Posts Tagged ‘nursing’

NICE guidance welcome but funding the only way to solve the NHS crisis

Monday, January 19th, 2015

The latest guidance from NICE (National Institute for Health and Care Excellence) offers instruction to A&E departments on how to ensure safe levels of nursing staff. This follows recent news that more people than ever are waiting longer to be seen at A&E – a problem likely to be exacerbated by the worsening weather predicted in the coming weeks. The guidance continues to stress the need for adequate numbers of staff to meet rising demand and pressures from an ageing population and more people with long-term conditions, while still ensuring a good standard of care.

The news, published in The Telegraph, that A&Es will be forced to declare nurse shortages is an interesting addition to the guidance that has the potential to give patients and their families greater scrutiny over care. Due to concerns about severely short-staffed units, NICE guidance calls for a maximum of four patients per nurse and believes that hospitals without the correct staffing levels should have to inform the public. This comes following widespread evidence of staff shortages and overcrowding across the NHS, as well as failings in the length of time people are required to wait and the standard of care that patients eventually receive.

Similarly, an article in The Guardian highlights the NICE suggestion that patients should be moved in instances of extreme overcrowding or additional staff brought in from other wards to address the shortages. While the benefits of such guidelines are clear to see, they fail to address exactly how this would be achieved in a time of funding cuts, staff shortages and greater demand on services across the entire health and social care sector – not just in A&E.

Legitimate concerns remain that many hospitals will simply be unable to meet the requirements set out by NICE. For example, it is not clear where the spare staff would come from. What is clear, however, is the need for all parties in the run-up to the election to come up with a cohesive and comprehensive plan to invest in the NHS and increase recruitment efforts. Greater emphasis on budgets and staffing levels must be taken into account as funding remains the key factor in solving the NHS crisis.



Nursing shortage to hit NHS hardest at Christmas

Friday, December 12th, 2014

Latest figures from Labour suggest that in the past four years alone, the NHS has lost more than 4,400 senior nurses and matrons. As a result this has led to concerns that hospitals and hospital staff may be lacking the level of experience and knowledge to cope with pressures of the job and unprecedented levels of demand – especially as winter approaches.


The Independent reveals that the combination of an ageing workforce nearing retirement and cuts to funding has impacted staffing figures. Anger and resentment over pay freezes along with increased job stress have also discouraged many from either returning to the profession or staying it in, adding to declining numbers.


The loss of more experienced workers risks producing a skills gap when hospitals are required to cope with more admissions than ever before and could significantly affect the standards of care people receive while in hospital. The last week in November saw 110,601 people admitted to hospital in an emergency, the highest number ever recorded in a single week. The Mirror also reports falling nursing numbers, with many choosing to leave the profession signalling concerns that this could see hospitals closing their doors to patients over Christmas.


Even with the additional funding for the NHS announced by George Osborne and examined in last week’s blog, this will not tackle all the problems the NHS faces. Ways in which the burden placed on the NHS could be reduced needs to be considered. Previous Prestige Nursing + Care blogs have highlighted just some of the benefits that alternative solutions for the elderly, disabled or those in need of any support, such as home care and community care can provide, while greater levels of support and funding for family carers would also be effective.


Some statistics suggest that the social care sector needs to recruit an additional 1 million people by 2025 to satisfy demand. It is therefore clear that something needs to be done to address the recruitment and retention challenges the industry faces. A recent survey found that health and social care was the most fulfilling to work in, yet this is not translating into recruitment. Many issues need to be challenged including poor pay (and pay freezes), cuts to funding and greater appreciation of the valuable work people in this sector do. Only by combining increased recruitment efforts with alternative options to hospital for those who need support or help will pressures on the NHS be reduced.

Importance of home care for an ageing population

Friday, October 31st, 2014

An article in The Telegraph this week highlighted the importance of home care to support an ageing population. Jeremy Hunt, the Health Secretary, has pledged more than £5billion to ease pressures on hospitals by providing an additional 18,000 community workers and increasing the number of elderly people who are receiving home care to reduce needless hospital stays and visits.

As previous Prestige blogs have frequently highlighted, there are numerous benefits of home care for the elderly which are becoming increasingly clear to the UK population. These benefits include lower costs (than a residential care home), retained independence for longer, and perhaps most importantly the fact that home care allows elderly patients to receive the care they need in the comfort of their own home. It can also act as a preventative measure. By providing people with support for the tasks they find difficult it can delay more extensive care being required.

This comes as a welcome development, following the news that 350,000 will lose out on their help at home as tighter restrictions on the threshold for funding take their toll. When the benefits of home care are so clear to see, not only for the individuals in question but for the care and health system as a whole, it is critical that the government reforms and restrictions do not damage the positive impact of this service in the care sector. A more open-minded attitude should be taken to arrive at a holistic approach for improving health and social care, by incorporating home care, community care and others alongside the more traditional routes of NHS and GP services.

In order for home care to operate effectively there are a number of areas that still need to be improved. Currently, council cuts to funding have left providers struggling to offer enough care to those that require it. Pay and recruitment is another challenge with higher wages and greater levels of training needed to attract high quality staff and to encourage more people to view care as the long-term and worthwhile career it is.

The prospect of an influx of additional community workers is especially welcome as community care plays an invaluable role in supporting care and reducing the pressure on clinics and hospitals. They would also offer vital support to unpaid carers who face huge responsibility in caring for family members – as regular readers of this blog will be only too aware.

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.