Elderly patients on hospital wards left alone, unwashed, unfed, dehydrated, water and alarms left out of their reach.

Frail and frightened, left – quite literally – to rot in their own urine and faeces, developing horrid bed sores and blisters over their bodies. Relatives recounting how their frail parent’s (I quote) “nether regions looked like raw meat.”

An 86 year old woman admitted for a broken hip. Against the warnings of her daughter left in a bed with no cot sides because no “risk assessment” had taken place. The result was a fall as she struggled to go to the loo, and a second broken hip.

Inedible food. Dismissive, rude nursing staff. Doctors unable to tell nurses to take action in case it caused a fuss.

An elderly woman begging to “be taken out into the car park and left to die” such was her shame and discomfort. Another who shied away from her daughter’s kiss, ashamed that she had not been able to wash and acutely aware that she smelled.

Elderly and frail patients stripped of their dignity at the time when they are most vulnerable.

These were the reports of treatment in hospitals I listened on to with increasing anger on the Victoria Derbyshire radio show on radio Five Live on Thursday morning. It is still available on the iPlayer here.

This week the Quality Care Commission published 12 reports into the standard of care for the elderly in NHS hospitals. Three were found to giving a standard of care below the legally accepted standard.

The named malefactors are: The Warwickshire Acute, The Ipswich Hospital, and the Royal Free Hospital.

The Care Quality Commission is a public body established in 2009 to regulate and inspect health and social care services in England. This includes services provided by the NHG, local authorities, private companies and voluntary organisations – whether in hospitals, care homes or people’s own homes. Part of the Commission’s remit is protecting the interests of people whose rights have been restricted under the Mental Health Act.

In highlighting this scandal the Quality Care Commission is doing a good job. But my first question is: what is to be done? What action will be taken to discipline staff?

Sir Keith Pearson took part in the radio discussion I have mentioned. He is the current chairman of the NHS Confederation.

He seemed an intelligent and caring man, and he talked a lot about how there had to be a better “dialogue” between management and staff. He said that whilst the NHS had become good at providing technical services and “outcomes”, the values which nursing care should embody seemed somehow to be being lost.

All true. The drive of governments has been policy initiatives, targets, figures, triumphalism about spending. Initiative, common sense, and kindness never figured much in the New Labour canon of values. So what if you are left on a trolley overnight, cold and dehydrated? You were treated within 45 minutes of admission! Huzzah, Minister!

The one thing I didn’t hear from Sir Keith was this: what sanction would be taken against nurses, doctors and administrators directly or indirectly responsible for these deplorable events. I have no qualms about wanting heads to roll. In short, people responsible for these shocking cases should be sacked.

But no, in the world of “systemic failure”, where “no one person is to blame” personal responsibility and proper sanction no longer seems to be in play.

In my mind, I dreamed of a system of Avenging Inspectors, clad in black, visiting wards unannounced at all hours and with the summary power to dismiss medical staff and management. No come backs. Clear your desk. Period.

Which leads to the Sharon Shoesmith case. In winning her latest round of her legal battle Ms Shoesmith declared that she “doesn’t do blame”.

Quit so. In “systemic failure land”, nobody is ever to blame. As it happens, I don’t blame Sharon Shoesmith for Baby P’s death too much. He was murdered (yes that is the word) by feckless irresponsible low life parents who have doubtless themselves been brought not to “do blame” by people like Ms Shoesmith.

No, I blame her for running a spectacularly useless department which didn’t do its job properly whilst on a six figure salary.

As was pointed out the Court of Appeal the OFSTED report into her department found:

“… insufficient strategic leadership and management oversight of safeguarding of children… by elected members, senior officers and others within the strategic partnership;

… managerial failure to ensure full compliance with some requirements of the inquiry into the death of Victoria Climbié, such as the lack of written feedback to those making referrals to social care services …

The local safeguarding children board (LSCB) fails to provide sufficient challenge to its member agencies. This is further compounded by the lack of an independent chairperson.

Social care, health and police authorities do not communicate and collaborate routinely and consistently to ensure effective assessment, planning and review of the cases of vulnerable children..

