You can`t have opened a newspaper, or watched the news in the last few days without hearing of the Care Quality Comission`s report, and the subsequent furore over the care (or abuse) of the elderly. As seems commonplace thses days, the report and the media coverage are somewhat different, although it does raise some interesting questions. Its significant, I think, is that a report ordered by Andrew Lansley was released just in time for his Health and Social Care Bill to be voted for in the House of Lords. I also find it somewhat suspicious that, to quote the report, `We had forecast that 10-20 % of hospitals could be non-compliant (20% were), and that a further 30-40% would show evidence of concerns (35% did), based on findings from our first set of inspections. Overall, 55% of hospitals were either non-compliant or gave cause for concern, against a forecast of 40-60%.` So…they found exactly what they were expecting to find. I make no further comment.
According to the report, only two wards in each hospital were inspected, only during the day, and with just one lunchtime. Yet one of the wards in two hospitals was considered `of major concern`. If that is so at mid-day, what was the care like when the day staff went home or at the weekend? Also, why did two wards in the same unit vary so much?
The biggest question of all though, is, are nurses becoming less caring, more abusive to the patients in their care?
Its important, I think, to distinguish between neglect by omission, and neglect by commission. Nurses aren`t deliberately abusing their patients (commission), but in some cases are neglecting by omission, for one simple reason, something that was mentioned in the report over and over……`‘Sometimes I am the only staff member to feed on the ward.`….“Staff were trying to help patients sit up and serve lunch, whilst a medication round was being carried out at the same time.”….“All the ward staff we spoke to on the stroke unit said they felt the unit was understaffed and the current levels were not appropriate to meet the needs of the patients.”
Indeed, one of the conclusions of the report was….`A lack of time to deliver care (due to short staffing, persistent high demand or excessive bureaucracy) can prevent staff from making sure that people’s needs are assessed and they are given the right support to eat.`
It is noteworthy that figures show the average ‘care of the elderly’ ward has just one nurse for 11 patients. Often you see comments in the media `My dad waited 3 hours for pain relief while nurses sat around the station gossiping and reading Heat magazine” . What these commenters don`t realise is that these `nurses` aren`t nurses at all…they`re physio, ward clerks or Occupational Therapists etc, and can`t help. Couple this with untrained, `care providers`, (who although willing, are sometimes just cowboys) and you have something that (like my old Austin Healey) looks good, but is going nowhere.
As for nutrition, there`s a couple of things I have noticed myself, both as a staff member, and as an in-patient. Quite often, the nurses only have a certain time to manage mealtimes. Food gets delivered, and a short time later, the porters have arrived to take the plates, containers and trays back to the kitchen. This gives the nurses limited time to get all the food out, ensure that its eaten ( and recorded that its been given and eaten) and return all trays back. Now, I spent a couple of years as a volunteer at both my local hospital, and the local old people`s home…and I know from experience that sometimes, assisting just one patient can take almost an hour…time that an overworked nurse cannot afford to take, no matter how much he/she might want to.
Secondly, many hospital trusts (mine included) has `protected mealtimes`. This evidently, is to `allow patients to eat their meals without disruption`. Truthfully, I can sometimes understand this, since some relatives can be a royal pain. I remember a friend of mine once complaining of supporting an elderly woman to eat as her two daughters sat there watching, while being acutely aware of the woman two beds down not eating at all…, but, on the whole…Why? Why NOT suggest that patients who need support with mealtimes have their relatives allowed in? (Also interesting to note, when Dr. Peter Carters comments saying the same thing in the Mail were printed, most of the comments were…`Its the nurse`s job`. Needless to say, these were the same commenters who moaned that `the nurses were sitting around, blah blah blah`)
On a smaller scale (I`ve only seen 4 consultants ever do it, tbh…but 4 is 4 too many, imo)… Consultants who INSIST on doing their ward rounds at mealtimes. Why? Why did they HAVE to do it then? Limited nurses trying to manage 20 – 30+ patients at lunch time…PLUS a drug round, with the usual suspects interrupting that, hence tabards…and the Consultant sweeps in….
Dame Joan Bakewell was quoted as saying that nurses needed lessons in empathy, which TOTALLY misses the point. Firstly, I am of the firm belief that nurses enter the profession for vocational reasons. But caring and empathy will only get you so far without resources (qualified staff and time both being resources). Secondly…how on earth do you teach `empathy`? You can be taught standards, practices etc…but you can`t be taught to care.
Nevertheless…there ARE occasionally some bad and/or lazy nurses, who deserve to be weeded out. At one hospital, the fact `that people in need of intravenous fluids did not have infusions` is inexcusable.
Having said all that…there ARE real problems in the NHS, which have to be acknowledged, and dealt with.
