The head of a scandal hit NHS hospital has claimed there is something “fundamentally wrong” with nurses and the nursing profession.Sir Stephen Moss, chairman of Stafford Hospital and himself a nurse for 40 years, said that “too many patients and families” are being let down but that staff shortages are not to blame.

He suggested the problems lie in the training nurses receive as well as the way they work on hospital wards, and plans to lead a new campaign to improve standards.

His comments come in the wake of a series of scandals at NHS hospitals in which vulnerable patients have been neglected with sometimes fatal consequences.

At Stafford Hospital, which Sir Stephen arrived at in 2009 to help turn around its fortunes, as many as 1,200 patients are feared to have died unnecessarily over three years as managers became preoccupied with cost-cutting.

A recent report by the Health Service Ombudsman condemned the NHS for failing to meet “even the most basic standards of care” for pensioners, while spot inspections by the Care Quality Commission have uncovered geriatric wards where doctors are prescribing water to elderly patients to stop them becoming dehydrated.

Unions and professional bodies have suggested that the problems are down to staff being over-worked or forced to focus on Government targets rather than providing personal care.

But other commentators have claimed that too much care is now provided by cheap healthcare assistants, who do not need to meet national training standards and who are not regulated by a professional body; or that nurses think they are “above” feeding and cleaning patients now that they have to be university-educated.

In an interview with a local newspaper, Sir Stephen said: “Not everything in nursing is bad, but after the events at Stafford Hospital, the recent concerns at New Cross Hospital [in Wolverhampton, where high death rates are being investigated] and others around the country you can’t tell me there isn’t an issue here that needs addressing and we have to do something about it.

“There is something fundamentally wrong with the nursing profession and the way it is focused at the moment.  We are getting a lot right but we are also letting down too many patients and families. We can’t just stand by and not do something.”

Sir Stephen is drawing together a group of seven “big hitters” in the health service to suggest ways that hospital care can be improved.

Their plans, to be disclosed in September, will focus on how nurses can be trained for “the real world of the NHS rather than the classroom”.

From: http://www.telegraph.co.uk/NHS-boss-something-fundamentally-wrong-with-nursing

Doctors are being warned to take extra care when using social media websites such as Facebook and Twitter.
The British Medical Association guidance highlighted a series of potential pitfalls doctors face.

In particular, it said there was a risk the lines between personal and professional lives could be blurred.

It comes after a series of cases in which NHS staff and other public sector workers have got into trouble through their use of social media.

In 2009, a group of doctors and nurses were suspended for posting pictures of themselves on Facebook lying down in unusual places, including a hospital helipad.

And last year a civil servant found herself in the newspapers after using her Twitter account to make political points and saying she was struggling with a hangover.

Dr Tony Calland, chairman of the BMA’s medical ethics committee, said: “Medical professionals should be wary of who could access their personal material online, how widely it could be shared and how it could be perceived by their patients and colleagues.”

The guidance advises both doctors and medical students to adopt conservative privacy settings where they are available.

It also warns them against making informal or derogatory comments about patients or colleagues as well as not accepting current or past patients as friends on Facebook.

The message was echoed by the Nursing and Midwifery Council (NMC), which has also issued its own guidance this week.

NMC official Andy Jaeger said: “What you regard as just an amusing story could end up causing serious offence more easily than you think.”

From: http://www.searchclinic.org/doctors-warned-over-facebook-risks.htm

Serious concerns have been raised by the NHS care regulator about the way some hospitals in England look after elderly patients.
The Care Quality Commission said three had failed to meet legal standards for giving patients enough food and drink and treating them in a dignified way.

The CQC, which carried out unannounced inspections, also raised concerns about three other NHS hospitals.

The commission has published the first 12 results of 100 such inspections, called for by the health secretary Andrew Lansley after a long campaign by the Patients Association, which highlighted poor care for the elderly.

While its inspectors said there had been many examples of people being treated with respect and given excellent care, in other cases people had not been helped to eat and drink, “with their care needs not assessed and their dignity not respected”.

