Posts Tagged ‘nursing’

Falling confidence in the care sector

Wednesday, September 3rd, 2014

A recent article from The Telegraph highlights growing concern in the care industry as only one in four voters believe they will receive proper care in their old age. New research involving 75 charities and voluntary organisations concludes that the care crisis could prove a decisive issue in next year’s general election, with the issue coming only second in priority to health.

It is interesting that old age care has become a top priority for voters and the public after what feels like many years of apathy. The issue has undoubtedly been brought to the forefront of people’s minds following devastating reports and investigations from the likes of Panorama into care home abuses. Combined with years of council cuts – 26% off care budgets in just four years – and tightened restrictions on those who qualify for care, this has left many unsupported and excluded, signalling the need for drastic reform and extra funding.

Previous Prestige blogs have examined various ways to address challenges facing the care sector, ranging from more robust monitoring and tougher inspections from trade bodies, improving the image and pay of nurses to increase retention and counter the growing nursing shortage while also considering the role those typically outside the sphere can play. An article in the Guardian inspired another Prestige blog which looked into the way that communities could help reduce loneliness and provide basic level support.

Community support is one way in which residential care can be postponed by providing basic needs early on. Another is home care. This offers a cheaper alternative to residential care – for which the average basic annual cost across the UK is now approaching £29,000 – while also allowing individuals to remain in the comfort of their own homes for longer. In doing so, it still provides an element of support and comfort, delaying the need for permanent care.

The recent overhaul of the care system – allowing people to defer paying care bills to avoid having to sell their homes and the introduction of the care cap – may be a case of too little, too late. Already senior care chiefs are warning that they may lack the ability to guarantee the safety of those in their care because of the financial squeeze. It is clear that more needs to be done, and quickly, to address the growing concerns and lack of confidence in the sector.

CQC failure to protect care home residents

Tuesday, August 26th, 2014

David Prior, chairman of the Care Quality Commission (CQC) recently admitted in an article for The Telegraph that the elderly and vulnerable were being failed by the organisation designed to protect them. A watchdog team focused on exposing care homes offering unsatisfactory care were too quick to ‘back off’ when legally challenged, fearing the prospect of prosecution by owners of sub-standard homes. This tactic, however, often left the vulnerable elderly lacking the care and support they need.

CQC data suggests that 750 care homes providing care to elderly and disabled people have been failing to hit at least one basic standard for more than a year with potentially devastating effects for the elderly who are forced to continue living with substandard care. The Telegraph article revealed the plans of the CQC to change its approach to be much more robust when tackling failing providers of care. A previous Prestige + Nursing blog also called for stricter consequences for homes that fail to meet a certain standard, especially in light of Panorama revelations earlier on in the year.

However, a new stricter inspection regime is planning to take a tougher approach regardless of the potential repercussions in a bid to ensure greater protection for those in care, to hold care homes to account and to regain the public’s trust. Overall the new system should bring around change in the way care homes are assessed. It has been made very clear to providers the standards that are expected of them.

The regulator anticipates around 100 care providers a year are likely to go into special measures under tighter inspection rules, giving them a fixed time period in which to make the necessary improvements or close if they fail to do so. This should also prevent any repetition of past scandals for failure to act after warning from whistle-blowers and complaints from family members.

It is vital that the vulnerable and elderly do not suffer due to CQC fears of recrimination especially when a care home is noticeably failing. We’re pleased to see recognition of the need for stricter rules and safeguards, and hope that they are able to effectively hold care homes to account by implementing harsher and more immediate penalties on failing care homes.

Ending care home abuse

Wednesday, July 2nd, 2014

 

Following the Panorama exposé in May a great deal was written – including  a couple of Prestige Nursing + Care blogs – about  the importance of, and ways to improve, standards of care in order to address the issue,.

