15.06.2021

The staff appear not to know what good care looks like

Shrewsbury and Telford Hospital Trust has been in special measures and rated inadequate by the Care Quality Commission (CQC) since 2018, but in a leaked letter, revealed today by The Independent, the chief inspector of hospitals reveals that the situation at the hospital is getting worse.

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Professor Ted Baker details a litany of concerns over the standards of care at the trust in a letter to NHS England earlier this month and he warned unless action was taken patients are being exposed to unnecessary harm.

His letter reveals the Midlands trust is facing more criminal investigations and enforcement actions than any other NHS trust in England. It’s been inspected five times since August 2018, and had more than 90 specific conditions imposed.

Prof Baker summarised his fears over “the depth and breadth of concerns” at the trust and demanded an urgent meeting with NHS England to decide the next steps.

Poor care and culture

Prof Baker said: “There is a lack of professional accountability and professional curiosity amongst staff to recognise, challenge and address poor care. Staff continue to describe and demonstrate disempowerment to change current practice; this has been a recurring theme across all grades of health professionals.”

During the inspection in June, there were “significant safety concerns” despite staffing levels that meant poor care could not be linked to a shortage of workers, he said, adding: “One ward had eight nursing staff for 13 patients, as an example. This makes the findings more compelling in terms of normalised poor care and culture.”

He said: “This culture and underpinning normalisation of poor care is the environment in which future health care professionals are being trained. We are concerned that unless this is addressed at pace by a sufficiently capable team, this will be compounded by those providing care to patients [at the trust] in the future not knowing what good truly looks like.”

Diminishing confidence in leadership

The trust’s current chief executive Louise Barnett joined the hospital only in February 2020. Before that Paula Clarke was acting chief since 2019, when the former boss Simon Wright left after four years.

Prof Baker said frontline staff at the hospital had told the CQC there was a “lack of visibility and diminishing confidence in the executive leadership team’s ability to acknowledge and address any concerns raised. This has been a consistent theme throughout our inspections.”

He added: “At our most recent inspection, this theme continued and worryingly staff at Princess Royal Hospital remained under the impression that Barbara Beal was still director of nursing.” Ms Beal had stepped aside in April.

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Prof Baker said: “This lack of visibility and confidence extends beyond the leadership team and is particularly notable within nursing. Senior nursing leaders do not highlight or challenge poor practice. This impacts upon the safety of patients and does not provide a learning culture within the trust.

“There is a lack of cohesion between the medical and nursing directorates to share ownership of the issues we continue to raise. There is a reliance on CQC inspectors to highlight areas of concern when the trust should be able to recognise these for itself. This is however reliant on the trust having appropriate oversight and monitoring within wards and departments; something which continues to be inadequate.”

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