NMC considers action against nurses as trust admits 'embarrassing' care failures

3 December, 2009 | By Dave West

The Nursing and Midwifery Council is considering action against nurses and nurse leaders at Basildon and Thurrock University Hospitals Foundation Trust in response to reports of poor care standards.

The NMC will carry out an inspection at the trust later this week, which it says will be only the second of its kind, and could also result in the trust being stopped from taking trainees.

A Care Quality Commission report leaked on 26 November said it had found blood-stained curtains, a lack of privacy for patients, soiled mattresses and equipment past its use-by date. Three days later health information firm Dr Foster reported the trust had an unexpectedly high death rate in 2008-09.

In a statement on Thursday the NMC said it had asked the CQC, Dr Foster and foundation regulator Monitor for their evidence that “patient safety may have been compromised due to poor nursing or midwifery care”.

NMC chief executive and registrar Professor Dickon Weir-Hughes said it would then decide “what appropriate courses of action should be taken”. The NMC confirmed this could include fitness to practice cases.

The regulator will inspect the trust on 11 and 12 December and check whether it is providing “a quality learning environment for nursing and midwifery students”. The NMC said the only comparison was an inspection at the North West London Hospitals Trust in 2005 which was prompted by a damning Healthcare Commission report on its maternity services, and resulted in trainees being removed.

An NMC spokesman said: “What has alarmed us is that people from all levels have come to us [since the news reports] and said, ‘We have known there have been problems for months.’ Why didn’t they come forward earlier?”

Meanwhile, Basildon and Thurrock University Hospitals Foundation Trust director of nursing Maggie Rogers has defended the trust. She said the reports did not reflect general standards at the trust. However, she said the problems found by the CQC should have been reported to senior staff by nurses or others.

Ms Rogers told Nursing Times: “There were senior staff who should have escalated that further. That would have been part of their role.

“We rely on the staff and teams to escalate anything they are not happy with because they essentially accountable. There is no doubt if anybody had escalated that level of hygiene deficit we would have acted on it.”

Reporting those conditions was a “joint responsibility of facilities staff and clinical staff”, she said.

Ms Rogers said she had been working to increase nurse numbers at the trust and make sure the mix of experience and skill was right. But she said: “We have been embarrassed by what the CQC found and have learned a very embarrassing lesson.”

Readers' comments (46)

Anonymous | 3-Dec-2009 7:17 pm
So after sitting on its hands throughout the Mid-Staffordshire revelations and then trying to shoot the messenger at Brighton and Sussex the NMC is at last creaking into action – albeit slowly. Perhaps they’re worried that if they get to Basildon and Thurrock too quickly the Trust won’t have had sufficient time to smarten up their act leaving the NMC with a difficult decision to make!

As for Maggie Rogers (Dir Nursing) reportedly blaming her staff for not escalating problems upwards, she might want to ponder why this is so. What is the culture like at Basildon and Thurrock? Is it a ‘learning organisation’ with a ‘no blame’ ‘my doors always open’ ambience, where staff are supported in raising and dealing with issues that compromise care? Perhaps not. Of course the other way Ms Rogers could have found out about what was going on in her organisation is by leaving her office and going for a look. Given the shock the top team seem to be experiencing one can only assume that she and her fellow directors stayed locked in their offices during the CQC inspection?
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Anonymous | 3-Dec-2009 10:27 pm
I worked as an auxiliary nurse at a hospital in Essex (not Basildon) several years ago, and was horrified to see the abject neglect of many elderly patients. Thirteen patients in the geriatric wing died in one weekend, and the barrier nursing of MRSA-affected patients was almost non-existent. Many of the staff were dishevelled and downright lazy, and expected the auxiliaries to do all the answering of patients' requests for attention. A lack of funding was NOT responsible for this situation; the nurses' attitudes were.
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sue low | 4-Dec-2009 1:04 pm
So maggie Rogers blamed her staff for the inadequacy of service!, what had she been doing ? Leadership involves knowing what your workforces doing and setting a standard.
I do not believe that all nurses were lazy and uncaring but what I do believe is that unless those in charge understand their workforce and the demands put upon them we shall continue to have horrifying issues like this occuring
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tim hartley | 4-Dec-2009 2:50 pm
All I can say is 'bring back traditional training and it's core values' and reinforce the basic skills into people who do not know 'how to care'.
It's just a pity that the NMC could not have taken a different approach to how it dealt with Margaret Heywood.
Sadly we have too many blame cultures now.
Tim Hartley
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Anonymous | 4-Dec-2009 3:20 pm
Perhaps the date has been set so far in advance so that the NMC will have time to put their own house in order before setting out to point the finger.
It's about time nurses started demanding their rights i.e. support from managers and stopped letting politicians set up even more qangos to tell us what we already know.
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Anonymous | 4-Dec-2009 5:47 pm
I was an in-patient recently at Basildon after a CVA, and the care was patchy. Initial triage assessment in A and E was very competently done, post-admission assessment was done by a Clinical Support Worker while a colleague chipped in with flippant distracting remarks. I told the flippant one to get lost. Patients fare much better if they are assertive, and even better if they know what to ask for.

