Patients neglected at Redditch and Worcester hospitals

[FiF]

link

So, a dire story over many years.

Including a patient allowed to starve to death.
Patient not washed for 11 weeks.
Patients left thirsty and water out of reach.
Ribs broken during a lifting procedure.

Inspectors have concluded the trust broke the law.

[Jasandjules]

Sad. Unfortunately deaths at the hands of the medical profession are not unusual. Mistakes happen, but neglect to that extent is incredible.

[aw51 121565]

Jeepers . Sadly this won't be a unique event .

[mph1977]

aw51 121565 said:

Jeepers . Sadly this won't be a unique event .

no,and here's why

Nursing leadership in the UK lives in a dream world,it's extremely rare to see staff above band 7 delivering clinical care( outside of a few specialised or specialist posts),unlike every other Health profession ...

Many Ward Nurse Managers are less qualified than the Junior Staff.

Nursing Management does not back band 5 and 6 Nurses when they attempt to make HCAs do their jobs properly.

Nursing Management are perfectly happy to toss junior staff to the lions to protect their position because they have been 'seen to do something'.

It's only now that Health Professional staffing is reduced to dangerous levels that trust management are looking at cutting the numbers of political commissars

[Happy82]

Doesn't surprise me, after the post natal 'care' that my partner received I am amazed that incidents like this are not more frequent.

[mph1977]

Happy82 said:

Doesn't surprise me, after the post natal 'care' that my partner received I am amazed that incidents like this are not more frequent.

'direct entry' Madwives now that's another one,

one plus point for Midwives is that regardless of 'rank' or 'grade' they have to do a certain number of hands on clinical hours and deliveries every year ... the minus point is the emphasis of 'normality' above all other things in their pre-reg education (where other health professions leave ' the normal' behind fairly early on and concentrate on the 'abnormal'or the 'return to normal' meaning that they DE Midwives can often struggle with basic 'nursing'tasks and struggle even more when a Mum has co-morbidities...

[dudleybloke]

overpaid managers are preparing a speech which will no doubt include the phrase "lessons have been learned".

[mph1977]

dudleybloke said:

overpaid managers are preparing a speech which will no doubt include the phrase "lessons have been learned".

Almost certainly, but the fundamental lesson has not been learnt and does not seem to be being learnt.

The 'standard staffing levels'are not a target they are the minimum you need to have a fighting chance to get things done and only then if the HCAs do their jobs properly and don;t expect the RNs to do 50 %of the HCA work +100%of the RN work -thisseemsto beabig problem in many places.

you cannot run units for weeks below the 'standard staffing level' and expect acceptable standards to continue -you can fudge it for a day or a week but not for months on end

[mattviatura]

dudleybloke said:

overpaid managers are preparing a speech which will no doubt include the phrase "lessons have been learned".

I'm just listening to this on R5 at the moment - that was the very phrase that passed into my mind.

The NHS has certainly got its press right, anyone who criticises is some sort of nurse-hating monster.

Very regrettably I have experience of a relative receiving appalling treatment at the hands of the NHS. Complaining is an exercise in absolute futility.

Edited by mattviatura on Monday 24th December 13:53

[aw51 121565]

mph1977 said:

you cannot run units for weeks below the 'standard staffing level' and expect acceptable standards to continue -you can fudge it for a day or a week but not for months on end

You can if you bury your head in the sand and sing "lah-dee-dah" to yourself every waking second while pocketing large sums of cash for facilitating this and embedding that in and around the patient care journey... (Not aimed at you, by the way ).

[dandarez]

dudleybloke said:

overpaid managers are preparing a speech which will no doubt include the phrase "lessons have been learned".

And 'we take all aspects of patient care and neglect very seriously'.

Oh no you bloody don't!

