Posts Tagged ‘nursing’

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.




Nursing in the spotlight

Sunday, July 24th, 2011

The charging of nurse Rebecca Leighton with causing damage with intent to endanger life after the death of 5 patients at Stepping Hill hospital becomes all the more surreal as more of her character and background comes into the public domain.

By all accounts hard working and cheerful, Leighton comes from a family of nurses, as her mother also works at the same hospital as manager for nurse training. Whilst everyone’s thoughts are obviously with those who lost loved ones as a result of the contaminated saline solution, the massive betrayal of trust by this nurse to her patients will inevitably lead to close scrutiny on how this was allowed to happen and what checks and balances should be put in place to ensure this never happens again. For a profession that quite rightly prides itself on the quality of patient care, this case illustrates all too vividly that there will always be those instances when something simply snaps inside a person without warning leading them to commit heinous acts such as this.

But would more stringent background checks have picked this up? Although it is far too early to say, there was nothing in Nurse Leighton’s background or work history that gave any indication that this might happen. If, as is being reported, she was turned down for a promotion, then again one could never have predicted her reaction to this news. The government, the NHS and the RCN need a measured and thoughtful response to this tragedy. Knee jerk reactions that serve little purpose but to assuage a media outcry will, in the long run, do little to prevent incidents like this happening again, particularly if they are perpetrated by people on the spur of the moment. It will be interesting to see how this story unfolds.