All six hospitals about which concerns were raised must now say how and when they will improve. The worst three offenders will have to improve or face action from the regulator.

The inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients’ weight and people not being given enough to drink, with water being out of reach for long periods of time.

In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

Inspectors also looked at dignity and respect, noting that elderly patients were sometimes not involved in their own care and were given no explanation of the treatment they were to receive or asked for consent.

Staff also treated people in a disrespectful way, spooning food into their mouths without engaging them.

The reports acknowledge examples of excellent care where treatment was explained in a way patients could understand and they were treated with respect and dignity.

Jo Williams, chair of the CQC, said the inspections had built a detailed picture of the care being received by elderly patients in NHS hospitals in England.

“Many of these reports describe people being ‘cared for’ in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs – people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

“These are not difficult things to get right – and the fact that staff are still failing to do so is a real concern. These are the basics that help ensure every patient is treated like an individual – not a nuisance to be ignored or a task that must be completed.

“This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them.”
Enforcement powers

Health Secretary Andrew Lansley said that everyone admitted to hospital deserved to be treated as an individual, with compassion and dignity.

More CQC reports will be published over the summer with the findings of the programme of inspections released in the autumn.

From: http://www.bbc.co.uk/news/health-13545780

Nurses have suggested they should undergo an annual health and well-being “MoT”.
The physical and psychological assessment could take place alongside yearly appraisals, according to nurses at the Royal College of Nursing (RCN) conference in Liverpool.

They believe the plan would help staff set a healthy example to patients and argued that there are more checks on wheelchairs than NHS staff.

Claire Topham-Brown, a critical care nurse from Peterborough, said: “There is no denying that nursing is a physically demanding job. You do need a certain level of physical fitness.”

She told delegates during a discussion on the issue that one activist had “observed that we take better care of wheelchairs than we do of the staff.

“Bizarre but true – we now risk-assess everything, yearly, monthly, weekly and sometimes daily. But when do we ever assess that vital, delicate and most valuable part of the machine – namely me and you?”

She said it was not just about the physical and psychological nature of nursing work but also the culture and environment in which they operated.

“Don’t we deserve an annual MoT?” she said. “It would allow our employers to be more proactive and supportive instead of reactive.”

Ms Topham-Brown was supported by other nurses, including Karen Webb, the RCN’s director of the eastern region of England.

She suggested support was even more important given the expansion in nurses in training in recent years, which could lead to an increase in the numbers not fit for a career in nursing.

She said students had a health check before joining a course but their psychological suitability was not tested.

“It is about making sure people have the right attributes,” she added.

In her local area, screening had been launched to “make sure that the people coming in have the right attitude to what is essentially customer care”.

She said nurses also had a duty to deal with public health issues, such as obesity and well-being.

And those nurses who were overweight themselves could be supported.

“It would be about supporting those people in that position to help them lose the weight.”

The Government’s NHS Health and Wellbeing report, published a year ago, said the NHS needed to do more to improve the health of staff.

NHS staff take an average of 10.7 days off work a year – more than the public sector average and nearly double the 6.4 figure for the private sector. Staff sickness is thought to cost the NHS £1.7 billion a year.

From: http://www.independent.co.uk/call-for-annual-health-check-for-nurses

Looking uncomfortable and sounding contrite, Andrew Lansley came to face his nursing critics yesterday – apologising four times and promising to listen to them in future.
Just hours after members of the Royal College of Nursing had voted overwhelmingly in favour of a “no-confidence” motion in Mr Lansley’s management of NHS reforms, the Health Secretary spent an hour and a half answering questions and listening to their concerns.

During the meeting he hinted that when the Government outlined its concessions to the Health and Social Care Bill in June, nurses would be given a greater role, particularly in deciding where NHS funds are spent. Nurses are likely to be given a statutory role on the new GPs’ commissioning boards, ensuring that at least one nurse is represented. The boards are also likely to be renamed to show that they represent other healthcare workers.

