Nurses have been told to do regular ward rounds, and patients encouraged to carry out inspections to improve hospital standards.
They are part of a package of measures announced by the prime minister for the English NHS to tackle what he sees as a “real problem” with patient care.
David Cameron told the BBC problems in some hospitals had been overlooked out of respect for the nursing profession.
This new move has come after a series of critical reports in the past year.
Read more at BBC Health.
The big story last week was the call for ministers to introduce standards for the growing number of unregulated healthcare assistants working in the NHS.
Firstly the Royal College of Nursing’s Peter Carter highlighted the increasing replacement of nursing roles with HAs. And then the Nursing and Midwifery Council’s Prof Dickon Weir-Hughes said the lack of compulsory regulation and training of HAs means that many are working beyond their competence levels, increasing the potential for things to go wrong. Hundreds of complaints are made against HAs each year, but with officials powerless to act, we continue in a circle where lessons aren’t learnt and changes aren’t made.
Our experience at MPS shows that working beyond the limits of competence is an issue for many other health professionals, including nurses and doctors.
Financial constraints can lead to more responsibilities being given to less expensive staff. While this may save money in the short term, it doesn’t add up to safe care and increases the risk of costly mistakes.
With savings of around 4% to be made annually over each of the next four years, the NHS faces a massive challenge in maintaining standards of healthcare. If high level tasks are pushed down the chain to staff with insufficient training, this will lead to unsafe practice and harm to patients. These short term savings could potentially lead to high cost claims and complaints in the future.
Today, our health service is staffed with people who have wide variations of knowledge, skills and experience. More and more, we see nurse practitioners and advanced nurse practitioners providing frontline care in general practice and out of hours, but there is no regulation or minimum standard for job titles. This causes confusion and a real potential for a mismatch between responsibilities and competence.
I am also concerned that doctors who have trained outside the UK can be recruited to work in the NHS without any language testing or familiarity of NHS structure. The GMC’s decision to introduce mandatory basic induction is a welcome step to address this issue, but I still think more needs to be done.
Employers have an important role to play in ensuring that they recruit the right people, with the right skills and experience, to the right role. It is unacceptable to recruit without assessing CVs, references, skills and reviewing performance. It is critical that they also invest in specific high level training to make sure all healthcare workers have the right breadth and depth of skills to ensure safe and sound assessment of patients.
The safety of patients should always be our primary concern and it is important that tighter budgets and increased responsibilities do not push an already stretched healthcare system over the edge.
Almost 75,000 nurses expect to lose their jobs, have their hours cut or see their roles downgraded in the next year, according to a survey that highlights the growing impact of the NHS’s financial squeeze.
Five per cent of the NHS in England’s 410,000 nurses - some 20,500 in all - believe their posts will disappear in the next 12 months. Another 24,600 anticipate a cut in hours, while another 28,700 expect to have their jobs reassessed as involving fewer responsibilities.
The findings, extrapolated from a Royal College of Nursing (RCN) poll of 8,000 of its members, have prompted renewed claims that the coalition is not honouring repeated promises to protect the NHS frontline from cuts.
Read more in The Guardian.
I don’t know if you’ve noticed, but the last few weeks have seen a number of reports in the medical and lay media that seem to be leading to a rather startling conclusion. Namely, that dumbing down in healthcare provision is widespread and may be a bad thing. It may even end up with the frankly bizarre suggestion that doctors have a useful purpose to serve.
But let’s not get ahead of ourselves. We’ll start with The Times’ report on the issue of the poor quality of nursing in our hospitals (I’ll link to some of those reports, but only those of you contributing to Mr Murdoch’s pension fund will be able to access them). It began with the now customary and justified complaint that nurses spend too much time in the classroom and not enough on the wards learning how to look after patients, with even Peter Carter, President of the RCN joining in the condemnation.
This then morphed into an argument that there weren’t enough qualified nurses on the wards because cash-strapped trusts have been replacing them with an army of health care assistants (HCAs) who now undertake most of the jobs traditionally performed by nurses, a move which today’s Times headline trumpeted as ‘a disaster in waiting’.
