'Significant staffing shortages' observed during hospital trust re-inspection

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A hospital trust which has been admonished over staffing issues has around one in six posts vacant.

Lewisham and Greenwich NHS Trust had a vacancy rate of 17% , according to the latest Care Quality Commission (CQC) report into the trust.

A previous inspection at a hospital run by the trust found that patients at a hospital were told to wear incontinence pads because staff were too busy to help them use the toilet, while others waited up to two months for their hair to be washed.

After re-inspection in March this year, the CQC found there were "significant shortages" of staff.

As of January, the trust had 1,159 vacant posts, including 346 vacancies in nursing and midwifery.

Staff told inspectors that the high vacancy rates put patients at risk, in particular in relation to medicines being given late when wards were short staffed.

Data from September last year showed that the proportion of consultant staff reported to be working at the trust were lower than the England average, while the proportion of junior staff was higher than the national average, CQC said.

While inspectors recognised that the trust was actively trying to recruit new staff, there was "limited evidence" of success.

The trust said it was running "major recruitment campaigns" locally, nationally and internationally to areas where there were staff shortages.

A previous CQC report into Queen Elizabeth Hospital in Woolwich, south London, which is run by the trust, saw inspectors raise concerns about patients using incontinence pads because staff were too busy to help them use a commode.

Meanwhile one nurse told the CQC that staff were often too busy to provide personal care and this meant some patients could go up to two months without having their hair washed.

And inspectors had to raise serious concerns about the A&E department after they observed a patient with sepsis deteriorate before them.

The latest CQC report rated the trust as "requires improvement" for its care.

The report said: "We observed examples of staff interacting with patients and those close to them with kindness and dignity.

"Staff told us they remembered that they were also supporting the families of the dying.

"However, there were also examples where the level of care in terms of ensuring patients were treated with compassion and dignity fell far below the expected standard."

But the authors did not provide any further detail.

CQC Lewisham and Greenwich NHS Trust serves a population of half a million people across the London boroughs of Lewisham, Bexley and Greenwich. 

CQC inspected the Trust in 2014 and rated it as "requires improvement".  

After it received an increased number of complaints it undertook a further inspection of the emergency department and medical services at the Queen Elizabeth Hospital in June 2016 - where services were once again rated as "requires improvement".

Following the latest inspection in March this year, the CQC gave the trust the same overall rating.

"We have noted that the pace of, and extent of change since our inspection of 2014 has been slower than anticipated," the report states.

In the latest report, inspectors also raised concerns over:

:: Patients with tuberculosis not being properly isolated.

::  Inspectors saw that some staff did not routinely sanitise their hands between patients and on entering and leaving wards.

:: They also observed anaesthetists and surgeons taking their outdoor bags and briefcases into the anaesthetic rooms and theatres on three occasions, which poses an infection risk.

:: In maternity and gynaecology, the report states that the cleanliness of the environment and some equipment was of a poor standard, even where green 'I am clean' stickers had been used to say equipment had been cleaned that day.

:: Provision of end of life care across the organisation was inadequate. 

The Trust has been instructed to make a number of improvements.

CQC's chief inspector of hospitals, Professor Ted Baker, said: "The trust has not made sufficient progress since our last comprehensive inspection.

"There remain areas of unresolved risks and areas for significant improvement."

Dr Elizabeth Aitken, medical director for Lewisham and Greenwich NHS Trust, said: "The CQC report shows that we were not getting it right for every patient every time when the inspection was carried out.

"We apologise to the individual patients and their families where the report shows that we were failing to provide the best care.

"We launched a major safety and quality improvement plan immediately after the CQC inspection in March and have made significant improvements for patients.

"This is a joint plan with our health and social care partners to make the improvements needed across the whole system to address the issues raised by the CQC.

"The CQC report also acknowledges several areas of good and outstanding practice and highlights many areas where Lewisham and Greenwich NHS Trust has improved since the last Trust-wide inspection in 2014.

"We are extremely proud of our staff who work so hard, often under significant pressures."