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Capital rated worst for nursing by patients

Patients in London hospitals say they receive worse quality nursing care than those in the rest of the country, analysis of the latest NHS inpatient survey has revealed.

Compared to other trusts, hospital patients in the capital tended to have less confidence in the nurses treating them and were less likely to be satisfied with dignity levels and communication skills.

Results from the 2012 NHS inpatient survey were published last week by the Care Quality Commission.

It included four questions specifically on nursing factors – asking whether patients received answers they understood to important questions; were talked in front of by nurses as if they were not there; had confidence in nurses treating them; and whether there were enough nurses on duty to provide care.

Nursing Times has received a breakdown of the results from the CQC, which shows the hospital trusts that scored significantly better or worse than the national average for these questions.

Of the 20 trusts in the worst five performers for each of the four nurse-related questions, more than half (12) were in London.

All of the trusts rated as the five worst for patient confidence in nurses were in London.

Barts Health Trust and Ealing Hospital Trust were both rated as significantly worse than average for three of the questions on nursing.

A spokeswoman for Barts said: “We greatly value patient feedback because it enables us to know when we are doing well, but also when steps are needed to make improvements.

“Dedicated teams are working hard to support staff across the new organisation to ensure consistently high standards of nursing care in every area and our values are also incorporated in our appraisal process.”

A spokesperson for Ealing said: “Three questions related to nursing have worse than expected scores, however, each of the questions has improved scores compared to the 2011 survey results which would indicate that progress is being made.” 

Meanwhile, Croydon Health Services Trust and Barking, Havering and Redbridge University Hospitals Trust were rated in the bottom five for two of the four questions on nursing. 

Zoe Packman, director of nursing at Croydon Health Services, said: “We are all focused on the quality of care patients receive and we are investing in additional nurses as part of £6.8m of planned improvements. This will help us to deliver high quality patient care and experience and is part of our ongoing commitment to steadily improving our services.”

Barking and Havering’s chief executive Averil Dongworth said: “These results are disappointing, but not unexpected. The survey was carried out in July last year, during a challenging time for the organisation as we worked hard to embed improvements in patient care.

“It is important to note that, while we still have a considerable way to go, there have been improvements in many important areas.”

The only nursing area where patients did not mark down London trusts significantly more than other areas was staffing levels.

Weston Area Health Trust faired worst when patients were asked patients whether there were “enough nurses on duty to care for you in hospital”.

A trust spokeswoman said: “We are pleased to report that we have already addressed this matter through a review of nurse staffing.”

The review concluded the trust needed 36.5 whole time equivalent nurses as well as more healthcare assistants and an out-of-hours sister. The trust is investing £1.7m in the additional staff.

The other trusts identified as “significantly worse” than average for staffing levels were Bradford Teaching Hospitals FT, the Queen Elizabeth Hospital King’s Lynn FT, Croydon Health Services Trust and George Eliot Hospital Trust.

Gwyneth Wilson, director of nursing at the Queen Elizabeth Hospital, said: “We recognise that in some areas our staffing is stretched and this has been particularly noticeable through the exceptionally long winter.

“In general terms we have been finding it difficult to recruit sufficient numbers to fill our vacancies and we have undertaken a skill mix review. Our board has agreed to invest a further £400,000 to improve our ratio of registered to unregistered nurses and to ensure our ward sisters are supernumerary and can therefore supervise staff.”

A spokeswoman for Bradford Teaching Hospitals FT said: “Although the survey’s findings are based on a small response rate of 37% we are keen to receive feedback from patients and we hope that, in the future, we will get a better response to this survey.”

Meanwhile, a statement from George Eliot said the trust “working hard to ensure our nursing workforce is equipped to provide the highest standard of care to our patients”. The trust has invested £1m in its frontline nursing over the past couple of years, recruiting an additional 32 nurses, it added.

Except for staffing levels, the only other trust outside London that performed significantly worse than average for one or more of the nursing questions was Heatherwood and Wexham Park Hospitals FT

The best performing hospital trusts across all four nurse-related factors in the survey were specialists. Among those significantly better than average, the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust in Bath was rated top in all four areas.

The trust’s chief executive Kirsty Matthews said she was grateful for the “hard work and dedication” of her staff.

Both the Christie Foundation Trust in Manchester and Clatterbridge Cancer Centre Foundation Trust were rated in the top five in all fours areas, and Liverpool Heart and Chest Foundation Trust appeared in the top for three areas.

Only two non-specialist hospital trusts were rated in the top five as significantly better than average for any of the nursing factors – Northern Devon Healthcare Trust and Poole Hospital Foundation Trust.

Overall the survey results revealed improvements in the results since last year in questions asked about nurses.

The majority of respondents said nurses “always” answered their questions in a way they could understand – 70% up from 66% in 2011 – and did not talk in front of them as if they were not there –81% up from 78% in 2011.

