Lord knows, the NHS may be up against it – and this Trust perhaps more than most – but I am continually humbled by the quiet and determined way that all the staff at Dewsbury and District Hospital, Pontefract Hospital and Pinderfields Hospital go about providing care and support in the face of what must seem at times like overwhelming odds.
The Trust and its staff have to work in a challenging environment. In the area covered by the Trust, the overall health of the population is below the average for England. Deprivation is higher than average, and nearly 20 per cent of children are living in poverty. Life expectancy is lower than the national average for both men and women.
Two weeks ago, I met the Trust’s new interim chief executive with my colleague Joe Cox (Batley and Spen MP). We were both very grateful to him for his candour. He told us that the leadership team has effectively been in crisis mode for the past 14 months. He said that the trust had recently put in an additional 120 beds across the Trust to cope with increasing demand, but the 100 extra staff who should have accompanied that expansion are nowhere to be seen. The posts simply have not been filled.
The Trust aims for a ratio of one nurse to every eight patients on adult in-patient wards. The Royal College of Nursing recommends 6.7 patients per nurse on adult wards as a maximum, so one to eight is not too far wide of the mark, though not ideal. However, the Care Quality Commission found that even the one-to-eight ratio was very inconsistently met.
During its unannounced visit to Pinderfields Hospital in August, of the 17 wards only one was staffed to safe staffing levels. Ten were at minimum level and six were actually below the minimum. Indeed, records show that in August 2015 only 71 per cent of nursing hours were achieved. Staff on the Trust’s spinal injuries unit at Pinderfields are constantly reallocated to other wards, in essence robbing Peter to Paul. A nurse even told a patient that because they were so short-staffed, if two patients got into respiratory difficulties, which is not uncommon on a spinal injuries ward, the nurses would have to choose which patient they were to save.
When looking at such statistics, we have to be very careful to remember that each number – each percentage point – represents real people. They are people who may be in pain, or vulnerable, worried or nervous. They may be upset or distressed. By any reckoning, the NHS is our nation’s most prized institution, and when people have to make use of it, they rightly expect a certain level of service.
NHS staff want to give that level of service, and when they cannot the result is more than just a delay in treatment – the dignity of patients is also compromised.
A few weeks ago I received an email from one of my constituents. Her 84-year-old father had been admitted to Dewsbury Hospital with stroke-like symptoms. He was on a trolley in A&E for 14 hours. After he had been admitted to a ward, his daughter came back to visit him. She found that his bed was a complete mess and covered in food, and her father was naked from the waist down.
When she asked why he had on only a pyjama top and was sitting on an incontinence pad, she was told that it made it easier when he needed to urinate. When she came back later that afternoon, his bedding had still not been changed, which in the end she did herself. That is a basic outline of one case, but it is by no means the only such correspondence that I have received from concerned constituents. At the moment I receive similar emails more than once a week, which is alarming.
All that, of course, has an inevitable knock-on effect on staff motivation. The amount of disciplinary action being taken against staff has risen in recent months, which is generally due to staff making minor mistakes or not being able to follow procedures through fully for want of time. That is a symptom of the shorthandedness that has been experienced on the wards, and it contributes to the general air of despondency as staff are effectively penalised for not being able to be in two places at once.
I have written to the Secretary of State (Jeremy Hunt) and the Minister has kindly agreed to meet me and other concerned MPs next month to discuss this in more detail.
However, we are in danger of forgetting the lessons learned from the Mid Staffordshire situation about the absolute priority that must be given to safe staffing levels. Unless we can crack this by getting the qualified staff we need, no amount of reorganisation will make up for poor care.
Paula Sherriff is the Labour MP for Dewsbury who spoke in a Commons debate on Mid Yorkshire Hospitals NHS Trust. This is an edited version.