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Mid Staffs trust used 60% HCAs

A skill mix of just 40% nurses and 60% healthcare assistants was introduced at Mid Staffordshire Foundation Trust to plug a £10m funding gap, the inquiry has been told.

Sharon Llewellyn, complaints manager at the trust from 1998 to 2009, told the inquiry the skill mix was worse on wards that cared for elderly patients and just two matrons covered both of the trust’s hospitals.

The inquiry heard that employees had raised incident forms in relation to staffing levels. Levels improved after Helen Moss took over as director of nursing in 2006.

Readers' comments (7)

  • Sounds about right.

    Hire more HCAs as cheap labour, never mind that they are not trained staff! Let them do a few clinical tasks anyway, it will save some money won't it? Patient safety, why bother? It'll save money to hire more HCAs and less Nurses! Death rates going up? Never mind, blame the Nurses anyway!

    An example of typical management 'thinking' (and I use that term loosely!)

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  • absolutely. i can see another crisis happening here. have they learnt nothing. i pity any patient having to be nursed there

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  • As someone who may be labelled as "one of those managers" I took part in a similar scheme that looked at upskilling the HCAs and I have to say that when we targeted specific areas for this sort of initiative it did rather well. A&E in particular benefitted in terms of waiting times as less severe cases (as identified by RN led triage) could be dealt with by HCAs who had been trained in observations, venepuncture and even ECG observations (not interpreting results obviously). HCAs need to have an appraisal and PDP in place before they are trained for these duties, so there is a system of support and management in place beforehand.

    Upskilling has been going on since nurses started taking on those roles traditionally associated with junior doctors, it isn't really a case of who carries out the intervention assuming they are trained, capable and competent, but also about the management and supervision, as well as the ability to learn from mistakes to ensure that they do not happen again. It is not just a people failure - but a system failure that allows standards to drop and remain low.

    By the way, don't nurses have the right to speak up about standards of care being compromised etc? As a profession have we learned nothing from the likes of Graham Pink?

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  • The elderly are unimportant and have no priorities - just leave them in a corner and give them a minimal of basic care – they don’t need so much attention and the financial and staffing resources are needed elsewhere. Don't worry that they need more staff to help them with basic living skills they can no longer perform for themselves which can be as simple as reaching for a drink or feeding (not to mention getting to the toilet on time - the rest doesn't need to be spelled out - or does it?) - no matter they are just old and confused - there is no time to listen to relatives or friends, if they are lucky enough to have any, who wish to inform staff that they are not normally confused. Visitors can really get in the way and don't know what they are talking about anyway (no wonder some become aggressive with frustration at not being listened to and at seeing their relative getting such poor care) - but then. almost too late, for some patients light may dawn and there is panic and an urgent need for action to restore their fluid balance maybe with iv fluids which requires trained staff (but where are they? those present may be rushed off their feet and have little time to deal with this urgent priority!) - but more trained nurses and ancillary staff would result in even more of a drain on the already, so-called ‘tight’ financial and staffing resources and would be all more costly in the long run, but then leaving aside compassion and human decency - cost cutting measures and false economies may have priority in some areas where staff are not heeded by non-clinical management, who naturally know best as that is what they have been trained for!
    Assistance and support for the elderly to enable them to maintain their dignity and quality of life, whilst enabling them to continue doing what they can do for themselves and offering them company and comfort or a professional team as well as physical and mental stimulation are luxuries which of course are not to be trifled with on a state healthcare budget!

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  • continuation of above

    Please do not let it be fogotten that these venerable elderly have also contributed their share to society and many are parents and grandparents and could even be one of yours and have the same right as everbody else to the highest quality of tailormade care to fit every one of their healthcare needs in order to live a fitting a fulfilling ending to their life in the dignity they deserve.

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  • Anon 11:53
    Graham Pink was sacked for whistleblowing. So was Dr Rita Pal. This is the NHS response to those who try to raise awareness of poor/dangerous practice. Is it any wonder that clinical staff try to bury their heads?
    As for "upskilling"...I have no problem with HCAs being trained to improve their caregiving...phlebotomists in clinics are generally Band 2 or 3 anyway. The problem arises when they are "trained" to try and meet a target-viz in ED (as quoted by yourself). Fair enough they can do an ECG and basic obs but these will still need to be acted upon by either a doctor or an RN. If you have ratios of nursing staff that mean less RNs and more HCAs, then the system falls down. The patient will still "belong" to an RN and once the ECG/obs are done, if they show anything (lets say an MI) then the RN needs to start treatment....if she has 15 other paptients then this treatment will be delayed.....who is going to carry the can? The RN has a PIN, the HCA doesn't. Ah, but the targets have been met, its all down to poor nursing care. Hmmmm.
    Finally
    Stafford will be the tip of the iceberg....other trusts will not be far behind as they struggle to cope with less money and fewer clinical staff. Nobody is listening to us. Why is it that other firstworld countries can provide safe staff ratios and the UK cannot? That will be because they listen.

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  • The over dependance on HCA's / Nursing Assistants has been aroundfor decade.......however we are trying to kid ourselves with terms like 'upskilling' and 'career enhancing' etc for this group.

    Within my organisation (Mental Health) HCA's outnumber trained nurses on wards dealing with suicidal / acutely ill individuals.

    Even our PICU at night is one trained nurse and 3 'Support Workers'........a bit like the open prison that recently got burned down !!!!!

    Why do we tolerate this ??

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