I thought that many of the nurses were ageist: I'm 71 (still practising until the stroke) and almost every nurse called the older people in the ward "mate", "sweetheart" or "young man".

Although doctors were uniformly adult in their conversational approaches to me, most trained nurses answered my reluctant queries or requests from the end of the bed, or the middle of the bay, sometimes over their shoulders, and in a voice so that everyone could hear - the commonplace "sing-song" voice that British nurses tend to use by default when addressing their public. Such a careless response doesn't encourage one to ask for anything, at least it didn't encourage me.

Apart from doctors, the most sensitive and courteous communicators were the Polish domestic staff, an African student nurse, and a male Ward Manager who I called to complain about the plight of helpless old people in my bay who weren't helped to take a drink, or food left on their lockers for hours at a time.

Older confused patients (there were lots) are not sympathetically or skilfully handled. I heard many insensitive comments made by nurses and by Clinical Support Workers to very sick people who were not able to make much sense themselves, again this was often done in a raised voice, as if to convey an attitude of "See what I have to put up with?" to anyone and everyone within earshot.

It's also very true that nurses don't make themselves easily available to patients in bed, and don't answer the patient-call system promptly. I was staggered when I eventually managed to shuffle my Zimmer down to the toilets to see so many nurses at the nurses' station.

On the whole, I'm grateful for the overall attention I got in hospital, but many of the nurses were not as thoughtful and respectful as the doctors, pharmacists, and radiology staff I met, and tended to defensiveness if asked questions. this was particularly true of the senior nurses (although it's hard to distinguish who is who, except that the more senior staff are much less accessible, except at the nurses' station, it seems).
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Anonymous | 4-Dec-2009 8:29 pm
I despair! Poor care is not acceptable but neither is putting the boot in for colleagues, behaviour needs to be challenged and changed but that includes all healthcare professionals. As nurses we all know how hard one voice is to be heard over many. Group think goes on and it is behaviour that needs to be challenged. Blaming is not going to change the culture but looking at what has allowed this to happen and what will help it change will. This needs to be from top down. however I imagine this may not be the case. What a sad sad case for all, patients and staff
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Anonymous | 4-Dec-2009 10:02 pm
It's not blaming anyone, or putting the boot in, to point out how I felt when I was ill and vulnerable in hospital, with rapidly progressive bulbar neuro signs, and with the thought I might die within 24 hours, not contradicted by my doctors, I should add.

I more or less staggered across the ward on a walking frame to try to help a cot-sided bloke, semi-conscious and with obvious cerebral irritation, who was trying jerkily to get a feeding cup to his mouth. I managed to get a straw in it and held it to his mouth so he could get a few swallows, he was parched. Apart from myself, no-one gave him a drink for ten hours.

In such circumstances it's very hard to challenge nursing behaviour (how?), and it ought not to be necessary to try from your sick-bed. Nurses are trained to be reflective (I thought) and that means challenging yourself at the most basic level of motivation. Having a bit of insight and noticing what's going on, what you're doing.

The culture starts (and finishes) with what lies between the ears of every individual. No need for despair, I reckon, but it's important to listen to what we're told.
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Anonymous | 5-Dec-2009 7:28 am
Regrettably this is a reflection of the culture we are living in! It is people like Maggie Rogers, the Dir Nursing, who is never easily accessible, and then tries to blame others. Mrs Rogers have failed to take responsibility for her contributions to the problem. My experience is that it is difficult to report such incidents to directors etc., due to the "chain of command" in reporting procedures. The Directors are not accessible. I sent many emails to my previous manager regarding health and and safety, and infection control issues, and retained copies of the emails, that compromised the care of the babies. Very little was done and the clinical director never visited the unit. I became so frustrated and disillusion that I left the unit and I am now working in Research.
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Anonymous | 5-Dec-2009 2:49 pm
I think that nurses seem so unavaliable due to the fact there are so few of them. There are very very few nurses out there that I think would knowingly give bad care (whilst i do know sadly there are the odd few). Low staffing levels has been a fundemental issue in giving poor care for years and everybody knows this what shocks me is that everytime these reports are leaked is that people are suprised its not new news the NHS needs more nurses! Finally in defence of Mid Staffs the NMC did decide not to take action however many other people did and no other trust so far has been subjected to the rubbish that those nurses have and are still suffering now and still holding their head up high and doing an excellent job.
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Anonymous | 5-Dec-2009 10:13 pm
BLAMING THE NURSES??

