Hospital approve £300k funding for extra nursing staff after CQC concerns

A Care Quality Commission (CQC) inspection took place at Salisbury District Hospital in December with a report - published in April - requesting a review of staffing on several wards including the night shifts on surgical wards, the emergency department, the children's ward, critical care, midwifery and the spinal unit.

Inspectors said the establishment of one nurse for 16 patients at night on the Amesbury ward did not meet guidance and was not safe, and said there must be a review of night staffing on other surgery wards where the ratio was of one nurse to 12 patients.

At a Salisbury NHS Foundation Trust board earlier this month, nursing director Lorna Wilkinson said: "The CQC were concerned about the nursing to patient ratios on Amesbury, Downton and Chilmark.

"We have increased the registered nurses on the night shift on Amesbury ward to three so it now has a ratio of one nurse to 11 patients.

"Professionally, that absolutely feels the right thing to do. It has meant making a change to the ward's late shift as we have had to take one of the RNs off that.

"That is having very good feedback from both patients and staff and we will continue to monitor it."

But Ms Wilkinson said the hospital's own review which took consideration of quality indicators, patient feedback and professional judgement, found the staffing on both Downton and Chilmark wards to be adequate on nights with there being nothing to indicate any problems.

As part of the hospital review, an extra nursing assistant is to work on the Redlynch (acute medical ward) at night while an extra nurse is to work during weekdays on Pitton (a specialist ward for respiratory medicine).

On Whiteparish (acute medical unit), an extra nurse is to work the weekend day shifts due to an increase in the number of patients attending hospital at weekends.

An extra nurse is to work nights on the spinal unit with the addition of a more senior nurse during day shifts.

Since the CQC inspection, there are always three children's nurses on Sarum ward with two during the day in the day assessment unit and a supervisory senior nurse.

In the emergency department, a nurse is to be allocated to minor injuries.

Twelve nurses have already been recruited to the intensive care unit while it is hoped all vacancies for the maternity unit will be filled by October.

Ms Wilkinson told the board: "There is quite a lot of detail [in the report presentation] but I think it required it because it has loomed large in conversations for everyone here and also the public in terms of our CQC report."

The hospital carries out reviews of staffing levels every six months.

Chief executive Peter Hill told board members: "When the CQC talks about nurse ratios they tend to exclude the nursing assistant input so when it talks about a ratio of one to twelve, that's the registered nurse.

"Our nurses are very ably assisted by nursing assistants who actually deliver a lot of the care to a very high standard."

Inspectors gave the hospital an overall ‘requires improvement’ rating, saying that while the overall care and effectiveness provided was ‘good’ and that staff provided ‘kind and compassionate care’, they had safety concerns over staffing levels on some wards.

They also highlighted issues with the response of external mental health providers and patient records not being consistently written and managed appropriately.

* In approving £286,919 funding, the trust board agreed savings of £303,002.
The savings come from the reduction in hours of supervisory ward sisters working across the hospital by one day a week.

Rather than taking a supervisory role, the ward sisters will take on their own caseloads for the day in question.

It also comes from the hospital no longer having to pay agency staff to provide patients on Redlynch and Pitton wards with one to one care who need it, as this will be covered by an increase of a nursing assistant and a nurse, respectively.