[mph1977]

aw51 121565 said:

mph1977 said:

you cannot run units for weeks below the 'standard staffing level' and expect acceptable standards to continue -you can fudge it for a day or a week but not for months on end

You can if you bury your head in the sand and sing "lah-dee-dah" to yourself every waking second while pocketing large sums of cash for facilitating this and embedding that in and around the patient care journey... (Not aimed at you, by the way ).

and in part it's because many of the Ward Managers Matrons and Directors of Nursing do not have the level of education of anyone else in comparable grades in the Health service, even the failed baked bean stackers in lay management have a better education as do Junior Staff. In part the dislocation of Ward Managers and Matrons contributes to this (meanwhile the trust Medical director maintains a clinical case load as does the Head of Madwifery and in ambulance services senior managers with a Tech or Para ticket are expected to crew a truck or responsd when the work load demands)

One of the greatest ironies about all the 'too posh to wash'stuff is that Ward Managers by and large and the majority of Matrons and Directors of Nursing are'traditionally trained' given in some places it's only 15-20 years ago'traditional training' stopped. even then some of the Diploma training was the same tutors, the same hospital based training schools,just a few more essays...

[scrawler]

mph1977 said:

and in part it's because many of the Ward Managers Matrons and Directors of Nursing do not have the level of education of anyone else in comparable grades in the Health service, even the failed baked bean stackers in lay management have a better education as do Junior Staff. In part the dislocation of Ward Managers and Matrons contributes to this (meanwhile the trust Medical director maintains a clinical case load as does the Head of Madwifery and in ambulance services senior managers with a Tech or Para ticket are expected to crew a truck or responsd when the work load demands.

This is not necessarily always the case...I am a ward manager of a busy specialised unit. I did do the 'traditional' training (25 years ago) but have since then gained a degree, specialist practitioner qualification, an adult teaching cert and numerous specialised degree level qualifications. I also work clinically 50-75% of the time, dealing with patients on my unit on a day to day basis delivering care.

I would say that where I work, in a large teaching hospital, to my knowledge the vast majority of ward managers are degree level educated, the matrons are in the majority masters level educated or working towards that. It may be different in smaller district general hospital hospitals but degree level education is usually a minimum when applying for a band 7 nursing job or above. This puts us at least on par with others at the same level even with the ' failed baked bean stackers in lay management'

Nursing, as a profession is degree level entry, unfortunately this carries its own problems as it excludes some of those that potentially make the best nurses, those with a basis of care and compassion rather than the 'too posh to wash' individuals who eventually find the day to day realities of the job too taxing and don't want to get their hands dirty. They tend to move on pretty quickly.

The issues with poor care are multi-factorial-

The nursing job has grown over the last 5-10 years-more paperwork, targets, audits. There is at times little movement from upper management in meeting these targets, at times care is interrupted, and in some places probably omitted in order to achieve deadlines.

As the job has grown, nursing establishment has been diminished-

less nurses, doing more work= not all the work getting done.

It is sometimes just not possible. It is more commonplace for nurses and midwives to have no breaks on a shift, to stay or finish late with no payment, to work extra hours for no overtime than it is for them to be found sat idling at the nurses station eating chocolates and drinking tea! Some areas are chronically understaffed, and there is often a shortage of suitable candidates applying for jobs when they are advertised or the candidates fail to meet the standard expected.

In conjunction to this patients in hospitals are much more work intensive than they were 5-10years ago. Medical science has thankfully improved and we are able to provide much more treatments than previously, many of these are nursing work intensive.

A simple example of this is if a patient previously had certain viral infections within my speciality 15 years ago, there were few drugs we could give them to turn the infection around and we would provide supportive care and they would, unfortunately succumb to the infection. Now we can monitor via blood tests for the viruses, and treat the virus with 2-3 drugs in order to improve their situation and get them through the infection as well as giving supportive care. These drugs require giving iv 4times a day, making up etc, monitoring for side effects, more blood sampling, portlier patient etc. etc. etc.

I digress, but my point is that the nurse will do all this work often with fewer staff than they had 15 years ago when just the supportive care was given. Multiply this increase in workload by 25 ( for the number of patients a nurse may be looking after) and your workload is massive!

