Katherine Murphy: Message of care must be learned in hospitals

As with our previous two reports, Patients Not Numbers, People Not Statistics (2009) and Listen to Patients, Speak up For Change (2010) this report contains firsthand accounts of some of the very worst stories of poor care in hospitals that have come to the attention of the Patients Association Helpline.

In this year’s report we have also included previous accounts of unsatisfactory care at the same hospital experienced by the families involved. We did this because it needs to be understood that these stories are not isolated incidents, but represent a systemic problem within the National Health Service.

Following the launch of Listen to Patients, Speak up for Change last year the Care Quality Commission (CQC) launched 100 inspections of acute NHS hospitals between March and June 2011. These unannounced inspections looked at the standards of dignity and nutrition on wards caring for elderly people.

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One in five of the hospitals inspected were found to be delivering care that posed risks to the health and well being of patients, with two hospitals offering care that put people at an unacceptable risk of harm.

While we welcome the CQC inspections, it should also be noted that the inspections picked only two wards per hospital, and visited on only one day of the year. That they still managed to find so many hospitals delivering unacceptable care is deeply concerning, and it would be logical to assume that a more detailed and comprehensive inspection regime would unearth many more problems at those hospitals and beyond.

We also strongly believe that, whilst the CQC should be applauded for identifying hospitals which are delivering poor care, only a long term action plan and repeated hospital wide inspections can ensure sustained and lasting improvements. It is simply not good enough to allow hospitals to make changes in the short term to pass follow up inspections, which mask a longer term culture amongst nursing staff who then allow standards to slip once the gaze of the CQC has shifted away to another problem hospital.

This was why last year we called for independent clinical “patient safeguarding champions” that would be able to identify those wards where a long term cultural change is required, and continue to scrutinise those wards until they deliver the levels of care and dignity that the elderly people being treated there deserve.

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We continue to call for their introduction, and believe that they would be a crucial step forward in tackling poor care.

The same elements that form the basis of poor care are heard with depressing frequency by our helpline. We know that if a patient or relative contacts us because nurses take forever to answer their call buzzers (or don’t answer at all) they are likely to also have had problems with one or more other key indicators – pain relief, eating and drinking, or toileting care.

In the 21st century, in one of the most developed countries and health systems in the world, patients should not be left starving or thirsty, they shouldn’t be left in pain and they shouldn’t be forced to urinate or defecate in their bed because the nurse designated to them says it’s easier for them to change the sheets later than to help them to the toilet now. Yet this is what is happening around the country every day.

The saddest thing is perhaps that in this report we have been able to highlight the cases of bad care where a relative is available to speak up for the patient.

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Yet there are many patients that have no one to speak up for them, and no relatives to challenge the care that nurses are giving them.

It is for those patients that changes need to be made in the future, which is why, along with the Nursing Standard Magazine we have launched our Care Campaign.

The Care campaign aims to drive improvements in patient care across the UK. Care stands for: C – communicate with compassion; A – assist with toileting, ensuring dignity; R – relieve pain effectively; E – encourage adequate nutrition. The campaign recognises that everyone who goes into hospital or a care home is entitled to these fundamental aspects of care – they are a human right.

Forged by a unique collaboration between the UK’s only independent patient organisation and its biggest selling nursing journal, we hope patients, relatives and nurses will use this Care slogan as a care checklist.

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We will be asking all nursing directors, chief executives and non-executive directors of NHS trusts, as well as care home groups, to sign up to the Care Challenge so that ‘Care’ becomes a universal expectation for patients.

Criticism of nurses has become louder in recent months following several critical reports about poor care. Often blame is laid too simplistically at “bad nurses” or “modern nursing”, but the reasons for poor care are multiple and complex.

Last month, the Patients Association and Nursing Standard magazine hosted a meeting in London to discuss the causes of poor care and its solutions. Attended by many of the UK’s top nurses, policy experts, patient champions as well as doctors and managers, all of them backed the idea of nurses and patients forming a partnership to tackle poor care concerns.

• Katherine Murphy is chief executive of the Patients’ Assocation

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