Mr Lansley tried to reassure the 60 RCN representatives who had been chosen to meet him that he did care about the NHS. He ruled out accepting any other job in Government, suggesting he would resign rather than be moved in any cabinet reshuffle.

“I believe in the NHS,” he said. “I am in politics for that. I am not here to do some other job. If there is an ideology behind what I am doing it is a belief in the NHS and a desire to protect it and make it stronger.”

Asked how he felt about being the only health secretary to receive a vote of no-confidence from nurses, he said: “It’s not something I sought out.

“I think it’s a rebuke and from my point of view I take it as a rebuke and I think listening to nurses this afternoon it was very clear some of the reasons why that happened is because they thought I was too focused on general practitioners when I was taking about clinical commissioning, GP commissioning.

“I know that nurses are not only the largest healthcare profession but are responsible for the delivery of most healthcare, and are often in the best place to be able to see the whole of care.

“From that point of view is it a rebuke in the sense that I didn’t get to the right place? Absolutely.”

Many nurses appeared partially mollified by Mr Lansley’s approach. But they all said they would wait to see how his “listening” materialised into concessions.

One of the problems Mr Lansley faces, however, is that it is not just the contents of his contentious Bill that the nurses object to. In the earlier no-confidence debate most were angered at cuts to frontline services as a result of the Government’s plans to try to make £20bn worth of efficiency savings over the next four years.

This is not something Mr Lansley has much control over as an ageing population means that the NHS will have to do “more for less” and savings will have to be found.

Earlier in the day delegates in Liverpool had voted 99 per cent in favour of the no-confidence motion, to 1 per cent against.

The RCN’s leadership had attempted to amend the motion to delay any no-confidence vote until after the conclusion of the Government’s listening exercise. But amid angry and passionate scenes on the conference floor the amendment was dropped when nurse after nurse took to the stage to condemn the Government.

“What this is about is how Andrew Lansley has introduced these reforms,” said Geoff Earl. “They are being driven by ideological dogma, not by what is best for our patients. This [vote] is about our patients, not about us.”

Another nurse went on to the platform and played a tape of David Cameron’s promise in 2010 to “stop the pointless reorganisation of the NHS”. Birmingham nurse Bethann Siviter added: “If these reforms go through, the NHS is dying.”

Andrew Frazer, an emergency care nurse, said: “When Andrew Lansley addressed us last year we listened to him politely and decided to adopt a wait-and-see policy. Well, we’ve waited and we’ve seen, and I for one don’t like what I’ve seen.

“We’ve been trimmed to the bone for years. Trying our damnest to deliver excellent care with limited resources. Here’s a message for Mr Lansley: if you cut frontline services, in the short-term care may be a little cheaper, but in the long-term care will be poorer and people will die.”

From: http://www.independent.co.uk/im-sorry-lansley-tells-nurses-afternoconfidence-vote

Nursing homes are to be told to submit to new “excellence tests” or risk losing public funding under new plans.
Homes will be assessed on staff training and turn-over, daily activities for residents, and the quality of care they offer.

Only those which professionally register all their staff are expected to be allowed to take part and the results of the tests will be published to give families information on what they can expect from individual homes.

Ministers have warned that only those institutions which meet the new standards are likely to be funded in future by local councils.

But critics of the plan said small independent care homes might not be able to afford the cost of registering for the new scheme and could go bankrupt, forcing residents to move even if the home was offering outstanding care.

The Independent has been highlighting the neglect of elderly residents in some homes, which campaigners say will get worse as public-sector cuts start to bite. More than half a million elderly people are in nursing homes and the number is expected to rise to 1.3 million by 2050.

Local councils spend around 50 per cent of their budgets on social care, the bulk of which is for the elderly. As a result of the public-sector funding cuts highlighting the neglect of elderly residents in some homes, which campaigners say will get worse as public-sector cuts start to bite.