In addition 76% of patients “always” had confidence and trust in nurses, compared with 74% in 2011, and 59% said there were “always or nearly always” enough nurses on duty to care for them in hospital – up from 58% in 2011.

However, there was a decline in scores for some factors linked to nursing. Of those who used the call button, there had been a decrease in the proportion saying that it was responded to “right away”, from 15% in 2011 to 14% in 2012.

In addition, 70% of respondents who experienced pain, said that staff “definitely” did everything they could to help control their pain, down from 71% in 2011.

Jane Cummings, NHS England’s chief nursing officer, urged hospitals to do more to tackle variations in the way patients perceived their care.

She said: “The NHS must get it right every time for every patient. This survey is, on the whole, encouraging and demonstrates progress in key areas. However, there remains too much variation in the quality of care provided and hospitals need to look closely at what they need to do to improve.”

 

When you had important questions to ask a nurse, did you get answers that you could understand? 
Significantly worse than average:Significantly better than average:
Barts Health TrustRoyal National Hospital for Rheumatic Diseases FT
Bradford Teaching Hospitals FTThe Christie FT
Ealing Hospital TrustNorthern Devon Healthcare Trust
Heatherwood and Wexham Park Hospitals FTPoole Hospital FT
Barking, Havering and Redbridge University Hospitals TrustClatterbridge Cancer Centre FT

 

Did you have confidence and trust in the nurses treating you? 
Significantly worse than average:Significantly better than average:
Barts Health TrustRoyal National Hospital for Rheumatic Diseases FT
Royal Free London FTLiverpool Heart and Chest FT
Ealing Hospital TrustThe Christie FT
Barking, Havering and Redbridge University Hospitals TrustPoole Hospital FT
Croydon Health Services TrustClatterbridge Cancer Centre FT

 

Did nurses talk in front of you as if you weren’t there? 
Significantly worse than average:Significantly better than average:
Barts Health TrustRoyal National Hospital for Rheumatic Diseases FT
Bradford Teaching Hospitals FTLiverpool Heart and Chest FT

North Middlesex University Hospital Trust

Patients in London hospitals say they receive worse quality nursing care than those in the rest of the country, analysis of the latest NHS inpatient survey has revealed.

Compared to other trusts, hospital patients in the capital tended to have less confidence in the nurses treating them and were less likely to be satisfied with dignity levels and communication skills.

Results from the 2012 NHS inpatient survey were published last week by the Care Quality Commission.

It included four questions specifically on nursing factors – asking whether patients received answers they understood to important questions; were talked in front of by nurses as if they were not there; had confidence in nurses treating them; and whether there were enough nurses on duty to provide care.

Nursing Times has received a breakdown of the results from the CQC, which shows the hospital trusts that scored significantly better or worse than the national average for these questions.

Of the 20 trusts in the worst five performers for each of the four nurse-related questions, more than half (12) were in London.

All of the trusts rated as the five worst for patient confidence in nurses were in London.

Barts Health Trust and Ealing Hospital Trust were both rated as significantly worse than average for three of the questions on nursing.

A spokeswoman for Barts said: “We greatly value patient feedback because it enables us to know when we are doing well, but also when steps are needed to make improvements.

“Dedicated teams are working hard to support staff across the new organisation to ensure consistently high standards of nursing care in every area and our values are also incorporated in our appraisal process.”

A spokesperson for Ealing said: “Three questions related to nursing have worse than expected scores, however, each of the questions has improved scores compared to the 2011 survey results which would indicate that progress is being made.” 

Meanwhile, Croydon Health Services Trust and Barking, Havering and Redbridge University Hospitals Trust were rated in the bottom five for two of the four questions on nursing. 

Zoe Packman, director of nursing at Croydon Health Services, said: “We are all focused on the quality of care patients receive and we are investing in additional nurses as part of £6.8m of planned improvements. This will help us to deliver high quality patient care and experience and is part of our ongoing commitment to steadily improving our services.”

Barking and Havering’s chief executive Averil Dongworth said: “These results are disappointing, but not unexpected. The survey was carried out in July last year, during a challenging time for the organisation as we worked hard to embed improvements in patient care.

“It is important to note that, while we still have a considerable way to go, there have been improvements in many important areas.”

The only nursing area where patients did not mark down London trusts significantly more than other areas was staffing levels.

Weston Area Health Trust faired worst when patients were asked patients whether there were “enough nurses on duty to care for you in hospital”.

A trust spokeswoman said: “We are pleased to report that we have already addressed this matter through a review of nurse staffing.”

The review concluded the trust needed 36.5 whole time equivalent nurses as well as more healthcare assistants and an out-of-hours sister. The trust is investing £1.7m in the additional staff.

The other trusts identified as “significantly worse” than average for staffing levels were Bradford Teaching Hospitals FT, the Queen Elizabeth Hospital King’s Lynn FT, Croydon Health Services Trust and George Eliot Hospital Trust.