The quality of front-line practice across all agencies is inconsistent and not effectively monitored by line managers.

Child protection plans are generally poor.

Arrangements for scrutinising performance across the council and the partnership are insufficiently developed and fail to provide systematic support and challenge to both managers and practitioners.

The standard of record keeping on case files across all agencies is inconsistent and often poor.

There is too much reliance on quantitative data to measure social care, health and police performance, without sufficiently robust analysis of the underlying quality of service provision and practice.”

Not good then, Sharon. I did in fact, have some sympathy with Ed Balls who summarily appointed a replacement Director of Children’s Services, and thus directly caused her to lose her employment by the spectacularly “right on” and spectacularly useless Haringey Council. However having read the full judgement I have had to review my position a bit. A link to the judgement is here.

It’s a complicated topic. But ultimately all the judges were saying is that brilliant bully boy Balls, anxious to present himself as the decisive hard man of the people, dived in and caused her sacking when she had never had the courtesy of being afforded the chance of answering any specific allegations against her. In the culture of non blame, the OFSTED report had made criticisms of her department but adopted the convention of not blaming any one individual. Employment law is a well known nightmare, and bulldozer Balls blazed ahead regardless. I suspect that the judges hated Balls more than her. As one Lord Justice concluded:

“Whatever her short comings may have been…she was entitled to be treated lawfully and fairly and not simply and summarily scapegoated.”

I sort of see their point. Perhaps summary dismissal where you have never had the chance to defend yourself against a specific allegation is a tad too far. Perhaps. But then on the other hand, as is the way of things, the Court never got round to addressing the issue of whether she was useless or not. It was all about procedure and process. Ah, the games lawyers play!

Maybe we could do less process and responsibility. Yes, blame even.

In the end, of course, nobody comes out of this particular scandal well. Balls and his department did what one would expect: “Ballsed” it up. Shoesmith may have won, but only on a technicality. Haringey got its procedures wrong too. The lawyers prosper.

It’s much reported Shoesmith is in line for a massive legal jack pot. That’s not actually what the Court of Appeal has said. They actually said that on one view all she should get is three months pay and pension, although there are other arguments. The correct legal result, in my view should actually be this: technical victory for the hard faces Shoesmith and nominal damages. £1.00. No order for costs. Thank you and good day!

But I suppose she’ll get her million. It seems to be the way of the world in modern Britain. The talentless, the greedy and the inept are rewarded by the bucket load.

But it’s OK. Shoesmith has grandly declared she’s not bringing the action for the sake of the money. So as one acid “tweeter” observed yesterday, if she does get her million pound pay out, she’ll be donating it to charity, maybe?

I won’t hold my breath.

Gildas the Monk

Anna, militant medical
nurse June 5, 2011 at 05:00

You guys are right, you don’t understand. This is especially true for those
of you who gave old school nurses as relatives. Your old school nurse
relatives would do no better than modern nurses if they were in ours.

After 10 years as an NHS staff nurse I am now working in the United States.
What a difference staffing and resourcing makes. The patients get amazing care
here. We are one RN to 4 patients here. In the UK I was one to 19. Here in the
US the kitchen sends up enough food. Management also sends extra help if there
are more patients on the ward that need to be fed than there are staff.

In the UK the hospital kitchen never sent up enough food and the ward staff
had 15 minutes TOPS to get that food out. They had to run out and hand out all
the trays and then go back and feed the patients. Many elderly patients are
confused and would grasp food and drink and pour it over their own heads .
Therefore the staff had to leave it out of reach whilst they got all the trays
out and dealt with all the interruptions. The kitchen would insist on
collecting the trays back in (so they could get home on time) before the ward
staff could backtrack and feed people. There are always many more patients
that need to be fed than there are staff. And during that 15 minute period
when we had food on the ward for patients unstable admissions would come in,
people would internally bleed, family members rang, patients asked for pain
medicine etc.

