YORK Hospital managers have been served with a warning notice calling for urgent improvements after watchdog inspectors found a series of failings in care for patients.

The Care Quality Commission (CQC) revealed today that it had carried out an unannounced inspection at the hospital in March after receiving 'significant safety concerns about fundamental standards of patient care.'

It said in a report that it found the hospital did not have enough nursing staff with the right qualifications, skills, training and experience to keep patients safe from avoidable harm and provide the right care and treatment.

It also found:

*Staff did not always make sure patients had enough to eat and drink, including those with specialist nutrition and hydration needs

*While staff treated patients with compassion and kindness, they told inspectors that - due to staffing pressures - they they could not always offer the level of care and support they wanted to.

*Staff did not always support patients to make informed decisions about their care and treatment

*Records of patients’ care and treatment were not always clear, up to date and stored securely.

The report said managers didn't assess the risk of harm to patients when decisions were made to increase inpatient beds and, after a sixth bed was put in a five bedded bay on ward 24, a patient fell because they had insufficient space to move around independently.

It said that all patient records the inspectors looked at had gaps in pressure care risk assessments, pain assessments, malnutrition universal screening tools scores, nutrition and hydration charts, and falls assessments.

It said that on Ward 26, a patient at risk of pressure damage had not had regular skin integrity check or positional changes documentation completed, and their skin had deteriorated to a deep tissue injury. "Staff told us that if documentation was not complete, this was not a recording error but because they had not had enough staff to complete tasks."

The CQC said staff did not always understand how to protect patients from abuse and didn't always make a safeguarding referral when required. "However, staff we spoke to knew how to identify adults at risk of, or suffering, harm but referrals had not always been made due to staffing shortage and the use of agency staff."

The report said that following the inspection, the CQC issued the York and Scarborough Teaching Hospitals NHS Foundation Trust with a section 29A warning notice because it didn't have effective systems for managing patient risk assessments, nutrition and hydration, pressure area care and falls prevention.

It added that the trust took a number of actions, including closing five beds on ward 28 in response to findings and staff concerns, and conducting reviews of every patient's care on the medical wards it inspected as an immediate safety measure.

|York Hospital's response to the report:

SIMON Morritt, Chief Executive, York and Scarborough Teaching Hospitals NHS Foundation Trust, said today that many of the issues raised by the CQC were known to the trust and reflected the extreme pressures facing it, the demands of Covid and associated staff absence, and well documented recruitment challenges.

“The report demonstrates that, when faced with these pressures, it is not always possible to give the standard of care we would want for all of our patients all of the time," he said.

"We know that there is a long journey towards sustaining improvements across the Trust. Our focus remains on ensuring that all of our hospitals are fit to cope with the growing demand we are facing, and to provide safe, quality care for all of our patients.”

Chief Nurse Heather McNair said the trust was taking every possible action to mitigate any risk to its patients.

She said she 'absolutely recognised' the seriousness of the concerns raised by the CQC and since their visit a number of actions had been taken, including an immediate inspection of every patient’s care on medical wards, including documentation and risk assessments.

"We also have daily staffing meetings to help identify gaps and any wards which require additional support.

“Like other NHS trusts, nurse recruitment continues to be a challenge and we are currently undertaking a nurse staffing establishment review to have a clear understanding of the enhanced required staffing levels on every ward to meet the current clinical demands.”