Morale in the health service continues to plummet, this is a vicious circle. If nurses are unable to fulfil their roles to a satisfactory standard, due to reduced staffing, and cannot provide the care they want to - it becomes demoralising. Most nurses want to care and to provide excellent care and services for their patients. I'm not blind that there are some nurses that are 'bad eggs'- that happens in all professions though! The media continues to bash the nursing profession but they are only skimming the surface of the issues in the health service, nurses are easy targets, they need to be looking deeper into the higher structures of hospital, medical and,further still, government management.

There's plenty more to add, I could rant for hours...but this post is long enough!

[RJJ]

The NHS is full of well qualified professionals, from all aspects of patient healthcare and rehabilitation.

Now shackle the professionals with unnecessary redtape, bring in managers who have no grasp of how strategic funding etc can effect the patient. Duplicate a lot of the paperwork, bring in more agencies to monitor like CQC etc

Worst of all, the patients are treated as a 'number crunch' exercise to satisfy central government. Year on year, the NHS will cost more to run. Techniques, improved drugs, improved training and a population that's living longer all put the cost up.

The truth IMO is the government cannot afford the NHS, no balls to tell the public it's not a vote winner. I have always said that as soon as you put a fixed budget on healthcare it will stall and it has now. Moral is at an all time low, more & more incidents are being reported of patients suffering unnecessarily.

The NHS requires its staff, professionals, but they should be allowed to do what they do best, Provide the best possible treatment for the patient, not worrying about budgets and choosing lesser treatments or drugs to satisfy the accountants.

[mph1977]

scrawler said:

mph1977 said:

and in part it's because many of the Ward Managers Matrons and Directors of Nursing do not have the level of education of anyone else in comparable grades in the Health service, even the failed baked bean stackers in lay management have a better education as do Junior Staff. In part the dislocation of Ward Managers and Matrons contributes to this (meanwhile the trust Medical director maintains a clinical case load as does the Head of Madwifery and in ambulance services senior managers with a Tech or Para ticket are expected to crew a truck or responsd when the work load demands.

This is not necessarily always the case...I am a ward manager of a busy specialised unit. I did do the 'traditional' training (25 years ago) but have since then gained a degree, specialist practitioner qualification, an adult teaching cert and numerous specialised degree level qualifications. I also work clinically 50-75% of the time, dealing with patients on my unit on a day to day basis delivering care.

If you did that in the trust I last worked for you'd have been labelled as 'failing',it was seen as a failure if Band 7s outside of A+E or critical care were actually involved in hands on delivery of care.

It was routine to move staff between units to 'protect' the supernumerary status of ward managers...

scrawler said:

I would say that where I work, in a large teaching hospital, to my knowledge the vast majority of ward managers are degree level educated, the matrons are in the majority masters level educated or working towards that. It may be different in smaller district general hospital hospitals but degree level education is usually a minimum when applying for a band 7 nursing job or above. This puts us at least on par with others at the same level even with the ' failed baked bean stackers in lay management'

but outside of the large teaching hospitals with their higher turnover of staff it;s typical to see senior Nurses who have only ever worked in the same hospitals through all the various changes of trust ...

scrawler said:

Nursing, as a profession is degree level entry, unfortunately this carries its own problems as it excludes some of those that potentially make the best nurses, those with a basis of care and compassion rather than the 'too posh to wash' individuals who eventually find the day to day realities of the job too taxing and don't want to get their hands dirty. They tend to move on pretty quickly.

by brown-nosing their way into band 6 and 7 roles in DGHs where it;s seen as a 'failure' if the Ward Manager actually does any nursing rather than sitting on their backside floundering through being unable to prioritise and delegate and allowing their favourities to have unofficial 'management days'when they should be working on the ward...

scrawler said:

The issues with poor care are multi-factorial-

The nursing job has grown over the last 5-10 years-more paperwork, targets, audits. There is at times little movement from upper management in meeting these targets, at times care is interrupted, and in some places probably omitted in order to achieve deadlines.