Elderly people need one to one care and if they don’t have someone with
them all the time the will deteriorate and show signs of neglect. It cannot be
done with 2 nurses and 2 carers on a 30 bed ward with critically ill, acutely
ill, and geriatric patients all mixed in together. In your grandmothers day
geriatric patients were kept separate from critically ill patients. Your
grandmother never had multiple patients on titrated IV cardiac meds and
insulin drips that needed constant monitoring as well as a dozen geriatric
patients who needed one to one assistance to drink and eat all at the same
time. This situation just did not happen in the old days.

Each NHS RN has 19 patients each. Each of those patients has multiple
doctors throwing treatment orders at the nurse all day long. Blood
tranfusions, medications, labs, diagnostics etc do not get done unless the
Nurse spends a lot of time on the phone and the computer getting them through
the system and ordered. This is how it is set up. The NHS nurses don’t like it
either. It isn’t something that your older relatives who were nurses decades
ago ever had to deal with. If a doctor orders a med then the nurse has to
chart it in many different places and do all sorts of computer work before
pharmacy will even issue the drug and send it to the ward. This is
extraordinarily time consuming and if the Nurse doesn’t do it she takes the
full blame for the patient not getting the drug. If you have 19 patients on 20
drugs each it gets very time consuming. In the old days patients were not on
as many drugs and what drugs they were on were kept in stock on the ward.

In the United States the Nurse has someone to do that computer crap for her
so that she can spend time with her patients. Not so in the UK.

The paperwork. The Nurses hate it. But if they don’t do it the patients
dont get treatment and the hospital doesn’t get reimbursed by the government.
In the old days the Nurse had less paperwork and she would leave it until the
end of her shift after she had handed over to an oncoming shift. These days
government agencies like the CqC are demanding that all Nurse documentation
get done in realtime. They audit this and if the ward Nurse doesnt document
everything that is happening as it is happening in about 5 different computer
systems and paper forms all day every day then they with hold funding from the
hospital as punishment. This has led hospital management to discipline
frontline nurses if there are gaps in that real time paperwork/computer
documentation. The nurses did not invent this paperwork and do not want to do
it. We did get threatened a lot by management (scared shitless that they will
lose funding) when we ignored the documentation to Nurse patients.

The paperwork situation is just as bad in the States BUT I have only 4
patients at once here compared to the 19 I had in the UK. I can get through it
fast enough to actually do some patient care. The RNs in the UK have no
chance.

Your older nurses who haven’t worked on a ward years do not understand any
of this. They just assume that the modern nurses are intentionally neglecting
the patients. Your old fashioned nurses would do even worse on a modern ward
than current nurses do. They simply had more help, a light workload, less
government and management rules. They are not fast enough to deal with a
modern ward.

Australia and the USA have all degree nurses and no one starves or gets
neglected. In the UK you have almost no degree nurses. Right now, your wards
are usually staffed with older RNs who trained in the old days. The younger
members of staff you are seeing on duty are healthcare assistants who never
had any kind of nurse training. Your new graduate nurses who are coming out of
the new training cannot find jobs. There has been an RN hiring freeze in
effect for years. Your newbies are stocking shelves at asda, not working in
the NHS. They aren’t going to find a job in nursing unless they immigrate
probably.

If you would bother to read a name tag you would see that the people
hanging around at the nurse’s station gossiping and laughing are not nurses.
The clinical techs, pharmacy assistants and other members of the allied health
profession and they love to use the Nurse’s station as a break room. And my
they are loud!! If a Nurse is at the station she is on the computer making
sure that pharmacy is getting your drug orders, or that the doctors request
for your blood transfusion gets onto the system in pathology lab so you can
get what your doctor ordered before you bleed to death. She has to take
responsibility for that stuff because she gets the blame if it all goes wrong
and you die because you never got your blood. And if she has 19 patients, that
is a hell of a lot of orders that need to get entered onto the computer.

In America I have someone to answer the phone for me!! That also helps me
to get lots of time with my patients and provide direct patient care. In the
UK the nurses were denied unit secretaries for much of the day and the phone
rang off the hook!! If we refused to leave patients to answer the phone we
would get complaints from family members who were trying to ring the floor and
got no answer. Then management would go apeshit on the Nurses for not
answering the phone. Answering all those phonecalls also took a lot of time
away from patient care and led to patient neglect.

