Hospital chiefs criticised by the national health watchdog for appalling dignity standards of elderly patients have blamed the failings on staff shortages and the ethnic diversity of the area.
Sandwell Hospital is awaiting a third unannounced visit from the Care Quality Commission (CQC) after two other inspections of a stroke ward failed to meet standards on privacy and dignity.
Shocking examples at Newton Four ward in the CQC report included a woman having to use the lavatory in view of other patients.
When inspectors returned in August, they again ruled standards were dire after an incontinent patient was left soiled and unwashed for an hour-and-a-half despite asking staff for help.
Rachel Overfield, the chief nurse at Sandwell and West Birmingham NHS Trust, which runs the hospital in West Bromwich, said staff shortages and the ethnic diversity of the area had played a part.
Use of agency nurses to cover for vacancies and sickness also had an impact as they are not as familiar with hospital systems, she added.
Miss Overfield said: “One of the issues is the diversity of people we are trying to serve. Privacy and dignity means different things to different cultural groups and we have a diverse number of patients and staff.
“Staffing levels undoubtedly are an issue. There will always be odd shifts on odd days when people call in sick at the last minute.
“Those days are reliant on good systems escalating the problem and getting a response.
“When the CQC came in March, that escalation system had failed so there were not enough staff on the shift. But 99 times out of 100 the system works and bank and agency nurses fill the gap. It was really unfortunate that day.”
She added: “We need to build up patient confidence again but it’s important to note the CQC inspected five wards and only found a problem with one,” said Miss Overfield.
“Newton Four is a stroke ward with acute patients, those having rehabilitation and some at the end of their life and they all have different needs. This report was a ‘penny dropping’ moment for all of us.
“Sometimes these inspections prompt us to think outside the box. Since then, the ward has been changed so rehabilitation patients and the new stroke patients are treated in separate wards. I have no doubt staff know what to do and it is about getting them to do it all the time.”
Trust bosses are now working on a plan to encourage a “regime of constant vigilance” to make every hospital worker, patient and visitor feel confident in speaking up when they see failings.
Miss Overfield added: “In the past, inspections were dependant on evidence we gave to inspectors like clinical audits. Now they are more focused on what individual patients say on one individual day.
“Patients’ views in real time are important and we need to get better at listening to those views, but the downside is that it is just a snapshot.
“You can have a ward having a really bad day for reasons outside their control. You have to take that on the chin because patients on that ward had a bad experience. I’m sure there were other hospital trusts the CQC went to that were having a good day.”
Sue Davis, chairwoman of the Trust, is pushing for a more open culture in reporting issues among staff and has even asked hospital chaplains to speak up as they are around wards night and day.
“We are trying to get a message to everyone, particularly the staff,” said Mrs Davis. “We are encouraging a regime of constant vigilance so if you spot a problem, tell us about it.
“If the CQC sees something that isn’t good for patients on the day of the inspection, we need to be aware of it, but it is a big leap to suggest that is what’s happening most of the time.”