During this time the Sunday Express has also launched its Care with Kindness campaign. This gained backing from the government as Heath Secretary Jeremy Hunt announced a crackdown on poor quality care in order to better improve standards for the 500,000 residents in care homes in Britain. It stresses that several steps will be taken to protect care home residents from abuse, such as tougher inspections and NHS whistleblowing helplines. Changes had to take place after the Care with Kindness campaign found that complaints of abuse in care homes have increased by 20 per cent in the past year.

While tougher inspections and consequences are a welcome change to tackle abuse, as this case shows low wages and staff shortages are also a key factor in unsatisfactory staff being recruited. This is part of what really needs to be addressed in order to end care home abuse.

To reiterate a point from a previous Prestige blog: the government needs to do more to address cuts to funding so that nurses and care workers have access to better training and higher pay. Improvements in both these areas would change the way that the profession is viewed and increase recruitment, leading to a plethora of high quality and well trained staff.

Evidence of the imbalance between NHS managers’ and nurses’ wages was highlighted by this Independent article and will only reinforce the view that nurses and carers are taken for granted and paid poorly for it, discouraging people from wanting to work in the sector. NHS managers’ salaries have increased at four times the rate of nurses’ salaries while the Independent also reports that in the past two years, NHS spending has increased by 6.1 per cent on executive directors while nurses, midwives and health visitors only saw a 1.6 per cent rise.

It is clear to see, therefore, that the challenges facing the care sector – the shortage of workers, council cuts to funding and poor quality care which leads to abuse – are intrinsically linked. And that, only by tackling them all will the care sector see substantial improvements.

 

Wake up to the carer needs of the UK.

Friday, June 20th, 2014

Last week, new analysis of the 2011 census by the Office for National Statistics (ONS) found just how hard council cuts and nursing shortages have impacted the provision of care and the way it will worsen over the coming years. It found, perhaps unsurprisingly, that the care of family members falls disproportionately on women.

This is an issue that will only worsen as the population ages with girls aged 15 today predicted to dedicate more than nine years over the course of their lives to care for loved ones or family members in the future.  As such, this places a heavier burden of care on them than any generation previously as a result of rising life expectancy and improvements in medicine.

Overall 5.8m people in England and Wales – a massive 10% of the population – provide unpaid care to sick, disabled or elderly loved ones, an increase of 600,000 since 2001. It raises serious questions about the financial burden and pressures families will be placing themselves under in future.

This follows a BBC article showing that while 1.4m people work for the health service, and a similar number are care workers, around 6.5million people identified themselves as carers in the last census. This is a figure that is expected to grow to 9m over the next 20 years – something that could have a dramatic impact on the wider UK economy as well as millions of family finances. Estimates show that 40% of those who will be required to look after loved ones as unpaid carers will have to reduce the amount of paid work they do in order to provide the level of care needed of them.

Previous Prestige blogs have talked about council cuts to social care, something which is obviously a factor in this topic. Cuts to council care have had a devastating impact on the services they can provide with eight out of ten local councils now only funding care at a ‘critical’ level. There are calls for the government to find a way to “fund social care services in a sustainable way” that don’t require millions of people to go without pay. The government carers grant is currently £61.35 a week, a figure that could easily be argued is too low, but more important is the fact most people aren’t even aware it may be available to them.

The nation as a whole needs to wake up to the country’s caring needs rather than brushing the issue aside. Our blog only last week showed how the requirement for carers as a profession is set to increase over the next twenty years but that will not go far enough to satisfy anticipated demand. The government needs to step up to the mantle and deliver a longer-term strategy so that families receive sufficient support to care for older family members without risking financial hardship or exhaustion.

Nursing shortage reaches crisis level.

Wednesday, May 21st, 2014

As nursing shortages reach crisis levels and a new survey reveals that an average of 1 in 10 posts is vacant in hospitals, the NHS is looking to entice old nurses back to work – including those that left up to 20 years ago. More than one in four London trusts is looking abroad for staff as the demand cannot be met in the UK alone, according to an estimate from the Royal College of Nursing London.