If a nurse has 19 patients that is 3 minutes per hour per patient. Now look
back at all the stuff I explained that the Nurse has to stay on top of during
the course of a shift. Do you really want to staff and run your wards like
that and then blame ‘mean’ nurses for substandard care. Nurses are not
magicians they cannot be ten places at once.

On my old ward in the UK I was the only degree nurse because I trained in
the USA and my british nurse colleagues all trained in the UK. We had one
nurse to 19 patients, and there was a lot of unintentional neglect. The nurse
there were completely unable to do any hands on care because of ward
conditions.

On my new ward in the USA all the nurses are degree trained. We have one
nurse to 4 patients and the nurse has tons of back up and support with
everything from getting meds ordered to answering the phone. There is no
neglect of the patients here whatsover. And because the nurses are well
educated, as well as highly skilled at the bedside, less mistakes and
oversights happen.

I saw so many english nurses do dumb things that hurt patients because they
just didn’t have that high level science background. It wasn’t necessary for a
nurse to have a good education in the old days as the patients, the system and
everything was a lot simpler. But these days it is a necessity.

Just trying to educate you so that you can fix your shitty NHS wards and
stopping them from sucking so bad. With hardly any degree RNs on staff, an RN
ratio of one to 19, no resources or back up for your RN’s, and scores of
untrained kids who aren’t allowed to do anything running around as ward staff
you Brits are a freaking laughing stock. And no one is blaming your Nurses for
the state of things in your wards or with elderly care. They are blaming you
for being too lazy, stupid, backward, ignorant and cheap to resource your
nurses properly. Everyone gets it but you.

My dad has worked in the banking industry all of his life, he has no health
care background whatsoever and even he gets the fact that UK nurses do not
have a snowballs chance in hell of caring for those patients properly.

ObiterJ May 31,
2011 at 11:29

Since judicial review is not about the merits of the Minister’s decision,
the court could NOT address the issue of whether she was useless or not.

The case has gone back to the Administrative Court to determine the
compensation. (I leave aside the Employment Tribunal claim which is stayed for
the time being). The Court of Appeal merely indicated the outer limits of what
she might be entitled to and hoped that it might be settled by negotiation or
mediation. Some hope I would say but you never know! When the amount of
compensation is determined then we shall see whether Shoesmith is about the
money or not.

There is a great deal to this case and, to be frank, Ofsted should not be
quite as complacent as they appear to be. Their Joint Area Review did not name
Shoesmith or her Deputy BUT they went to a meeting with Ed Balls and verbally
stated some very damning things and named her and the Deputy. It is all in the
Court of Appeal’s judgment.

Lilith May 30, 2011 at 09:51

I asked a nurse about her ward manager in a mixed medical ward. She said
that the manager came to the ward for a couple of hours one morning a week. I
said, “Oh, does she manage other wards too?”
“No”
“what is she doing the
rest of the time?”
“She is in meetings”

Derek M May 30, 2011 at 16:05

That’s the style. Committees avoid making descisions, and it is always
the committee to blame, not an individual. The committee produces a report,
that no one reads, except to make sure that they are shown as attending, so
that they can claim their expences.

Committees should be banned, they are just a parking place for mostly
incompetent individuals to spout about things that they do not understand,
in the sure knowledge that there will be no comeback for their ignorance,
except for handsome expences.

berenike May 30,
2011 at 07:47

You should, in the interests of fairness, have mentioned that great
contribution to child welfare made by Labour. Their efforts over the years may
not have been able to prevent the death of Baby P., but they did destroy that
horror with which parents across the land threatened their naughty children,
the Catholic adoption agencies. No child will ever again be denied the right
to be adopted by a homosexual couple.

I should like to second the “all it needs is a little thought” comments on
the care of the frail and elderly. But some folk seem to have no empathy or
imagination. Perhaps sensitivity training should be focused on age. A series
of emotionally-manipulative films to put viewers in the skin of the frail and
elderly.

