Body left on ward for five hours as nurses forced to look after 17 patients each, NHS inspectors find

Nurses working at one of the country’s largest hospitals were forced to look after up to 17 patients each during the autumn surge in coronavirus cases, a new inspection report has revealed.

Managers at the University Hospitals Birmingham Trust have been criticised over poor governance and management of patient safety incidents after inspectors from the Care Quality Commission (CQC) found multiple examples of errors in patient care and risks that had not been tackled.

The CQC’s latest report follows an inspection of the trust and its three main hospitals during December in response to concerns raised by staff.

The regulator found that nurse staffing ratios dropped to dangerous levels, with nurses having to care for up to 17 patients each at the trust’s Good Hope Hospital in Sutton Coldfield.

Of the main hospital, the Queen Elizabeth in Birmingham, inspectors said: “On every ward we visited during our inspection, staff consistently told us that they were short staffed. Registered-nurse-to-patient ratios were often one to nine during the day and one to 12 during the night shift.”

Repeated research has shown that avoidable harm may start to occur where nurses have to look after more than eight patients on an acute ward.

The inspection report said a patient who had died was left on a ward without staff to look after the body or prepare it for transport.

The report said the patient died on a ward at Good Hope Hospital at 6.45am and was still there at 11.35am.

“This was reported by several staff members and it caused them distress,” the report said.

The CQC found that the hospital was regularly using less qualified healthcare assistants as substitutes for nurses.

It said: “From September 2020 to November 2020, 72 per cent of registered nursing shifts were filled during the day and 82 per cent of registered nursing shifts during the night. However, this was balanced by shift fill rates for HCA [healthcare assistant] staff being over-filled at 118 per cent during the day and 174 per cent during night shifts.”

Inspectors also highlighted how another patient died and others came to harm after avoidable falls.

The inspection report said: “We were provided with examples of potentially avoidable falls due to low staffing numbers.

“On ward 11, a patient fell and passed away after sustaining an injury. At the time of the fall, the ward was short-staffed, and all staff were busy with other patients.

“An investigation report was produced as a result which highlighted staffing as a concern.”

In some cases, concerns about poor staffing levels dated back years, underlining the wider shortage of staff across the NHS, which had almost 40,000 nurse vacancies before the start of the pandemic. Although numbers working in the NHS have increased, they have struggled to keep up with the level of patient demand.

The CQC also said some staff had told inspectors that patients had caught Covid-19 after being admitted to hospital, with some patients screened as negative for the virus being put on Covid-positive wards.

Some patients who needed help eating meals had to wait, while some staff regularly worked beyond their 12-hour shifts.

Inspectors also criticised the discharging of some patients, with relatives complaining that patients left hospital “in a worse condition than when they were admitted”.

In addition, the regulator highlighted failures by staff to assess patients for the risk of blood clots – a standard assessment in all hospitals.

The CQC made recommendations for the trust, including ensuring that nurse staffing is adequate to keep patients safe, and improvements in the assessment of patients for blood clots.

A spokesperson for University Hospitals Birmingham NHS Trust said: “There are some issues raised in the reports, all of which we were aware of prior to the inspection, which we recognise as requiring further work and this is ongoing.

“At the time of the inspections, which took place on 2 and 9 December 2020, the trust and our amazing staff were 10 months into a pandemic response with over 450 Covid inpatients on the days the inspections took place, rising to 1,054 Covid inpatients during January.

“The effort of our staff to provide care to what is now well over 11,000 Covid inpatients, during the most difficult period in the history of the NHS, has been and remains quite extraordinary. It continues to be our focus.”