Health Education England is in the midst of preparing a new campaign aimed at encouraging ex-nurses back to work with a focus on better pay and flexible working. If done well, it could be effective in increasing staffing levels. This highlights two of the key challenges the sector faces in bringing on new staff and improving staff retention. The inadequate levels of pay nurses receive are especially notable when you consider the demanding nature of the job that nurses do. They should be rewarded for the work they carry out.

If working conditions – and the perception of working conditions – improved this would also make a difference to recruiting additional nurses. Benefits such as flexible working could help in this regard while at the same time making it a viable career for those with fewer hours available. Attitudes towards nursing as a career should also be assessed. Emphasis on promoting nursing as a career with longevity and progression, for example, through greater training could see strong results.

Latest figures show the NHS is short of 12,500 nursing posts and many hospitals are struggling to recruit, especially for highly trained, senior staff members. More than eight out of ten NHS trusts have a staff shortage. This follows research that Prestige Nursing + Care carried out last year which found that 20,000 new care workers would be needed in Britain by 2020.

Criticisms surfaced last week that patients are at risk if a nurse has to care for more than 8 people on a ward during the day. Clearly this is an issue that extends past nurses and across the whole sector and as such needs to be addressed, before shortages jeopardise the quality of patient care.

Budget cuts lead to elderly flooding in A&E

Wednesday, February 12th, 2014

In the past five years, the number of elderly people taken to accident and emergency departments has doubled, with a 93 per cent increase in admissions for patients over 90. The elderly are being taken to hospital for basic infections, falls, or pains – a large proportion of which could be treated quickly and early at home – and in some cases are spending far longer there than they need to.

The National Care Association blames doctors for their reluctance to visit patient homes out of hours and instead patients are left to call an ambulance. MPs, doctors and campaigners alike are all pushing for greater budget to be allocated to GP services in order to increase home visits in a bid to improve support to the elderly and reduce the number ending up in A & E. While this may be a factor to an extent, at the root of this problem is a lack of funding for social care, ultimately limiting the availability of care to the elderly at home, where many minor conditions could be spotted earlier preventing them from requiring hospital treatment, or even a visit from the doctor.

Budget cuts are limiting the amount of people being cared for at home. Previous Prestige Nursing + Care research has seen spending on adult care fall 2.05% in real terms, year on year. It also found that 54% of Councils across the UK have decreased their spending on adult care which has contributed to the recent flooding of elderly people in A & E units across England as seemingly minor aches and ailments are left untreated until immediate hospital care is required. With the right support at home problems can be spotted and treated early on allowing people to stay in their own homes for longer.

Proper funding would not only provide homecare to those who would benefit from it, but also adequate compensation to the caregivers, ensuring quality care to the people who need it, thus eliminating unnecessary hospital trips for patients that put increased pressure on an already struggling NHS, something they can ill afford. With the proper council and government budget allocation, home care can continue to be an invaluable and viable option for the elderly and their families.

The thin end of the wedge

Monday, November 28th, 2011

For anyone with some experience of poor care on an NHS ward, or who has read the numerous stories of patients badly treated by over-worked or harassed nursing and care teams, yesteday’s revelation in the Sunday Times that people are now employing private nurses to look after them on NHS wards will seem understandable.

Although the practice of employing private nurses, often at around £200 per day, is not that widespread yet, the article suggested that the Patients Association believed that many NHS nurses welcomed these privately-funded nurses onto the wards as it helped ease their workload. That may be true, and there certainly can be no doubt that the intensive supervision that those with private nurses receive will certainly help to identify and ameliorate any post or pre-operative complications. The mantra of choice and patient-centered care has been at the heart of government health policy for the last 10 years, but why does the idea of people employing their own nurses on NHS wards seem so strange?

