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Katy Meade: 'The link between understaffing and neglect must not be ignored'

The whole tone of the government’s response to the Francis report concerns me, says Katy Meade

Described as “a story of appalling and unnecessary suffering of hundreds of people” by Robert Francis QC, the Mid Staffordsire Foundation Trust Public Inquiry listed systematic failures at every level of the NHS. Findings of “corporate bullying” and “insidious negative culture” point to deep-seated problems that many will sadly recognise.

As a former nurse who now represents patients injured by negligence, I’ve seen failings in care from both sides.

While medical injuries are often caused by human error, wider problems, such as chaotic wards, understaffing, miscommunication or inadequate supervision, play a part in most of the cases I see. I suspect the link comes as no surprise to nurses. When I was nursing, staffing levels were at times so low that providing an appropriate standard of care was challenging and at times close to impossible.

I think many of the Francis report’s recommendations have the power to make fundamental improvements, but the whole tone of the government’s response concerns me. While several good recommendations are being adopted, much focus has wrongly been put on compassion training.

“Being exhausted, undervalued and under-supported with a high ratio of patients to staff can make it difficult to provide the care people are entitled to expect”

Compassionate nursing is vital but, in my experience, student nurses already have compassion. Low wages and exhausting shifts hold little attraction unless you’re passionate about looking after people. The real issue is what leads someone who is motivated by kindness to treat a patient with neglect.

Being exhausted, undervalued and under-supported with a high ratio of patients to staff can make it difficult to provide the care people are entitled to expect. The want of anything close to compassion evident in some of the cases at Stafford Hospital was truly shocking, and perhaps politicians felt they had to create a headline-grabbing policy to address this, but it cannot work if the root causes are ignored.

The other risk is that the government’s plans may deter people capable of becoming wonderful nurses. Spending a year as a healthcare assistant before beginning a nursing degree should in theory create understanding for the caring role of frontline staff. Yet, to be effective, those who wash, clothe and feed patients must all be shown more respect and experienced nurses must lead by example, which will only happen if time is freed up and they are supported themselves.

One thing with the power to spark real change is the duty of candour recommended by Mr Francis. This would legally require staff to tell patients when a mistake is made. Being honest with families would allow lessons to be learnt faster and drive up standards. In Staffordshire management ignored patients’ complaints while local GPs and MPs failed to speak up. If the very first complaints had been taken seriously a great deal of pain might have been avoided.

While health secretary Jeremy Hunt says a legal duty of candour will apply to providers it is not, as yet, being extended to staff. I wonder how trusts can be entirely candid when health professionals don’t have to be. Yet, even at trust level, duty of candour may help foster a more open culture, which can only be a good thing. It has the potential to transform the way complaints are dealt with and reduce legal claims, as many patients simply want to see their concerns properly addressed.

The Mr Hunt says he wants the Francis report to become a “catalyst for change” not a “byword for failure”. It’s a bold ambition and duty of candour can only help, yet minimum staffing, communication, supervision and proper support are all vital. Clearly finances are tight, but austerity is no excuse for ignoring the correlation between understaffing and neglect.

Katy Meade is a clinical negligence solicitor at Mayo Wynne Baxter

Readers' comments (33)

  • same old, same old.

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  • looks like the same old story.

    problems in healthcare eventually push for an enquiry

    publication of a report some considerable time later, which if significant enough will attract attention from the top politicians, Minister of Health and even the PM in some cases.

    attracts media attention and public outcry for a while

    it will be discussed by all of the above for some time and further problems may come to light

    a few recommendations may be discussed and even fewer may be acted up

    case is filed and forgotten about until similar or some related problems come to light again

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  • there could be lessons to be learned from some prominent whistle blowers

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  • I have never neglected my patients, like myself many hardworking,very experienced and very loyal staff strive to offer a really high level of care, problem is there are not enough staff to be able to do this. We are all getting really fed up saying the same thing over and over again - why isn't anyone listening to us.
    We want to look after our patients properly to the standard we expect ourselves - give us more of the right staff, the right equipment and the right support to do this please.
    How many more times do we have to say this.

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  • apparently not just a UK problem. Maybe interesting to see the experiences of nurses in other countries and how they are tackling it.

    Kaiser Health News

    Nurses Fighting State by State for Minimum Staffing Laws

    David Schultz
    Apr 24, 2013

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  • If you know that nurses are under pressure, the wards are chaotic and understaffed and that there is no money for nurses to do their jobs properly then why not address this to the government and the governing bodies.

    Nurses know they cannot do their jobs properly, we don't need to be told over and over again, what we want is people who have the power to change things to speak up on our behalf so that we can look after our patients safely and with the level of care we expect ourselves.

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  • Kate, what made you leave nursing and go into law?
    As an ex nurse and now a negligence solicitor do you think you could advise us how you think we can get the staffing issues sorted out once and for all.

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  • michael stone

    I pointed out ages ago, that the goverment was trying to side-track the issue of staffing levels, by pushing 'are nurses inherently caring'.

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  • Anonymous | 1-May-2013 10:46 am

    "....what we want is people who have the power to change things to speak up on our behalf..."

    Who might these "people" be?

    Anonymous | 1-May-2013 10:56 am

    Seriously? Asking a negligence lawyer for advice?!


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  • Anonymous | 1-May-2013 10:28 pm

    sounds like you are the man for the job!

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  • An ex nurse who now handles litigation cases might be able to help, why the 'jeez' reply?

    We have to ask for help wherever we can get it and many people seem to listen to lawyers rather than nurses. We need as many people on our side as possible.

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  • Anonymous | 2-May-2013 6:50 pm

    How about helping yourselves?! Like I said....Jeez!

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  • anon 8.56 - like someone else said, you sound like the man for the job, how can you help us.

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  • Anonymous | 2-May-2013 8:56 pm
    i hear your pain. nurses like the comment above only look for someone else to help them. it never occurs to them that they themselves could and should be taking measures to change the state of their own working conditions. if you are looking for them to be prepared to behave as a unified force to challenge eg understaffing? if you are looking to them to be prepared to back up challenges with the threat (and the intention) of effective action?.....then i would say that you'd be as well to move along and find a less self destructive profession to support. really. i'm sure you must agree that there is nothing to see here.

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  • tinkerbell

    I agree, there is nothing to be seen here. Move along. All concerns have been fantastically ignored.

    We have the power to speak up on our own behalf but won't use it.

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  • does that mean all is now well and there is nothing else to discuss?

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  • Anonymous | 4-May-2013 7:38 pm

    what do you think?

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  • Anonymous | 3-May-2013 8:00 am

    "...there is nothing to see here."

    tinkerbell | 4-May-2013 7:18 pm

    "I agree, there is nothing to be seen here."

    ? ? ?

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  • As a rat that left a sinking ship so to speak I got fed up with being called uncaring. As I had not been granted the powers of superman. It is boring covering the same old ground but it is frustrating seeing the headlines about uncaring nurses when you are working your butt off trying to do your best and receiving a negative response as it is only commented about what you didn't do not all that you did do.
    So I left as have many others who tried to do a good job.
    the wards that get all the flack are usually the understaffed medical/elderly wards with the most dependant patients and least staff how the general public/media cannot understand this I don't know.
    but yes this is covering old ground isn't it.

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  • You see nurses are a sitting duck. Nurses are very easy to blame:

    They never fight back
    They never explain to the public what is really happening on the wards
    The publuc have no idea what you actually do

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