Why is it that nurses are blamed all the time.

Where were the managers, where were the directors and matrons - certainly not on the floor or they would know about the incidents.

At our place of work, we are all stressed and having to cope with fewer nurses because the managers have been told to make cuts.

We try our best to keep the standards but in the end, I can see the nurses all stressed out.

I think that the people who make the rules or change things should spend a minimum of three months on the floor beside a nurse, doing the same duty and no slacking or rest just like us. We do not even have a break because we are so busy.

The NHS is going down believe it or not and NOT DUE TO THE STAFF.
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Anonymous | 5-Dec-2009 11:02 pm
As a close friend to a nurse that works in Basildon A&E I would like to ask Maggie Rogers some querstions.

Why does she always lay the blame at the feet of nursing staff, when there are long delays in Basildon A&E ?

Why does she lay the blame with A&E, when patient's go over this 4hr target when there are on beds in the hospital ?

I am reliably informed that when this happens the staff still have to keep taking patients form the ambulance crews when there are still paitents waiting to go to the MAU ward so they have to look afetr all the patient's.

It would apper that the trust arehappy to contunie to uas agency staff even thought they they are very expensive rether than use there own staff and only pay them the very minimum overtime rate. But according to the national news papers Maggie is still willing to accept her recent very large pay rise.

Has the Trust considered that by using such high numbers of agency staff may be one of the reasons for the high mortiality rate that DR Foster keeps reporting in the papers.

Has Maggie ever though the poor standards of hygiene and cleaning in A&E that the papers talk about may also be related to this as their own staff run around doing 3 and 4 jobs at a time, i have seen this with my own eyes having been a patient in A&E at Basildon.

When you have 5 or 6 agency staff with limited skills on a shift, does she not think that this will have adverse effects on patient care and her staff's welfare ?

It would appear that this trust is more concerned about the goverment's 4 hour targets (deadline) than actual patient care or the health and wellbeing of it's staff.

As for "escalating up", how does Maggie explain that when A&E staff asked for a new mattress for a trolley they wated for weeks but when the CQC came in they had 30 in 6 hrs.

I would ask Maggie to look again at the A&E situation and rather than apportion blame to the nursing staff try to support them and visit the department once in a while to show said "support" and you will see what i and meny others see nursing staff run off their feet !!!

Since the publication of the CQC report A&E have had visits from members of the public with cards giving staff their support.

I would like to ask does the press get given this information (the good news) or as usal do we just get to read the bad news. But i do know that the staff in A&E are very greatful to the members of the public that have sent good luck and thank you cards.

I would also ask Maggie to read the comments made above by others on this page and notice that there are NO comments made re Basildon A&E therefore, her dislike and lack of support for the nursing staff on A&E does not appear to be the opinion of others.
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Martin Gray | 7-Dec-2009 9:48 am
Lot of valid issues raised in this thread. Firstly the nurses and care staff ARE to blame - but no more so than the domestics for not doing their jobs properly (no doubt because of an ever increasing work load and the expectations of their employers), the HCAs and junior nurses for not providing the basic levels of care and courtesy expected by all and for which they are being both trained and paid, the senior nurses for not tackling these problems at ward level and fighting the management to get them resolved, the managers and directors for NOTdoing the jobs they are (overpaid) to do and spending precious time attending numerous meetings that prove to be pointless and unconstructive except to generate MORE meetings.

To summarise - THEY ARE ALL TO BLAME; and that is true in every hospital!

Nursing wants to regain its professional standing with the public instead of chasing academic equality with other professions. Are solicitors well respected? Not if you hear what most peole have to say about them - and they charge over £100 an hour. Hospital doctors do not get as well remunerated as GPs except for those that have the ability to take on private work (mainly consultants - except those working in A&E as there IS no private work in that specialism).

Change HAS to happen, whether we like it or not, but that change appears to be at the cost of forgetting the very essence of nursing care. Not one body or organisation seems to be using any common sence in looking at the faults in the arguments for and against degree level entry.