The first reason is a practical one. How can care effectively be organised so that the dividing lines between what the NHS nurses and private nurses do is clear to all? Would the private nurse step in if he or she saw another patient suffering on a ward and there was no immediate NHS nursing assistance available? There is also the insurance ramifications and certainly the experience of Prestige Nursing and Care with some NHS Trusts in Bristol is that they simply do not countenance this type of arrangement for that very reason.

Then one has to consider the morale of both the NHS nurses and patients on wards where these private nurses go into work. With an Orwellian twist it now seems that all patients are equal, except that some are more equal than others. This has always been true when you consider private hospitals and clinics and even private wards within NHS Trusts, but such encroachment into your common or garden NHS ward sends dangerous signals to both patients and nurses alike. On a larger scale it also calls into question how holistic the care the NHS gives can be. If patients are effectively voting with their wallets by saying they are happy to have the more acute clinical procedures undertaken with the NHS but do not trust it to provide effective after-care, you are faced with the very real danger of fragmentation of many services which themselves rely on an holistic approach.

So how has it come to this? Those with means have always had the opportunity to choose additional care if they so wanted, but the NHS has largely remained sacrosanct. The debate must now move on to address two key questions, both of which have been asked many times throughout this year. The first concerns the role of acute hospitals in a modern 21st century healthcare system and whether there are other options best suited to treating the elderly or those with long term ocnditions. The other question relates to nurse training, and whether the current system is producing those with the right skills and attitude to flourish in the role. We can never be sure whether instances of poor care are because nurses are either unwilling or unable to provide the level of care they should all aspire to, but public perception seems to be favouring the former explanation at present.

The late Steve Jobs of Apple famously favoured closed systems over the open ones of Windows, because be wanted to control every aspect of the user experience without outside software or hardware developers becoming involved. He felt that this control delivered much higher levels of user satisfaction and reliability than his rival Windows, which was put onto any PC that wanted it. The analogy  is certainly true here, the traditionally closed system of the NHS ward is in danger of opening up to outside parties and in doing so becoming merely a platform where disparate parties co-ordinate to deliver care. Although agencies like Prestige Nursing and Care do benefit from the demand from private nurses going into hospital wards, I still favour the good old-fashioned closed system of the NHS. What Apple did to ensure this type of system remained popular was to relentlessly innovate, what the NHS must do now to stop this becoming the thin end of the wedge is to follow suit, starting with how it organises and delivers nursing care.

More elderly care scandals in the NHS

Thursday, October 13th, 2011

As if things couldn’t get any worse for the elderly receiving care in the UK, the CQC has today published a damning report on how the elderly were cared for at 100 hospitals across the NHS. The CQC made a series of unannounced visits to the hospitals and what they uncovered once again highlights the inadequacies of the current NHS setup for certain types of care.

Before we look at the negative side of the CQC’s findings, there are some positives here. Firstly, and most importantly, the CQC is doing exactly what it should always have been doing – conducting spot checks on the standards of care across a range of institutions. I wonder how many of those hospitals that received these visits had previously received a clean bill of health from the CQC when the visits were notified in advance? It is only by constantly checking that care is being provided in an appropriate way that the CQC can hope to raise standards, not by the beauty parades of inspections that often take place in their place.

Although the CQC seems to becoming more adept at uncovering the symptoms of poor care as shown in this exercise, what is being done to tackle the causes of these shameful events? Andrew Lansley’s assertion that more nurses should become whistleblowers does little to tackle this problem and smacks of desperation. Is the training of staff to blame as in the RCN’s recent pronouncements, or does this mistreatment of the elderly go deeper, possibly into the relevance of hospitalsthemselves? Let us not forget that 20 of the 100 hospitals visited fell below legal minimum standards, so something, somewhere is wrong.