Derek M May 29, 2011 at 15:44

The problem with the NHS, like so many other public organisations, is that
no one is responsible. All descisions are taken by committee, so no blame can
fall on any one person. This state of affairs will not improve until a proper
management structure is imposed. Each person, each department knowing what
they are responsible for. Each manager or head of department knowing what they
are responsible for, and taking actual charge of what is going on, and
answering to the next tier up, for good or ill. There must be a clear
management line from the newest nurse, or cleaner, right to the top civil
servant in charge of the NHS. Remember, ministers are only responsible for
policy. Civil servents are responsible for how it is carried out. Policy, the
electorate throw the politicians out. Opperational malfunction, a civil
servent goes.

Ed P May 29, 2011 at 18:30

Agreed, but also remove the disfunctional “marzipan” layer before
applying a clear line of responsibility, as you describe.
The “marzipan”
layer (copyright Nigel Farage) is entirely composed of useless bureaucrats
on 6-figure salaries, and was inflicted by Blair on most public services.
These parasites absorb money intended for front-line services and contribute
nothing. As they are a main part of the problem with responsibility, they
will resist any reforms, but should all be removed before a single nurse is
made redundant.

Dave May 29, 2011 at 14:25

Surely Shoesmith won’t be bringing an action-she doesn’t “do blame”?

Randy Hack
May 29, 2011 at 17:41

Good point!

Andrew Duffin
May 29, 2011 at 09:34

She was in charge.

Her department cocked up, and somebody died.

So she carries the can. End of.

That is what responsibility means, or should mean.

Rex May 29, 2011 at 12:07

Absolutely!!

If not why was she paid £130,000 a year?

Catherine May 29, 2011 at 09:21

Perhaps you should read this article on the Care Quality Commission
By
EMMA MORTON
Health Editor

Published: 19 Mar 2009
Add a comment Add a comment (13)
THE NHS boss
in charge of the filthy hospital where up to 1,200 patients died in
“appalling” care has a new job – as a top health WATCHDOG.

Cynthia Bower will start on APRIL FOOLS’ DAY – in a move branded a “cruel
joke” by relatives who lost loved ones.

Her appointment emerged as PM Gordon Brown yesterday apologised for the
“inexcusable” failings at Stafford Hospital.

Ms Bower is to be the £200,000-a-year head of the new Care Quality
Commission.

The watchdog replaces the Healthcare Commission, which produced Tuesday’s
damning report on the “death wards” at Mid Staffordshire Trust.

As West Midlands Strategic Health Authority boss, she was ultimately in
charge at Stafford.

Mark Bennett, 38, whose mum died while a patient, said: “This is like some
kind of cruel joke. It isn’t fair that someone with a connection to this
appalling incident should be in charge of a body that oversees hospitals.”

The death toll was caused by dirty wards, staff shortages and managers
obsessed with targets.

Mr Brown told MPs yesterday that standards fell “far short” – and promised
a review.

Ms Bower insisted last night that she was “passionate” about quality health
care.

Read more: http://www.thesun.co.uk/sol/homepage/news/article2327967.ece#ixzz1NjANAYtY

PT May 29, 2011 at 09:16

It’s starting to appear that “nurses” are not nursing people. They’re not
angels, not carers, and are no better or worse than the rest of us. They’re
just pen-pushers, justifying everything on paper and chasing political
agendas, learning buzzwords for new initiatives, rather than caring for
patients.
There’s some talk, above, about employing people to sit with
patients in order to ensure that they receive the necessities of life, and are
treated with some respect, something which doesn’t happen at present. As a job
title for these new employees, may I suggest the title “Nurse?”

rogerh May 29, 2011 at 07:11

I reckon there is a thick layer of hypocrisy lurking here. Why, because it
cannot be that hard to run Social Services and Hospitals without very many
scandals due to neglect and carelessness. Now you can beat the staff over the
head for a while, but in the end to do a good job consistently costs money and
political willpower – and therein lies the rub.

