Lack of support for nurses blamed for Mid Staffs failings

24 February, 2010 | Updated: 24 February, 2010 4:41 pm | By Graham Clews

The Robert Francis Inquiry says staff contributions confirm that there was a “pattern of sub-standard service delivery”, at Mid Staffs rather than isolated incidents.

But clinical staff at the hospital largely escape blame.

His report says that while some of poor care was due to unprofessional behaviour, “the overwhelmingly prevalent factors were a lack of staff, both in terms of absolute numbers and appropriate skills, and a lack of good leadership”.

Although staff did raise concerns with trust management, both individually and collectively, the poor response they received dissuaded more to report concerns.

But the report does accuse clinical staff of “accepting standards of care…that should not have been tolerated”.

Within the A&E department, the source of much criticism in previous reports on Mid Staffs, Mr Francis’ report says there was a lack of management, and both nurses and doctors felt there was inadequate leadership.

One consultant told the inquiry that nurses were “hung out” in the department, and “not supported”.

One A&E doctor said: “The nurses were so under-resourced they were working extra hours. They were desperately moving from place to place to try to give adequate care to patients. If you are in that environment for long enough, what happens is you become immune to the sound of pain.”

The report found that the lack of staff in A&E contributed to the situation highlighted in the HCC report where triage was provided by unqualified receptionists.

One advanced nurse practitioner, who had worked at the trust for a long time, told the inquiry that triage nurses were moved to other duties because a ‘see and treat’ policy had been introduced. But in fact that had not been put in place, so triage effectively stopped.

“Therefore the waiting room became full of patients who were not being assessed in any speedy manner at all and they waited regardless of their condition,” the nurse said.

Nurses told the inquiry of pressure to meet the A&E four-hour waiting target, with patients being moved out of the department to beat the breach without being fully assessed, and of subsequently being told to “lie” to make sure target breaches were not recorded.

More to follow.

Readers' comments (22)

Anonymous | 24-Feb-2010 1:15 pm
A whitewash of an enquiry set up by lawyers for lawyers.

A public independent enquiry needs to be held....and those who are accountable made accountable.

One question. Where were the nursing unions during all of this? Why didn't they respond to the complaints about care they were recieving? The RCN (and unison to an extent) are a shambles when it comes to this type of thing.

Over 400 deaths at the hospital during that time that estimates have said were probably avoidable. That is criminal. Corporate manslaughter charges should be brought against the chief exec and hospital managers.

Andy Burnham should do the right thing and hold a full independent public enquiry in to this.....if he wants to restore public faith in the NHS and himself.
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Simon Daubney | 24-Feb-2010 5:20 pm
This seems to be the way NHS heading in many areas (though hopefully not so extreme). Policy seems to overide people whether they be the patients or those trying to care for them.
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Anonymous | 24-Feb-2010 5:59 pm
it was inevitable that the cost cutting antics by each nhs trust/ Pct would result in such a negative outcome. It is now the norm for money to be trimmed away from the frontline services that need it most when the mid/higher tiers should have been targeted. Sadly, the NHS is nothing more than a business nowadays.
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Anonymous | 24-Feb-2010 8:24 pm
If this report had been about nursing in the private sector...yes the nurses would be hung out to dry even struck off....so why do the NHS get away with covering up their wrongdoing.....
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Anonymous | 24-Feb-2010 8:31 pm
The movement of patients to avoid the 4 hour breach is widespread. Even moving patients that require more intensive nursing to a facility that simply cannot provide it is commonplace in my experience. 4 hour targets are all management care about. Seemingly doesn't matter if the patient doesn't get their treatment or they're still in crashing heart failure, get them out before they breach.
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Anonymous | 25-Feb-2010 4:26 pm
Too often the problems lie in weak nursing leadership.
The fact is general management has devalued nurses and removed them from the decision making structures.
It is difficult for a nurse to report issues to lay managers who have little understanding of clinical roles and even less interest other than meeting the government targets.
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helen britton | 25-Feb-2010 4:36 pm
Yet again targets override patient care and nursing staff numbers. When will the government realise that the only effect that targets have is dilute patient care and place extra pressure on staff, consequently staffing levels decrease because nurses cannot keep up the pace and leave. We are all burnt out. Where are the unions in all of this why arent they shouting out and supporting us.
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Anonymous | 25-Feb-2010 10:10 pm
Anon 4.26pm. I agree completely. Nursing is now a lost cause as far as being in charge of it's own affairs.