Nor will the heavily revised Health and Social Care Bill, currently making slow progress through the House of Lords, make much difference to the lives of the confused and frail elderly people in our hospitals. How we treat our elders is one of the defining tests of a society’s humanity, and how good our intentions are, we are not meeting their needs at present. It is becoming increasingly clear that hospitals are not the best places to care for the elderly, given the demands on resources and people’s time. Instead the returning them to the community, whether it be ina residential or domiciliary care setting, seems the best answer. In this sense, Andrew Dilnot’s suggestions as to how elderly care will be funded in future and where it should take place, suddenly become very pressing indeed, and will once again attract attention as the most obvious alternative to hospitals.

Own goal

Monday, September 26th, 2011

Just a few short days after admitting that many UK nurses found it hard to deliver the kind of care patients required because of a lack of clinical training, the head of the RCN, Peter Carter, along with the head of Royal College of General Practitioners has called on relatives to take more responsibility for looking after them in hospital.

Refreshingly realistic or hopelessly out of touch? In contrast to his earlier comments over the inappropriateness of nurse training , these comments have attracted opprobrium in large amounts, coming as they did so shortly after the announcement that the much vaunted NHS IT project is to be scrapped at a cost to the tax payer of £11Bn. Given the significant investment pumped into the NHS over the last 10 years, with nurse numbers alone rising by 75,000, it is almost inconceivable that the head of the union that indirectly benefited from much of this largesse, can so blithely state that more needs to be done by relatives, without at least accepting some responsibility as to why this should be necessary in the first place.

Everyone accepts that a lot of additional care and support should and is given by relatives when visiting people in hospital, but this should be in addition to not instead of nurse care. Somewhere along the line the NHS’s priorities have got obscured, and unsurprisingly no one is now standing up to accept responsibility. The obvious comparison that will be drawn is how many nurses and doctors etc could have been hired or hospitals built with the money wasted on the NHS IT disaster, but it still does not explain why when significant investment has been made over the last 10 years, we are still left with a system that is often not fit for purpose.

In the context of this, Dr Carter’s opinions come across as a massive own goal and will add fuel to the debate about the relevance of current nurse training and indeed of hospitals themselves. Talk of nurses, auxiliaries and relatives and the dividing lines that should exist between them within care is somewhat fatuous; the real issue is the care itself. There are simply not enough people on NHS wards who are either willing or able to give the care that is so desperately needed. Until someone addresses that issue straight on, and most importantly takes responsibility for solving it, everything else is irrelevant.

Angels of mercy?

Thursday, September 22nd, 2011

Peter Carter. the chief Executive of the RCN, today launched a withering attack on many of those he seeks to represent by claiming many nurses lack caring skills and arrive on the wards with not enough practical skills. At first glance this may seem like the own-goal of the century, but Dr Carter makes a very salient point about how nurses are recruited and trained for a 21st century NHS.

He links the decline in nursing standards with the unregulated growth in the use of healthcare assistants, many of  whom are asked to perform basic nursing skills without the relevant degree of training. All true so far, as is his long-term proposal that there should be mandatory registration of all care workers to ensure standards are kept high.

Many chart the decline in nursing skills back to the introduction of Project 2000, which combined as much theory as practical work in an attempt to recruit more nursing staff into the profession on the basis that it was now a degree. All of this under the shadow of a long-term shortage of nurses, which will get more acute as many reach retirement age. As nurses began to take on more of the roles previously performed by doctors, and in the absence of a significant number of  student nurses to learn on the job, then it has been inevitable that the less well-trained, but more cost-effective healthcare assistants would be recruited to fill the gaps.

In many ways the issue of healthcare assistant regulation and training is somewhat irrelevant. The principle question is re-defining or at lest clarifying what it is we want nurses to do in a 21st Century healthcare system. Are they employed to be quasi-doctors or are they employed to be hands-on practioners of care in a different way? The rise of healthcare assistants in the NHS is a direct result of the movement away from the more practical nursing skill of old by this generation of nurses. A clear definition of what nursing stands for in the modern setting is probably long-overdue – we get the nursing care we deserve and everyone’s expectations need to be managed before the nursing profession’s reputation becomes increasingly tarnished. Dr Carter’s observations are a step in the right direction.