As the job has grown, nursing establishment has been diminished-

less nurses, doing more work= not all the work getting done.

It is sometimes just not possible. It is more commonplace for nurses and midwives to have no breaks on a shift, to stay or finish late with no payment, to work extra hours for no overtime than it is for them to be found sat idling at the nurses station eating chocolates and drinking tea! Some areas are chronically understaffed, and there is often a shortage of suitable candidates applying for jobs when they are advertised or the candidates fail to meet the standard expected.

In conjunction to this patients in hospitals are much more work intensive than they were 5-10years ago. Medical science has thankfully improved and we are able to provide much more treatments than previously, many of these are nursing work intensive.

A simple example of this is if a patient previously had certain viral infections within my speciality 15 years ago, there were few drugs we could give them to turn the infection around and we would provide supportive care and they would, unfortunately succumb to the infection. Now we can monitor via blood tests for the viruses, and treat the virus with 2-3 drugs in order to improve their situation and get them through the infection as well as giving supportive care. These drugs require giving iv 4times a day, making up etc, monitoring for side effects, more blood sampling, portlier patient etc. etc. etc.

I digress, but my point is that the nurse will do all this work often with fewer staff than they had 15 years ago when just the supportive care was given. Multiply this increase in workload by 25 ( for the number of patients a nurse may be looking after) and your workload is massive!

Morale in the health service continues to plummet, this is a vicious circle. If nurses are unable to fulfil their roles to a satisfactory standard, due to reduced staffing, and cannot provide the care they want to - it becomes demoralising. Most nurses want to care and to provide excellent care and services for their patients. I'm not blind that there are some nurses that are 'bad eggs'- that happens in all professions though! The media continues to bash the nursing profession but they are only skimming the surface of the issues in the health service, nurses are easy targets, they need to be looking deeper into the higher structures of hospital, medical and,further still, government management.

There's plenty more to add, I could rant for hours...but this post is long enough!

I can agree with that, what is your view on HCAs who refuse to be directed by band 5s and/or those HCAs who refuse to do 'the other teams work' when directed to do so and go on to wind down from after lunch on an early ?

[scrawler]

mph1977 said:

If you did that in the trust I last worked for you'd have been labelled as 'failing',it was seen as a failure if Band 7s outside of A+E or critical care were actually involved in hands on delivery of care.

It was routine to move staff between units to 'protect' the supernumerary status of ward managers...

A key feature in a successful ward team is IMO visible leadership, hence working as part of the team promotes this and the quality values that we should have in healthcare. My Trust promotes this, all ward managers are contracted to 50% clinical, don't get me wrong I think at times this leads to us backfilling staff shortages and means it is difficult to fulfil some management responsibilities. At times I feel I 'fail' at some management aspects of my role, but patients and patient care are my priority, so often management has to wait.

mph1977 said:

but outside of the large teaching hospitals with their higher turnover of staff it;s typical to see senior Nurses who have only ever worked in the same hospitals through all the various changes of trust ...

In fairness, within my speciality we do not have a high turnover of staff despite it being within a large NHS Trust, we do have staff that have only ever worked within the same Trust but they have developed during their time served. That said, my personal opinion is that I do think that it aids promotion and development if staff have worked within different Trusts/hospitals as it tends to lend to a greater openness to healthcare structures and changes

mph1977 said:

by brown-nosing their way into band 6 and 7 roles in DGHs where it;s seen as a 'failure' if the Ward Manager actually does any nursing rather than sitting on their backside floundering through being unable to prioritise and delegate and allowing their favourities to have unofficial 'management days'when they should be working on the ward...

Chance would be a fine thing to give anyone an unofficial 'management day'!

mph1977 said:

I can agree with that, what is your view on HCAs who refuse to be directed by band 5s and/or those HCAs who refuse to do 'the other teams work' when directed to do so and go on to wind down from after lunch on an early ?