I agree with returning to some of the old methods of training; it would allow entry to those that WANT to be nurses and weed out those not suitable; it would also allow each and every nurse to achieve the academic and specialist level they can and only be limited to their own individual capabilities and ambition.
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Anonymous | 7-Dec-2009 12:31 pm
The government is to blame!!! There is not enough funding for the NHS to adequately cover for the amount of nurses, Healthcare Assistants and equipment needed to do the job safely and adequately. Because of trusts getting foundation trust status, they move more towards running the hospital as a business and managing their own budget and then start cutting staff and equipment to save money. That means that staff become overworked in difficult conditions, morale is low, they become stressed, more staff go off sick, which means staff shortages, and some even leave. All of this will certainly affect the levels and standards of care given on these wards and so it is the government and the people at the top with their big salaries that are to blame!!

Nurses are trained to care and be compassionate in their profession. The NMC codes of conduct is drilled into them for 3 or 4 years by the training institutions and then they find it difficult to implement those values into practice because of the conditions they encounter at these trusts. Nurses are not to blame to start off with because they go into a caring profession to care and not to abuse or make money. It is the people at the top who are making the cuts and not managing budgets effectively that are the cause of the problem!
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Anonymous | 7-Dec-2009 9:22 pm
I was in A & E at Basildon for a few hours and both I and my wife, both nurses with very very long experience totalling over 90 years, were very impressed by the very calm atmosphere there (it was pretty busy) and the way staff there moved about and communicated with each other without fuss, and effectively. A young male cleaner moved about constantly looking for things to pick up and tidy away. It's not a huge department and quite squeezed for space but it seemed to operate smoothly and there was care at hand for everyone, including two very emotionally distressed and restless patients who were managed skilfully and with tenderness and good humour. Just a "thumbnail sketch", but please bring it to the attention of the managers if you want to.

I don't think there's a hospital in the land where you couldn't find a bit of concealed grime, it's in the nature of hospitals for people to leak and excrete, however hard you try to keep on top of it with wiping and mopping. Hospitals don't ever close down for spring cleaning (they used to in the 1950s and 60s but the occupancy and turn over was a tiny fraction of what it is now) so staff are fighting a losing battle against dirt, and always were. Basildon Hospital wasn't as clean in 1980 when I worked there (for six years) as it is now, it's a huge improvement in every way. I don't think there are many people at Basildon who knew it then, but I certainly do.
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Anna Lincoln | 7-Dec-2009 11:55 pm
@ Martin Gray,

Martin I have seen many of your comments on this site, and frankly they are upsetting. I have been a senior staff nurse for 12 years and have extensive work experience in the NHS, the USA, and Canada. I have worked on general medical wards in all of those places.

I have very recent experience working on an NHS ward in England.

If you don't have extremely recent experience on the wards then you don't really understand what is going on. Really you don't.

NHS managers are intentionally starving the wards of trained staff at a time when patient acuity is sky rocketing. The patients we take on general wards now would have been in HDU/ITU a few years ago. These are people who will die if they do not get one to one care and monitoring....but their nurse has 14 other patients! They have extensive IV meds/ drips etc. The amount of information you have to know about each patient would fill volumes.

On today's wards you also have many many elderly, confused and dependent patients. Medical wards are like 25 % ITU and 75% EMI. That means that the staff nurse, who is probably the only trained nurse on duty cannot leave her sickest patients to attend to the basics without killing someone. This is the situation trained nurses are finding themselves in when they show up for work. Management has resorted to just hanging up on us, and ignoring our pleas. Why should they change? It is obvious that they could leave one nurse to cover 1000 patients across the whole hospital by herslef and people would still blame that nurse and describe her as lazy and uncaring when call bells went unanswered.

Anything more than one RN to 4-6 patients causes patient mortality to skyrocket. It skyrockets. NHS wards are staffing these wards with 1-2 RN's to something like 35 patients that are much more acute and complex than what you remember. In the USA and Canada we were never allowed more than 6 patients per RN. And we had ward clerks to answer the phones and a senior charge nurse on duty on the ward to coordinate and protect us from interruptions. NHS nurses do not get this. They are absolutely overstretched...they do not go more than 30 seconds without interruption. They have to spend so much time at the nurses station ordering drugs, equipment by filling in forms and faxing them etc drugs and equipment needed to keep their patients alive. If they refuse to do it and run around bed bathing instead they will be held responsible for someone's death. That is a fact. They have to page doctors for hours before they can get one and nurse gets the blame if the patient has a bad outcome. They have more IV drugs due than they could take the time to obtain ,prepare and administer during the course of their shift. During the 20 minutes they have at mealtime to feed all of their patients who require feeding they find themselves running between 3 critical patients, taking admissions, giving life-saving drugs and the phone ringing non stop, with only themselves to answer those calls.

