Today, DW is taking a break from covering U.S. health issues and taking a look across the pond. Millie Whitehead discusses recent research that indicates a disturbing trend of missed activities and nursing care for NHS patients.
Recently reported research indicates a disturbing trend of missed activities and nursing care for NHS patients. There have also been numerous reports of failing UK hospitals in the mass media. Much has been made of NHS trust and hospital executives and managers allowing bad practice to take place and multiply. Management is under significant pressure to keep costs down while still ensuring good quality care for patients. One of the ways to reduce costs is to cut the wage bill. The numbers of nurses working on wards have been reduced to what is considered the bare minimum.
In July 2013, the BMJ, journal of the British Medical Association, published a report of a survey of almost 3,000 registered nurses who worked in the general medical or surgical wards of 46 NHS hospitals in England. The survey found that the majority of nurses did not have time to perform activities such as comforting patients and making sure they and their families understood their conditions and how to deal with them. They also often missed developing or updating nursing plans for patients. In some cases, even pain management and treatment procedures were missed during a nurse’s shift. It really seems that the bare minimum is not enough.
Meanwhile the rising cost to the NHS of insuring against medical negligence claims, or settling them is another financial burden. Specialist negligence solicitors, such as those at Irwin Mitchell, have seen more and more people understandably seeking compensation when things have gone wrong.
The Mid Staffordshire NHS Foundation Trust Public Inquiry
The publication of the BMJ study followed the Francis Enquiry Report into failings at Stafford Hospital in the English Midlands. The seriousness of the problems at this hospital was recognised through the excessive mortality rate among its patients over a period of two years. The failure to ensure adequate nurse staffing levels was clearly earmarked in the report. Patient safety was being put at risk.
In a news item in the Independent newspaper, Jeremy Hunt, Secretary of State for Health, is quoted as saying, “One of the most chilling accounts of the Francis Report came from Mid Staffs employees, who considered the care they saw as being normal. Cruelty became normal in our NHS and no-one noticed.”
One among the 290 recommendations of the Francis Report was to improve support for compassionate caring and committed nursing, stating specifically that “regular interaction and engagement between nurses and patients and those close to them should be systematised through regular ward rounds.” Another recommendation was that “training and continuing professional development for nurses should apply at all levels, from student to director, and commissioning arrangements should reflect the need for healthcare services to be delivered by those who are suitably trained.” But of course, when nursing staff levels are minimal, not many nurses can be released for the training that they should have. In general, nurses appear to be overworked and undertrained.
According to the BMJ report, it also appears that the situation is not helped by the use of lower paid unqualified healthcare support workers. When they are on wards alongside registered nurses, the missed care still occurs. If they are meant to complement the work of the nurses, it’s not happening.
The Government Response
The UK Government has now announced its response to these concerns about the Stafford Hospital and the crisis across the NHS. The culture of secrecy is to be erased and doctors, nurses, patients and hospital visitors are to be encouraged to report any care failings they come across. Hospitals will have to make reports four times a year on complaints received and how they have been dealt with.
A new criminal offence of wilful neglect will be introduced, and a new safety website on which to publish the numbers of staff on hospital wards. The authorities will not impose a minimum staff to patient ratio but hospitals must adhere to guidance to be issued by NHS England’s chief nurse about appropriate staffing levels. The Care Quality Trust will also consider this aspect in inspections to make sure they have the right number of properly trained staff. Hospital chiefs and NHS Trusts will have to find other ways to cut costs.
Millie Whitehead is passionate about medical law. She frequently writes about everyday legal concerns people about about the health care industry.