More than half a million elderly people are in nursing homes and the number is expected to rise to 1.3 million by 2050.

Local councils spend around 50 per cent of their budgets on social care, the bulk of it on the elderly. As a result of the public-sector funding cuts announced in October’s comprehensive spending review, the same councils will have their budgets cut by up to 9 per cent a year for the next four years.

At Christmas, the Care Quality Commission (CQC) carried out spot inspections of 234 health and social-care institutions, including nursing homes, which revealed significant lapses in standards in more than a third of cases. Ten reviews resulted in the highest form of censure, which could to lead to the commission withdrawing licences to operate.

After one review, a nursing home in Luton – run by Southern Cross, Britain’s largest care-home provider – was closed immediately because conditions were so bad. The commission found that 26 other institutions were not meeting required standards in all areas and ordered improvements.

Later in the year, the Government will unveil its long-term plans for reforming the care sector. These are likely to include the introduction of a new “insurance model” to pay for care in later life. People without insurance forfeit their assets when they die to pay for care they have received.

Speaking before a consultation to decide how the excellence rating will be assessed, Paul Burstow, the Care Services minister, said good-quality care was not always about money. “Compassion, common sense, treating people with dignity and respect are not simply about spending more. They are about the way you do things. We want to look at what’s being done [in nursing homes] to add life to the years you’re having rather than just adding years to the life you’re leading.

“The new ratings will provide further pressure within the sector to improve. So it creates another lever for the commissioner to pull, to say we are only going to place people with you if you are excellent.”

The scheme will start out as optional and the cost of the inspections will be borne by the care homes. The commission’s chief executive, Cynthia Bower, said: “CQC’s role is to identify and react to signs that people may be at risk of receiving poor care. But this is not the same as saying other provider are offering ‘excellent’ care.

“An excellence award can recognise best practice, be a spur to improvement for providers who already meet CQC’s essential standards, and can help people who need longer-term care to make choices.”

Under the plans, all staff working for “excellent” nursing homes will likely have to be registered with a new Health and Care Workers Professions Council. This means care workers could be “stuck off” for poor practice and eventually the body could require minimum qualifications for registration.

“We want to see if we can work it on a voluntary basis but you probably won’t be able to have an excellence rating unless you employ people who are registered,” said Mr Burstow.

His long-term intention was to make the care system much more transparent and clear for both residents and their families,” he said.

From:  http://www.independent.co.uk/excellence-ratings-for-care-homes

Warning labels on medicines should be simplified because words such as “drowsiness” and “avoid” are too confusing for modern patients, experts claim.Research by the British National Formulary (BNF), which advises doctors, nurses and pharmacists, found labelling that has been around for decades is now too difficult for members of the public to understand.

It found phrases such as “may cause drowsiness” are no longer “readily understood” and should now be simplified to say “this medicine may make you sleepy”.

Likewise, the phrases “avoid alcoholic drink” and “take at regular intervals” caused indecision among modern takers.

The report recommends the labels should now read “do not drink alcohol while taking this medicine” and “space the doses evenly throughout the day”.

The research was carried out by Professor Theo Raynor, and colleagues at the University of Leeds.

He said: “Most medicines do contain leaflets which provide detailed information for patients.

“However the leaflet may get lost, which means that the label on the medicine plays a very important part in guiding people’s behaviour.

“It is vital therefore that wordings on labels are simple and straightforward.”

Prof Raynor’s team tested a selection of instructions on almost 200 people aged 20 to 80.

The experts reworded phrases that people found confusing, and then retested them in several sittings, including one-to-one interviews.

Prof Raynor said “avoid alcoholic drinks” was a good example.

“Our user tests have shown that the word “avoid” can cause confusion and that some people think it only means they should limit their alcohol intake.

“This phrase will now be replaced by the instruction: ‘do not drink alcohol while taking this medicine’, which is far clearer.”

Other recommendations include changing “do not take indigestion remedies at the same time of day as this medicine” to “do not take indigestion remedies two hours before or after you take this medicine”.