We’ll pause there for a moment to allow you to savour the image of nurses complaining about the usurping of their role by less highly-trained workers. There - you enjoyed that, didn’t you?
Incidentally, the first of those articles prompted a letter from someone asking why, if this decline in nursing standards had been going on for so long, the doctors hadn’t spoken out against it. I couldn’t be arsed to reply that we had, and that I, for one, had had a letter in The Times stating that we were raising a generation of nurses more at home with a clipboard than a bedpan. And of course the result of letters and articles in that vein, coming from doctors, is the accusation of arrogance and elitism - usually from nurses. As is so often the case, we’re damned if we do, and damned if we don’t.
Which would bring me on to skills mix, and the rise of the ‘practitioner’, but we’re all sick of reading diatribes about noctors, and the arguments for and against have been rehearsed at tedious length here and elsewhere. For what it’s worth, and at the risk of repeating myself, I believe that role extension, properly instituted and monitored, can rationalise the use of highly-trained staff and improve the service. I have even been actively involved in the training of radiographer practitioners who fulfill a very useful role in many of our imaging departments. There’s no doubt, though, that this whole process is now running out of control, driven by managers hell-bent on cutting costs, with no regard for quality of service or patient safety.
And then we have the recent report on the capital’s health services, telling us that more consultants are needed to cover junior staff, and that this could save 500 lives a year. In other words, from top to bottom, we are seeing a downshift in the grading structure of NHS staff, with an over-reliance on less highly-trained, and cheaper, staff. And this can only get worse as Lansley and Cameron drive through their ill-considered ‘reforms’, fragmenting the service further and exposing it to the wholly commercial motives of ‘any qualified provider’.
But as I say, if you follow the HCA/nurse argument up the food chain, it does at least look as if there may eventually be a grudging admission that doctors have some small contribution to make to the health of the nation. Which would be nice.
Lord Winston, the medical professor and television presenter, warned yesterday of the potential risk to patients from nurses with poor English.
Speaking in the House of Lords, he pointed to particular problems with nurses coming from some former Eastern Bloc countries such as Romania and Bulgaria.
“Communication between the patient and the professional is of vital importance,’’ he told peers. “We run the risk of losing it with this issue of nurses who can’t speak the English language and have been trained in a different way.”
Lord Winston was taking part in a debate on the different training standards for foreign health workers.
Read more in the Telegraph.
I hope none of you were too encouraged by the vocal opposition of the nursing profession to Andrew Lansley’s NHS ‘reforms’. I see from yesterday’s Times (sorry - can’t link to it since Mr Murdoch started charging for electronic access) that the hitherto hidden agenda of our nursing colleagues was made explicit at the no-confidence debate at the RCN’s annual conference.
Actually, let me amend that last sentence. I have lots of nursing colleagues for whom I have the greatest respect. The comments I’m about to describe came from that strident subset of the sisterhood who strut their stuff on the national stage provided by the conference.
The two key comments were the following. First, a lady from Birmingham, one Bethann Siviter, told delegates that since GPs had mismanaged the flu jabs, “how are they going to manage the NHS?”. Then in the face-to-face session with Lansley, an un-named nurse spoke of his (Lansley’s) “Victorian view that the doctor is everything”.
The first of those comments is presumably a re-hash of complaints in the media earlier in the winter that some GPs had not ordered enough vaccine, and takes no account of the effect of moving DoH goalposts such as the late inclusion of healthy pregnant women in the vaccination group. Whatever the truth of that particular matter (and even the Daily Mail blamed the government rather than the GPs) the glee with which the argument was resurrected hints at the underlying reasons for the interest shown by nurses in the reforms, and their opposition to them.
