A vicious circle of low morale

Barnet and Chase Farm Hospitals Trust in north London is a typical example of how a hospital can become gripped in a vicious circle of staff shortages, low morale and poor performance from which it can seem impossible to escape.

The trust, which combines Barnet Hospital, Chase Farm Hospital and Edgware Community Hospital, received the lowest "no star" rating in Department of Health league tables published last week.

It is already in the hands of a management hit squad after receiving no stars in the previous league tables published last year and has suffered the resignation of its chief executive amid other management failures. The trust, which has 1,000 beds and 2,700 staff, also has the worst shortages of accident and emergency nurses in London, with 35 per cent of posts unfilled.

Chronic shortfalls in casualty staff are reflected in a damning report into the hospital published in March by government watchdog the Commission for Health Improvement.

Inspectors found that A&E patients were unable to "maintain their dignity, privacy or confidentiality" and up to 10 at a time were left on trolleys in corridors because of delays. Inspectors found racist graffiti around the hospital and patients complained of fluff under their beds.

Tom Sandford, London head of the Royal College of Nursing, said: "The problem is that you have a hospital which is old and rundown in places, so it doesn't look that good when people come into it.

"Then it gets a no-star rating, which means morale falls, and staff leave, and then no one wants to work there, so the problems get worse.

"Combined with all this, the hospitals are in an area of London where housing is expensive - so even if they wanted to, nurses probably couldn't afford to live there."