Another phrase, “do not stop taking this medicine except on your doctor’s advice”, becomes “warning: Do not stop taking this medicine unless your doctor tells you to stop.”

The revised phrases are included in a new, updated version of the BNF.

“The software used by large pharmacy chains and independent pharmacist to print instruction labels is updated regularly, so we would expect to see these new phrases appear within the next six months,” Prof Raynor said.

Professor Nick Barber, a pharmacologist at London University, said: “When serious errors occur which cause harm to patients, it is often as a result of a series of minor failures at various stages.

“Therefore in taking more care about the wording of detailed instructions we can help improve the safety of medicines.

“With two million prescriptions being issued every day, a small percentage improvement through labels being more understandable could make a significant impact”.

Duncan Enright, publishing director at BNF publications, said: “It has never been easier to change labels on medicines given current computerised systems and therefore we hope that the large pharmacy chains and independent pharmacies will adopt these recommendations.”

The words “drowsiness” and “drowsy” are thought to date back to 1520 probably from the word drusan or drusian “to sink,” also “become languid, slow, or inactive” which are related to dreosan “to fall”.

From: http://www.telegraph.co.uk/May-cause-drowsiness-too-confusing-for-modern-medicine-labels

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 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”.

The Patients Association said the 17 cases highlighted wider failings in NHS nursing care.

It is calling for the introduction of independent “patient safeguarding champions” at every hospital to check that nursing standards are maintained. It also wants the NHS complaints process to be overhauled.

“Surely the essentials of nursing care are what every patient deserves and should get?” said Chief Executive, Katherine Murphy.

“It’s a scandal, and it’s outrageous that it has been persisting for years.”

The family of former Patients Association president, Claire Rayner, who died in October, is backing the calls for change.

“If she were here today she would have been hollering from the roof tops about it,” said Claire Rayner’s son Jay.  “Any health system is only as good as its failings, and those detailed in these pages are truly dismal.”

The Royal College of Nursing said there was no excuse for poor care.

General Secretary Peter Carter said: “Neither the RCN nor the overwhelming majority of committed and caring nurses can possibly condone the neglect, rudeness and in some cases outright cruelty outlined in this report.”

However, he said problems often arise when staffing levels are cut.

Care Services Minister, Paul Burstow said the report painted a disturbing picture.

“It is an unacceptable legacy that this government is committed to tackling. The NHS must become much more tuned into patient views and experience.”

He said that was why the government would soon start publishing details about complaints.

From: http://www.bbc.co.uk/news/health-11889342

NHS staff are going to extraordinary lengths to get hold of the new style uniform.
BBC Scotland has seen an internal e-mail asking managers to put an end to the “antics” of those trying to get their hands on the new kit.

We understand some staff have been deliberately damaging old uniforms or losing them to get the new ones.

NHS Grampian said staff may have been trying to “jump the queue” but no-one had been disciplined.

The e-mail was circulated by Nursing Services Manager Frances Dunne on 9 July, but was originally written by a staff member named Stephen.

It states: “The new National uniform is proving to be very popular and as a consequence some NHS Grampian staff are going to extraordinary lengths to obtain it.

“Whilst for the most part the behaviours of uniformed staff and their managers – at all levels – may be described as ‘antics’, some are negligent, dishonest and in a number of extreme cases, fraudulent.”

The new NHS Scotland uniform was launched a year ago to replace more than 250 previously-used varieties.

It comprises just one style of tunic, which is available in seven colours depending on the job of the wearer.

The email says that sewing room staff will now request an old uniform for a new one and will check that returned uniforms have lasted as long as expected.

It warns that if staff do not change their behaviour their “conduct” will be investigated.

NHS Grampian said no-one had been disciplined.

A spokeswoman said: “In Grampian our priority is to our new starts, then those who have waited longest.

“It seems, however, that some staff are so anxious to obtain the new uniform that they have been trying to jump the queue.”