Whitehall and the politicians do not want to face the cost (in money and
unpopularity) of doing a good job consistently – so they hire smart-arsed
managers to duck and dive and evade the media whilst ‘managing’ to make it
look as if the work is being done. Shoesmith’s greatest sin was not to have
her paperwork straight. If the filing had been squeaky she would have been in
the clear. Why, because all Social Service and NHS managers know they are
being asked to do the impossible and the way to protect themselves from blame
is to do the paperwork first and the patients last.

You can beat a bit more personal responsibility out of people for a while,
but in the end its’ the budget that counts. The hypocrisy lies with Mr Balls
and his friends Lib, Lab and Con.

Sister Eva
Longoria May 29, 2011 at 07:40

Does it take money to put water within reach of a frail patient? Or just
a bit of thought?

JuliaM May 29,
2011 at 20:21

Spot on!

Bill Quango
MP May 29, 2011 at 02:30

Great piece. There are numerous stories. I can think of several recently
told to me old relatives uncared for in wards.
Its not hard to fix. a
simple matter of employing non medical carers to check a person has drunk,
slept, eaten etc.

I thought Balls acted decisively at first. But as soon as I heard he had
sacked, rather than suspended, the Shoe, it was bonus day for her.

john malpas May 29, 2011 at 01:45

I read somewhere that in some american hospitals you can actually employ a
person to sit with your relative and make sure things are done right. Probably
illegal in the UK.
When nurses started getting accademic the patients
became a bit bof a bother ( here in astralia as well). Add thyis to the
political destruction of family and hence family care.
Import lots of
people who have no kinship with the English .
As well there is a feeling ,
not being discouraged , that old people shouldn’t be a burdon.

WitteringWitney
May 28, 2011 at 22:52

Care for our own or overseas aid? No contest!

JuliaM May 28,
2011 at 23:15

Seconded! But it isn’t money that’s the problem. Throw 10 times the
financing at the NHS, it’d still be a basket case. It’s the attitude and the
ethos that needs to change, and the ‘no blame’ cultures needs to become a
‘If anyone starves or is thirsty on your ward, you’re out”!’ culture.

Dick the Prick
May 28, 2011 at 20:37

Can’t have maverick ministers; don’t agree with Shoesmith but as soon as
Balls went off the hymn sheet as to his authority he lost the case.

icequeen May 28, 2011 at 18:37

Please read militant medical nurse http://militantmedicalnurse.blogspot.com/2011/05/new-job-new-life.html
before crucifying nurses for not caring for their patients.

Gildas theMonk
May 28, 2011 at 18:40

Ah hang on. In fact what I should have gone on to say is that these are a
minority of hospitals and cases. Lots of nurses do splendid work under
pressure. BUT and it’s a big but these cases are just not acceptable. Just
listen to the podcast before crucifying innocent bloggers

JuliaM May 28,
2011 at 23:13

But it’s NOT a minority, Far from it. Ask anyone with recent experience
of it…

And I’m not impressed with ‘Militant Medical Nurse’s’ excuses and ‘Nah,
not us, someone else’s fault, innit?’.

Disenfranchised of Buckingham May 29, 2011 at 12:30

Agreed. It doesn’t explain why drinking water is out of reach or why
blind people don’t get help eating and drinking. Or why nurses sit at a
central desk yabbering or doing computer work when call bells are going
mental. I’ve spent enough time as mother’s carer to have seen that this
is endemic and not an occasional lapse.

Mum was a pre NHS trained nurse and couldn’t understand modern
nursing. Matron would have skinned her alive if a patient was soiled in
bed or had bed sores or hadn’t had a bed bath or…

And if the nurses can’t do their job properly it certainly doesn’t
explain why the nursing profession supports the NHS.

The Cowboy
Online May 30, 2011 at
19:57

“And if the nurses can’t do their job properly it certainly doesn’t
explain why the nursing profession supports the NHS.”

I think you’ll find it’s precisely that the NHS supports the
nursing profession, is the reason the nursing profession supports the
NHS.