Concerns over bullying and accident and emergency department performance have emerged in the latest Care Quality Commission inspection reports of hospitals.
The CQC has today released the third tranche of its first wave of new-style inspection reports, covering four trusts, which were all visited by inspectors in November.
Barts Health Trust has been issued with a total of 15 compliance actions across five of its hospitals after inspectors warned that some staff believed there was “a perception of a closed culture and bullying”. Many staff members only agreed to speak to inspectors under condition of anonymity.
“Across the trust, a significant number of staff told the inspection team that they felt disconnected from the trust’s executive team and felt undervalued and not supported,” the report said.
“The culture was not sufficiently open and some staff felt inhibited in raising concerns. Morale was low across all staffing levels, and some staff told inspectors they felt bullied.”
A spokeswoman for Barts Health said: “We are reaffirming very strongly that bullying has no place at Barts Health and staff are strongly encouraged to raise any concerns they have about their workplace or the care provided to our patients.”
The trust was included in the CQC’s first wave of inspections because it was judged to be “high risk” under the regulator’s new intelligent monitoring system.
In August last year warning notices were issued relating to Barts’ Whipps Cross Hospital site after inspectors found staff working with older people were inadequately supported and the maternity ward was unclean. These notices were today removed after requirements were met.
Inspectors in the latest inspection also found Barts’ staffing levels were variable and a reliance on agency staff meant patients did not always receive care promptly.
Some patients felt frustrated with how complaints were handled. During the course of the inspection the team were contacted by several patients who wanted to voice their grievances.
While care was found to be effective at the trust’s smaller hospitals it was less consistent at the larger acute hospitals. The Royal London and Whipps Cross hospitals had problems with patient flow, bed occupancy and discharge planning. This was found to be less of a problem at Newham University Hospital.
Although the inspection team found the executive team was “well established…with a clearly shared vision”, it was not visible across the trust. The report states: “The executive board must urgently re-engage with staff.”
Inspectors found that patients were satisfied on the whole that staff were compassionate and caring.
A&E concern at Heart of England
Care Quality Commission inspectors have expressed concern about standards at Heart of England Foundation Trust’s accident and emergency departments.
Patients visiting the A&E departments at Birmingham Heartlands and Good Hope hospitals were not given initial assessments upon arrival, resulting in delays to their treatment.
Good Hope Hospital was been issued with a warning notice following the inspection.
At Good Hope medicines were not being stored securely because cupboards could not be locked. The team also found that a fridge with a “do not use” sign had been used to store insulin.
The team saw patients in the hospital’s A&E department having to wait on trolleys in a corridor because of a shortage of cubicles.
Inspectors wrote: “We observed two patients calling for help in a distressed manner; both were disorientated as to time and place. Some staff walked past and did not respond to their requests.”
In the maternity unit at Birmingham Heartlands Hospital some staff reported that they felt they were working in an environment “where mistakes were feared and not allowed to be used as a learning opportunity”.
The team found that the trust was addressing its shortage of nursing staff but currently had too much of a reliance on agency staff.
Maternity and paediatric care was sometimes not always meeting care needs because of a lack of staff.
The team also found that children’s care services struggled to meet the needs of children and adolescents with mental health issues.
The intensive care unit at Solihull Hospital caused inspectors concern, with staff seemingly unaware what the unit was and with insufficient training to look after patients with high dependency needs.
Inspectors concluded that the hospital’s A&E department was in fact a minor injuries unit and a medical assessment unit and that “there needs to be a degree of public honesty about the services that are on offer”. It concluded that it was inappropriate to rate the service as an A&E department.
CQC’s head of hospital inspection Fiona Allinson said: “The concerns CQC found were unacceptable and we have warned the trust it must improve. CQC will continue to monitor the service closely and our inspectors will be returning unannounced to check on whether improvements have been made and standards are being met.”
Heart of England chief executive Mark Newbold said he accepted the CQC’s findings.
“It is well known that we are under great pressure in our emergency departments and I and the trust board are putting all our efforts behind a number of major initiatives to bring about improvement,” he said.
“In particular, there has been a shortage of facilities locally for patients who need continuing care after discharge from hospital, which has led to longer stays in hospital than desirable and consequently a shortage of beds for new admissions. In recent weeks we have made significant progress and I am determined to continue all efforts until the situation is further improved.”
Frimley Park Hospital Foundation Trust and Harrogate and District Foundation Trust were also inspected and received mostly positive reports. No compliance action was served on either trust.
A report into University College London Hospital Foundation Trust, which was also inspected by the CQC in November, was due to be published today. However, the report has been delayed with no revised publication date supplied.
A CQC spokesman said: “The report is still being finalised.”