Career desk nurses like Beverley malone are to blame and her cronies. They have about as much leadership capability as a boiled egg.
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Anonymous | 26-Feb-2010 8:10 am
Nurses are afraid to approach the NMC because of the blatant mis-management and self-absorbtion of that organisation. Failed and abused time and again by this monolith nurses struggle on without realistic support, but facing ever increasing pressures and risks. Nurses have to share the responsibility for poor practices and inexcusably bad care, but we need to drill down to some root causes, and the NMC would feature large in culpability.
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judith allen | 26-Feb-2010 9:24 am
Agree with everything that has been said. Certainly the RCN seems very quiet, but so to is the NMC (they are the regulator). NMC is apparantly investigating 1 nurse!!! is this the Director of Nursing (Which one) Mid-staffs had a few it would seem. Was anyone held to account, apparantly not. One point, Beverly Malone is no longer chief exec of the RCN it is Dr Peter Carter. Beveley Malone went back to America some time back.
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susan | 26-Feb-2010 3:16 pm
The NHS is highly bureaucratic , controlled by central government and top heavy with excessive management which can seem like an anonymous and over controlling policeman.
Professions like nursing are almost entirely based on compassion and a morale concience and concern for the service that is offered to the patient . Such all pervading centrally controlling systems soon begin to stifle innovation and nursing leadership needs this if it is to survive.
It appears that nursing lacks some forthright and committed leadership to challenge some of these overly managerial, authoritarian and bullying structures currently operating throughout the NHS who have nothing to do with patient care, but have a strong tendency to 'pass the buck'when things start to feel uncomfortable .

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Anonymous | 26-Feb-2010 3:31 pm
I know for a fact that the RCN were aware of the situation at Stafford and yet did nothing. It reminds me of my own situation years ago when I approached the RCN over dangerously low staffing levels. They seemed impotent then, it seems little has changed.
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Anonymous | 26-Feb-2010 4:02 pm
Wondered how long it would take for the bureaucrat managers to shift the blame to the frontline nurses at Stafford - didn't take them long to pass the buck did it ?
And it is shameful that other nurses are prepared to fire the bullets at these hard pressed staff -there but for the grace of god ?
Don't look to the NMC for support -they are incompetent
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Alicia Pridmore | 28-Feb-2010 11:08 pm
I left Mid staffs 5 years ago. Ward staffing was a travest then, no one seemed to address the number of incident forms that where sent in daily from a large number of wards. If ED needed a bed you have the right to refuse if you know that the level of care you can give due to staffing would be inadequate. This was over ruled time and time again by nurse leaders, the patient would be sent, therefore deal with it!
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Anonymous | 2-Mar-2010 1:25 pm
When Performance Indicators, unrealistic budgets and National Targets supersede basic nursing care and remove patients' and their relatives/significant others from the central focus, then this is a recipe for disaster.
Where does the 400,000GBP payoff fund come from?
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kathleen white | 2-Mar-2010 5:36 pm
Many of the above contributors ask where the unions were,during the bullying spree that left so many patients dead.

I can answer that question.

I raised concerns about poor care and bullying in 1999. The RCN that claimed to be representing me was in bed with management. Still accpeting my subscriptions !!!

I raised similar concerns in another trust in 2005. I approached UNISON for support. Quess what ?
Yes, Unison was cosy in bed with management.

That is possibly why the unions did nothing about criminal activity at Mid Staffordshire NHS Trust.
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Anonymous | 3-Mar-2010 11:53 am

The uk public deserve a public independent inquiry and staff nurses,doctors,matrons and managers and UNION reps brought to justice.

Accountability - the NHS did not demonstrate it, now what about our governement - are they too "immune to the sound of pain"

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Anonymous | 3-Mar-2010 5:29 pm
what surprises me is that patients are still happy to be referred to the hospital....
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Anonymous | 3-Mar-2010 7:16 pm
'When Performance Indicators, unrealistic budgets and National Targets supersede basic nursing care and remove patients' and their relatives/significant others from the central focus, then this is a recipe for disaster'
..is one thing, when they're wielded as a weapon for getting an agenda achieved whatever the cost, it's something different again. I think the thing that disturbs me most is the complete lack of insight and acknowledgement of the impact these policies are having, despite the loud voices of the nurses. It speaks more of something like a kind of psychosis in the management and government. Not something that can be easily reasoned with.
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Anonymous | 5-Mar-2010 6:05 pm
Matrons who want all the glory of being the head of profession but lack the professionalism and passion to do anything about staffing levels. They are resposible and should be made to answer for it. They were hired to ensure quality care, thats their job. No point just singling out the chief exec. Matrons & Managers - thats were we can safe money, get ride of those that have no evidence of doing anything about poor staffing.
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