Gwyneth Wilson, director of nursing at the Queen Elizabeth Hospital, said: “We recognise that in some areas our staffing is stretched and this has been particularly noticeable through the exceptionally long winter.

“In general terms we have been finding it difficult to recruit sufficient numbers to fill our vacancies and we have undertaken a skill mix review. Our board has agreed to invest a further £400,000 to improve our ratio of registered to unregistered nurses and to ensure our ward sisters are supernumerary and can therefore supervise staff.”

A spokeswoman for Bradford Teaching Hospitals FT said: “Although the survey’s findings are based on a small response rate of 37% we are keen to receive feedback from patients and we hope that, in the future, we will get a better response to this survey.”

Meanwhile, a statement from George Eliot said the trust “working hard to ensure our nursing workforce is equipped to provide the highest standard of care to our patients”. The trust has invested £1m in its frontline nursing over the past couple of years, recruiting an additional 32 nurses, it added.

Except for staffing levels, the only other trust outside London that performed significantly worse than average for one or more of the nursing questions was Heatherwood and Wexham Park Hospitals FT

The best performing hospital trusts across all four nurse-related factors in the survey were specialists. Among those significantly better than average, the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust in Bath was rated top in all four areas.

The trust’s chief executive Kirsty Matthews said she was grateful for the “hard work and dedication” of her staff.

Both the Christie Foundation Trust in Manchester and Clatterbridge Cancer Centre Foundation Trust were rated in the top five in all fours areas, and Liverpool Heart and Chest Foundation Trust appeared in the top for three areas.

Only two non-specialist hospital trusts were rated in the top five as significantly better than average for any of the nursing factors – Northern Devon Healthcare Trust and Poole Hospital Foundation Trust.

Overall the survey results revealed improvements in the results since last year in questions asked about nurses.

The majority of respondents said nurses “always” answered their questions in a way they could understand – 70% up from 66% in 2011 – and did not talk in front of them as if they were not there –81% up from 78% in 2011.

In addition 76% of patients “always” had confidence and trust in nurses, compared with 74% in 2011, and 59% said there were “always or nearly always” enough nurses on duty to care for them in hospital – up from 58% in 2011.

However, there was a decline in scores for some factors linked to nursing. Of those who used the call button, there had been a decrease in the proportion saying that it was responded to “right away”, from 15% in 2011 to 14% in 2012.

In addition, 70% of respondents who experienced pain, said that staff “definitely” did everything they could to help control their pain, down from 71% in 2011.

Jane Cummings, NHS England’s chief nursing officer, urged hospitals to do more to tackle variations in the way patients perceived their care.

She said: “The NHS must get it right every time for every patient. This survey is, on the whole, encouraging and demonstrates progress in key areas. However, there remains too much variation in the quality of care provided and hospitals need to look closely at what they need to do to improve.”

The Christie FT
Ealing Hospital TrustClatterbridge Cancer Centre FT
Heatherwood and Wexham Park Hospitals FTPapworth Hospital FT
Were there enough nurses on duty to care for you in hospital? 
Significantly worse than average:Significantly better than average:
Weston Area Health TrustRoyal National Hospital for Rheumatic Diseases FT
Bradford Teaching Hospitals FTLiverpool Heart and Chest FT
The Queen Elizabeth Hospital King’s Lynn FTThe Christie FT
Croydon Health Services TrustClatterbridge Cancer Centre FT
George Eliot Hospital TrustPapworth Hospital FT

Readers' comments (2)

  • Unfortunately, I am not surprised. This confirms the knock on effect from the 80's when standards at the London hospitals outstretched those in the District General Hospitals. Money was diverted from the London hospitals. I do not have a problem with the principle of improving standards then or increasing budgets but the problem was, that it was just about money... money taken from London and given to the provinces but the overall standard fell to a mediocre level instead of improving the provinces to the standard of London hospitals. On top of that, differences in nurse education (which hopefully, at last is being addressed), from practice based to non-relevant academia, together with the rising costs of living and working in London (despite London weighting), the difference in cultural and age related attitudes to society and caring in general, has led us to this situation. Add lastly the stress caused by rate of admissions and lack of beds, it is hardly surprising that the nursing staff cannot cope all the time. 12 hour shifts have not helped with continuity of care and tired nurses who also work bank shifts to make ends meet could also be a contributing factor. I could go on as this is multi factorial and nothing new. I am at a loss as to what to do as I have highlighted exactly these issues to my managers who have blindly ignored them up until now and I was just told that my 'standards are too high for anyone to achieve'. What a put down and insult. How come I can attmept to achieve them? Suddenly, of course, after Mid Staffs most of what I have already been trying to improve is now flavour of the month but in a 'headless chicken' type of way. Still trying to paper over the cracks to appear trouble free. It is so depressing.

    Unsuitable or offensive?

  • My daughter stayed overnight at a London hospital and she was looked after superbly


    We are really, really pleased by the service we received

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