

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  • In response to 12.51 & 12.58 above I did say in my comment that I realise I was not privvy to all the facts so do appreciate the financial constraints are both complex and tricky to negotiate. However, as 1.25pm has said quite rightly 'budegts will continue to be squeezed" and so can we at least try a different approach? Please note, I am merely a concerned taxpayer who has empathy with the service, but worries about the patients and staff too.

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  • It's not always finance that is the issue but being able to recruit to vacancies!

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  • Why let the facts get in the way of a good story? Lets wait for the investigation and then take a view on whether the Trust was playing fast and loose with its patient safety

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