I will not hear a bad word said about NHS nurses (and I am Canadian). British nurses are going through hell. They cannot do their job as a result of ward conditions not lack of caring or training. They need nurse ratio laws in this country or nursing care will continue to fail. Violently so.

And by the way the more highly educated a bedside nurse is, the higher the patient survival rates are. It's been well researched.

I know nurses who have won compassionate care awards and nurse of the year awards across the pond They would refuse to work in the NHS because they know that having to take on that many patients means that no matter how hard you work your patients will be neglected and you will be blamed. They refuse to take on any more than 4-6 patients. They just won't. NHS nurses have no choice. Google international council of nurses staffing ratios or california nurse patient ratios.

I had a man collapsed in a room with a pulse of 35 yesterday. When I went running down to that room with the drugs he needed visitors and patients shouted after me for all sorts. I had to run past them and get to the collapsed man. But in their minds I am just running past them because I can't be bothered. They do not understand the situation and neither do you.

People really need to knock it off with the "oh yes the wards are horrible because the nurses need to learn compassion and caring " Statements such as that just give management a green light to divert funding away from the wards.
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Anna Lincoln | 8-Dec-2009 0:09 am
Oh and British nurses are some of the most compassionate, caring, and hardoworking that I have met. And we do learn about compassion, caring, and basic care in very academic training programs.

Too bad we cannot demonstrate what we know because of ward conditions.
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Martin Gray | 8-Dec-2009 9:58 am
Anne, I'm sincerely sorry you have found my comments upsetting - no maliciousness was intended I can promise you; I fully accept that, not having worked on hospital wards for many years, I do not have first hand experience of what is happening.

However, in my defence, I have made my opinions based on the posts made on numerous threads and on what I have gleaned from the media. That, unfortunately, is what people do; it is a fact and one which you need to take into consideration before aiming your anger at myself. I am only trying to voice what others may feel but not made known.

We all know where the main problem lies and where blame should be placed - in the management eschelons of care provision. However, and again please don't take this the wrong way, nurses cannot avoid having some of the blame laid at their feet; perhaps it's the potential results of whistle-blowing or being deemed 'militant' that prevents care staff from standing up to management; and that management may well, in turn, be afraid of exactly the same results so there is no progression and senior management never get to really appreciate the extent of the problems and their consequences. I certainly don't see how my comments can be interpreted as giving the 'green light' to management!

Nurses have, to my knowledge, never made any significant stand; indeed, as a profession, we rely on the hope that our concerns will be heard and action taken while we continue to provide the care to patients. Sadly, even criminally, our voices are quashed - even by our unions and the NMC. What do you think would be the effect if nurses and care staff DID go on a full strike? Not in areas where nurses are keeping patients alive using the technology available ( ITU, HDU, special baby units, dialysis, etc...) but left the basic essential care to others? The 'others' would be family and friends, not trained staff and certainly not management. Do you think we would get the public on our side and stop having the detrimental view of nurses as those portrayed on TV programmes such as 'No Angels', 'Casualty' and 'Holby City'?

I am not the only person that has attacked the nurse training methodology in use at present; it is voiced throughout many threads. I do add my voice to any debate and encourage further debate; you have now made it clear how you feel and I'm sure many agree with you.
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Anonymous | 8-Dec-2009 3:53 pm
Like Martin says, the problem is that people are basing their arguments on what they read or hear in the media. They will naturally have a biased view of what is happening because they have no insight into what the conditions are for nurses at present or what their role entails. But for people like you who have a connection with nursing but no recent or present experience of what it is like to work on the wards now, you should know better! You should not be trying to voice what other people say just because it is there on forums or threads etc. That is whay THEY do but not what you should be doing. Your opinions can not bear water when it is based on subjective knowledge and not experience. The media thrive on isolated incidents of nurse neglect or hygiene and will froth at scandals involving whole trusts and the impression projected to the public is that nurses are bad and evil.

Anna Lincoln is right to be aiming her anger at you because you should know better!
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Anonymous | 8-Dec-2009 10:23 pm
What type of leader will blame her staff withour clearly accepting personal responsability first? Its a mess and it stinks.

Look at the amount of comments where the writer is not prepared to be clearly identified. What does this tell you about the support and leadership from the Nursing leaders at Basildon Hospital?

Fundamently the Director of Nursing must accept personal responsability first before she tries to blame others.
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