Big Report: Staffing levels at KGH

Kettering General Hospital
Kettering General Hospital

Kettering General Hospital bosses have been told by inspectors that they do not have enough staff to keep patients safe and meet their needs.

A critical report by the Care Quality Commission said patients sometimes had to wait six hours for a doctor at night, that there were up to seven ambulances waiting to hand over to too-few A&E staff and that children had to be treated in adult areas as the paediatric waiting room was closed due to staff shortages.

And an investigation by the Telegraph has shown there are 188 vacancies at the hospital, including 40 doctors and 80 nurses, and that the trust had to spend nearly £19m on agency workers in the past three years.

The CQC first discovered staffing problems at the hospital in early 2013. They re-inspected twice in 2013 but found the necessary improvements hadn’t been made.

The results of their latest inspection, which took place on 16 wards at the end of January, have now shown that there are still problems at the Rothwell Road hospital.

The report said: “There were not always enough qualified, skilled and experienced staff to meet people’s needs.

“One member of staff said ‘I have never worked anywhere as dire as this for staffing’.

“Staff were keen to say that they were under pressure due to low staff numbers.

“Nursing staff on the medical wards also reported that during the night they had to wait a long time for a doctor to come to the ward.

“They told us they could be waiting as long as six hours.”

The CQC have told the hospital they must report back to tell them how they plan to meet the required standards.

While they were in the hospital, inspectors also noted management of medicine regulations were not being met, although they had not originally planned to look at that area. They found medicines administered late and discovered staff had not told a doctor when a patient had refused to take medicine for several days.

They also witnessed medicines being left on a table for three hours after staff had signed to say a patient had taken them.

Their report said that patients were not always protected against the risks associated with medicines. They again asked staff to address this and report back to them.

The Telegraph submitted Freedom of Information Requests to the hospital to discover more about the depth of staffing problems.

We discovered that the picture has improved since 2013 when there were 254 vacancies out of 3,148 staff. Then, there were 100 nurse vacancies and 50 doctor and dentist jobs that needed to be filled.

Now, there are 188 vacancies, although a recruitment programme is in place to fill some of the gaps.

The hospital needs to find 40 doctors, 80 nurses and 10 scientific and professional staff. It is also short of 21 clinical services staff in areas including pharmacy, pathology and radiology and about 27 administrative staff.

Because of the staff shortages, the money spent on agency workers has risen over the past three years.

In 2011 the trust spent £4.4m on agency staff including £524,000 on qualified nurses, £860,000 on doctors at senior house officer level and £350,000 on specialist registrars.

The total rose to £6,843,922 in 2012 and £7,706,348 in 2013.

Jobs to fill

There are 188 vacancies this month, representing six per cent of the total 3,148 workforce.

There were a total of 254 vacancies in March 2013

Current vacancies

40 doctors

79.51 nurses

1 midwife

10.37 scientific and professional

21.42 additional clinical services (areas like pathology and pharmacy)

27.27 administrative and clerical

Agency spending

Agency spending was £4.39m in 2011 and went up to £6.84m in 2012 and £7.71m in 2013

Money spent

Agency spend in 2013 included:

£2,706,662 for nurses

£896,349 on SHOs

£869,491 on specialist

£831,350 on consultants

£711,925 for speciality doctors

£416,846 for senior managers

£197,975 for pharmacists

£29,489 on housekeeping

£24,181 for porters

Move to find workers to fill vacant positions

The report by the Care Quality Commission came at a time when Kettering General Hospital was in a transient period.

Director of nursing and quality Clare Culpin said: “The inspectors came when our new critical care unit had just opened and that was having a depleting impact on staffing in the rest of the hospital.

“There was a policy to recruit on a one in, one out basis. But actually, by the time you had recruited that person, someone else had left so there was a backlog.

“We are now much better at forecasting when staff will leave so we can get ahead of the curve.”

Hospital bosses admit it is sometimes tough to encourage medical staff to work in Kettering when they are competing with large hospitals in big, university cities for staff.

Interim human resources director Charles Marson said: “We have to sell Northamptonshire. We know it is a lovely county with beautiful countryside and good schools but it’s about getting that message out to people.

“Having a six per cent vacancy rate is actually about average.

“It’s not senior managers we struggle to recruit, it’s the middle managers and the specialist doctors that we often can’t find from the local area.”

A staffing matrix alerts managers of potential low staffing on wards each day.

Miss Culpin said: “Sometimes we will move nurses from one ward to another within their speciality. This has not always been popular with staff.

“Nursing managers will sometimes go on to the wards themselves to help out if needs be. I have done it myself.”

One area the CQC was critical of was the level of agency staff. Miss Culpin said she is determined that this year they will reduce the money spent on agency nurses.

The trust has also conducted a complete review of nursing staffing levels for each shift, ward and department to ensure nurses were being used in the best way.

In January the hospital took on its first clinical apprentices.

These are local people, often school-leavers, given NVQ training with the goal of becoming registered nurses.

In September the trust became one of the first to trial a new way of preparing student nurses for life on the wards by giving them experience as healthcare assistants to ensure recruits know what they are signing up for in the early stages of their degree.

Recruitment of overseas nurses

A key tactic used by hospital bosses to ensure there are enough nurses in the future was to recruit from overseas. A trip to Madrid costing £3,600 resulted in the recruitment of 20 Spaniards, three Romanians, one Italian and one Portuguese member of staff.

All of these nurses came on to rotas in January after training.

Director of nursing and quality Clare Culpin said: “Often we find that nurses from overseas are very well trained technically but haven’t always done a lot of personal care.

“When they come here they will probably have less patients to care for – about six at a time – which they enjoy.

“When we went overseas to recruit we were up against lots of competition so we weren’t all that hopeful but actually, we were delighted with the number of recruits.

“The language barrier has not been a problem as they speak good English.

“We held a big celebration in November to celebrate 10 years of overseas recruitment at KGH. More than 50 staff attended.”