The above situation would be picked up initially by ward management and dealt with informally, if there continued to still be problems the staff member would be spoken to more formally as this is, in my view, a performance issue. It would need investigation as to whether it is due to lack of knowledge, competence or just malevolent refusal!! Either way I would manage initially with an action plan, supervision and accurate documentation on my part. This documentation would be formalised in letters to the individual to avoid future dispute, in line with HR policies and consultation on my part. Further refusals would inevitably lead to disciplinary...

Unfortunately the above scenario is not uncommon, it tends to arise IMO from ward culture and the HCAs being long term employees within a ward, they then tend to revert to a type of 'top dog' status when dealing with new and junior staff. Obviously if there is a high turnover of qualified staff and the majority of band 5s are junior it compounds the problem. If this perennially goes unchallenged it develops and becomes difficult to break, especially if there is a group of strong willed individuals.

The key to this is higher management and HR support for the ward manager to deal with this. I know i can get HR advice and have a very approachable line manager who I can consult. I'd hazard a guess that there are few staff nurses/ward managers that have not encountered this difficulty with HCAs unfortunately. Patients are there to be cared for, that care needs to be undertaken despite staff members teams etc., on a shift basis band 5s delegate the work to HCAs as the band 5 is responsible for that shift. The important aspect is that the band 5s communicate the issues to the ward manager in a timely and accurate manner and work as a team with this as far as possible.

As stated previously strong leadership from top nursing management in a Trust down is key, that and good HR advice. EVERYONE needs to be aware of their roles, responsibilities, and the standard at which they are expected to work at. If this has not been so it can take a long time and a lot of work to put right through information sharing, meetings, appraisal etc. unfortunately for some individuals it does take for the situation to be managed formally for it to sink in.

Can I ask what your role is within the health service?

Edited by scrawler on Tuesday 25th December 23:31

[mph1977]

Scrawler ,by training,education and for the last 10 or so years I'm a Nurse,i'm not currently on the Active NMC register for a number of reasons some health some to do with my last Job...

[BlackVanDyke]

Since 2006 I have spent a cumulative total of just under 1 year in 4 different hospitals, and 9 months and one week in privately run nursing homes. I now live in my own home with intensive community based support, including from the district nurses (a minimum of 11 visits per 7 days) as well as social services- and ILF-funded care.

I've seen the best of hands-on care - a ward manager taking an hour to feed me and get my IV pump set up, a healthcare assistant remembering with photographic precision exactly how I need to be positioned when I am turned on my side.

And the worst. I'm dealing at the moment with a district nurse who seems truly incompetent, showing no evidence of understanding how to safely record controlled drugs (that's the class As) dosing, unscrewing the lid of a water bottle without first turning it right side up, letting air run into the feeding pump and then seeming genuinely baffled by what to do next given that I was unwilling to have a load of air pumped into my stomach.

A ward manager turned and walked away as I painstakingly spelt out a message for her on a letter chart - I heard her say "I don't have time for this" as she left.

Nursing home carers repeating lies and rumours to the extent that I was labelled with 'challenging behaviour' for such heinous infractions as asking for the toilet and then noting that I'd been waiting for over an hour, trying to offer comfort to a bereaved relative who'd been left in a communal area just after her partner had died, and suggesting thoughtfully that a violent and unpredictable 18 year old boy with learning difficulties could not be safely supported in a nursing home 95% occupied by extremely frail elderly people, and staffed by carers who'd only ever had experience or training caring for those elderly folk.

Redditch and Worcester can change but I'm not sure that they will - the changes have to start at the top and the bottom simultaneously, you don't get a ward where someone starves to death because of one or two lazy nurses, it happens when a whole huge chain of people utterly fail to do the most basic parts of their jobs, across the whole system and over many months. It'll be easy for them to blame a ward manager, maybe even a couple of shifts worth of nurses and care assistants, and if they do nothing at all will improve.