The problems started, I think, with Roy Griffiths. He was the author of the `Griffiths Report`, which ushered in General Managers. His report contained the famous phrase “If Florence Nightingale were carrying her lamp through the corridors of the NHS today she would almost certainly be searching for the people in charge.” At the time, there was great resistance to the report, Doctors and nurses feared their professions would lose influence after the dissolution of the consensus management teams that had run the NHS until then…and they were right, tbh. But after the Government `accepted the proposals`, Regional Health Authorities had four months to appoint their own general managers, then embark on District Health Authority appointments. Districts had until the end of 1985 to find unit general managers. The Department of Health began recruiting a national general manager. Mr Griffiths said this should be someone “almost certainly” from outside the NHS and civil service, with experience of effecting change in a large organisation.
Straight from the Militant Medical Nurse book of common sense, but nobody ever listens, reads, or care’s for the Truth
Ooh…I hadn`t seen that blog before…thanks for the heads-up…someone after my own heart.
Shame she hasn`t posted for a while, though… 😦
Aaaaah dear Nurse Anne, I used to love her rants. I think she returned to her roots where the nurse patient ratio is dictated by law.
I’d been researching for a piece which shared much common ground with this post. I guess many of us who are NHS and ex-NHS are feeling mightily peed off!!
I remember, one week, walking through the corridors of the teaching hospital where I once worked wondering why we’d been taken over by large numbers of hyper, double-breasted suit-wearing estate agent types. They were a huge influx of new managers recruited by the new General Manager in his own image. They knew SFA about the NHS and had the interpersonal skills of a vengeful Dalek!
`the interpersonal skills of a vengeful Dalek!`
Love the description….but true, sadly….
Oh…just seen a bit in The Daily Mash`, entitled
`NHS to focus on young, healthy people`
A couple of paragraph`s caught my eye….
“At a pre-meeting last week it was suggested that the average young person who has no physical ailments whatsoever is being scandalously neglected by our care infrastructure.
“I would stress that it was only a pre-meeting, so it wasn’t as if there was any discussion about how a decision would be made, but if this makes it on to the agenda of a full meeting we could be looking at nothing short of a full-scale re-purposing of our resource target philosophy.”
EXACTY the sort of runny horse manure that was spouted by countless execs at meetings I was obliged to attend…
Somehow (and I’m not sure when the mutant child arrived) the NHS, Police,and Education became behoven to this fcuking shite.
I deliberately left out Social Services as I think they probably fathered said mutant bastard.
I’m old enough to remember from my police service (1970s/80s) that it wasn’t always this way.
@Sabre – I don’t think that ‘focussing on the worried well’ is anything new? After all, they are far more likely to ‘get better’ after a range of tests and some therapy than a smelly gran who may pop-off without warning and show up as a minus-mark on ones efficiency (sorry ‘Patient Outcomes’) calculations.
Greetings, Sabre.
May I draw your attention to this (although it IS in the Wail!)
“Doctors ORDERED to treat elderly with respect… but shouldn’t that go without saying?”
\\The General Medical Council has drawn up new guidelines reminding them that their care does not begin and end with providing clinical treatment.
They are urged to be ‘guardians of patient safety’ and take the lead whenever there is a risk that dignity or comfort are being compromised.\\
http://www.dailymail.co.uk/health/article-2055896/Doctors-ordered-treat-elderly-respect–shouldnt-saying.html#ixzz1cSbL1bAV
Also to this (on-going) NMC tribunal
“Alzheimer’s patient who choked to death on sausage ‘was not resuscitated by nurses who didn’t follow instructions'”
http://www.dailymail.co.uk/news/article-2055747/Alzheimers-patient-choked-sausage-resuscitated-nurses.html#ixzz1cSdJwd5W
Apologies to Sabre but I simply had to congratulate you on your excellent PC poem, (shijuro). Bravo.
We’re missing you Sabrewulfe. Hope you are OK.
ditto. send us a sign…
Yes mate, where are you? Are you alright?
Echoing the above – How are you?
Missing your posts (Here and elsewhere)
Was it something…I said?
Hope you are still ‘troshin’ sabre. I have missed your comments.
SP
I’ve been suggesting that for a while now, parking should be free of charge over lunchtime and a max of two people per patient who are there to help feed them.
Most of the MSM cannot be trusted to tell the truth. Most don’t know the difference between care workers and RN nurses.
Militant Medical Nurse blogged about this over the years
Apologies to all…I`ve had a lot of things going on recently….but I`m back to my old (with emphasis on the `old`) self….so expect some banal, trite, ramblings any time soon…. 🙂
Phew! What a relief Sabre. I was really concerned for your health. Hope you’re feeling OK and looking forward to Crimble
Seasons’ Greetings, and welcome back, Sabre.
Nice to see you back, hope you’re well.