A Scottish government spokeswoman said: “We are pleased that the new uniform is proving so popular and it will be rolled out to all staff by 2012.”

A NHS staff member who responded to the BBC news website story said: “I work for the said trust, and I have heard stories about staff ‘pretending’ to lose uniforms to have the new style ones, if a qualified nurse was doing his/her job correctly then they would know that an apron should be worn when doing certain jobs, so I feel that the comments about them being unhygienic do not stand true.”

From: http://www.bbc.co.uk/news/uk-scotland-11730212

On April 14, 2010 Health Direct posted -New nurses uniform revealed when nurses and midwives at a hospital in west Wales have become the first to start wearing new national uniforms.

They have been designed to make it easier for patients to see who is in charge of hospital wards after research found many were confused.

http://www.healthdirect.co.uk/2010/04/new-nurses-uniform-revealed.html

The National Health Service (NHS) is the only major area of Whitehall spending in which there will be a rise in real terms. However, an increase of just 0.1 per cent a year will be dwarfed by the rise in the cost of drugs, an ageing population, the cost of reorganisations and inflation.

The cuts:
Technically the NHS has been given an increase in funding but this is less than half a per cent over four years.

£1bn will be diverted from the NHS to social care to help cut emergency readmissions to hospitals.

Psychological therapies will be boosted for those with mental health problems.

A new cancer drug fund for medicines that have been turned down by Nice worth up to £200m a year.

Three new hospitals were given the go ahead including Epsom and St Helier, West Cumberland and the Royal Oldham.

However the extension of free prescriptions to people with long-term conditions will be stalled.

One to one nursing care for cancer patients and a pledge under the previous government to have cancer tests conducted within one week will also be postponed.

The number of quangos will be cut from 18 to 10 by 2014 and the administration costs will be reduced by a third.

Radiographers will examine some x-rays as well as take them in order to save £7.9m of consultant radiologists’ time.

What it means:

Although an increase in funding sounds generous compared to the other departments it is nowhere near enough to keep pace with inflation in the NHS or the increase in demand for healthcare as the population ages and new treatments are developed.

The NHS has already been planning to make £20bn worth of savings over the next four years and it is not yet clear if this will have to be increased in light of the CSR settlement.

The Chancellor said the NHS spent £102bn this year but this is £5bn lower than what was planned for in the 2007 spending round, raising the question of where that money has gone.

Thousands of jobs in the NHS are already earmarked for cuts as primary care trusts and strategic health authorities are to be abolished as part of the coalition’s reforms and it is feared that some hospitals may seek to cut frontline jobs as well.

Experts have warned that plans to give GPs greater control over the NHS budget and the reorganisation this will take will cost between £2bn and £3bn.

What is the department’s budget?

£109.4bn

How well does the department perform?

Waiting times for patients needing treatment in hospital reduced dramatically under Labour, following the introduction of many targets. But with them came an expanding bureaucracy. The number of managers rose by 84 per cent in a decade, while nurse numbers grew by just 24 per cent.

Recent scandals such as that at Stafford Hospital, where patients suffered appalling and basic failings, illustrated the dangers of prioritising finances and targets over care.

Britain’s record in funding drugs for many serious diseases – especially cancer – compares poorly with the rest of Europe, and survival rates are worse than in other countries.

While growth in spending on the NHS in the past decade was at a record level, most of the money went on pay. GP pay rose by nearly 50 per cent in a decade, to an average of £106,000.

Had any savings already been identified?

The Government says more than £1 billion will be saved by halving the size of NHS bureaucracy in four years. 150 primary care trusts and 10 health authorities will be scrapped. However, redundancy payouts to get rid of so many managers will be expensive. Quangos such as the Health Protection Agency will be culled. Funding for a £75 million public campaign against obesity and drinking is to be stopped, with food and drinks companies asked to foot the bill.

From: http://www.telegraph.co.uk/Spending-Review-What-it-means-for-the-National-Health-Service-NHS-Department-of-Health