But it’s that second comment that confirms the true nature of the nurses’ dissatisfaction with the government proposals. It’s not the threat to the integrity of the NHS that drives their concern - it’s their obsession with an outdated perception of their position in the medical hierarchy. They clearly haven’t grasped the real problem with Lansley’s plans - the fact that the insistence on plurality of provision will result in the fragmentation of the NHS - for them, it’s all about their unrequited desire to take up the mantle of the white coat and stethoscope. They need to read Jacky Davis’s clear description of the issues in these pages.
I was tempted to write to The Times, but it won’t help the opposition to Lansley if we are seen to be fighting amongst ourselves. However, it is depressing to witness the failure to grasp important issues exhibited by fellow professionals in their national forum, and their determination to use the genuine fears over the effects of reform programme to advance their own agenda. And of course, the government’s belated recognition of the fact that GPs are not the only health professionals who need to be involved in commissioning is likely to result in the promotion of these same politically active nurses to the consortia, not the more sensible ones we work with in our hospitals.
I can’t help thinking, like the unreconstructed, arrogant, paternalistic monster of a consultant that I undoubtedly am, that it would be a lot better for the NHS, and certainly for patients, if nurses would just get on with the job of nursing. Then perhaps we’d hear fewer complaints about elderly patients sitting in pools of urine all day, and going unfed because they can’t reach their dinner.
Health Secretary Andrew Lansley has been given a vote of no confidence by nurses.
Delegates at the Royal College of Nursing conference overwhelmingly backed a motion questioning his handling of the NHS reforms in England.
Mr Lansley said he was visting the conference to ”listen to them about how we can improve the Bill”.
But instead of addressing the whole conference he will meet a group of 50 nurses separately. The decision has prompted some to question his nerve.
During the debate on the overhaul of the NHS, nurses said they were angry over the reforms and the way the government is running its new “listening exercise”.
Read more at BBC Health.
Front-line clinical jobs in the NHS are under threat in England, a union says.
A Royal College of Nursing analysis of 21 NHS trusts where cuts were taking place found more than half of posts under threat were in areas such as nursing and midwifery.
RCN leader Peter Carter said cutting thousands of doctors and nurses could have a “catastrophic” effect on care.
But deputy prime minister Nick Clegg maintained radical reorganisation of the NHS is needed.
While the health budget has been protected, savings still have to be made because of the rising demands linked to the ageing population, new drugs and lifestyle factors like obesity.
A target of £20bn has been set by 2014-15 - a saving of about 4% a year - which ministers have insisted can be achieved through cutting management costs and by front-line services becoming more efficient.
But the union, which released the findings at the start of its four-day annual conference in Liverpool, said its research showed this was not happening.
Read more at BBC Health.
Patients could die because staffing levels in the NHS are being reduced to dangerously low levels, the leader of Britain’s 400,000 nurses has warned.
The quality of care received by patients in hospitals is also bound to worsen as tens of thousands of posts are cut, says Dr Peter Carter, general secretary of the Royal College of Nursing.
He voices alarm that the NHS in England needs to make £20bn of “efficiency savings”, which risks the service returning to a situation last seen in the 1990s, when patients faced long waits and some even had to be treated on trolleys.
Writing in the Observer, Carter says that meeting the £20bn target is leading to the NHS experiencing “some of the most widespread cuts in its history”. At least 27,000 posts are due to disappear across the UK and “many more posts are at risk” as hospitals search for ways to reduce their costs. He accuses hospitals in England of making “ill-advised short-term cuts to save money” that risk compromising patients’ safety and will have a negative impact on their care.
Read more at The Guardian.
Nursing care must be strengthened and the complaints system overhauled because of continued poor care of older people in hospital, says the Patients Association.
The patient lobby group has highlighted 17 cases in England and Wales where patients were left lying in faeces, or desperately hungry and thirsty. It said it had been inundated with similar stories.
The government said it was committed to tackling shortfalls in patient care.
The Patients Association acknowledged that most patients do get good treatment, but said some were still being denied the essentials of nursing care, even though it highlighted serious problems last year.
A national survey of hospital experiences in England suggests that nearly half of all patients rate their care as excellent, and just 2% said it was “poor”.
Read more at BBC Health.
