'Immune to the sound of pain' - Why the lessons of Mid Staffs must never be forgotten

27 February, 2010 | By Gabriel Fleming

The NHS is still reeling from the catastrophic care failures uncovered at Stafford Hospital. Beyond the Bedpan has one question - what now?

The frank conclusions of the Robert Francis Inquiry into care failings at Mid Staffordshire Hospitals Trust were felt far and wide this week.

Hospital managers bore the brunt of the criticism. Staff shortages and a lack of leadership led to chaos in the A&E department, with one doctor saying nurses were forced to work extra hours and “were desperately moving from place to place to try to give adequate care to patients”. The results were predictably dire: “If you are in that environment for long enough, you become immune to the sound of pain.”

Others pointed to a slavish commitment to the four-hour target, leading to 96 complaints about inappropriate discharge from patients who were effectively sent home before they were ready or well.

Nurses were not blameless. The attitude of some “left a lot to be desired”, the inquiry heard. Examples of patients being left in sheets soiled with urine or faeces make painful reading for all concerned.

The outrage and recriminations will continue. But the million dollar question (not to be confused with the departing chief exec’s £400,000 pay-off) is simple: how can we make sure this does not happen again?

The latest from a Nursing Times survey suggests that 20% of nurses think the serious care failures at Mid Staffs could happen where they work. Whether fair or not, nurses themselves will shoulder a lot of the responsibility for making sure they do not.

We may not be the problem, but we can be the solution. Nursing is the single most powerful force for improving patient care in the NHS. When things go wrong, will you do something about it?

Readers' comments (36)

Sandra Robinson | 27-Feb-2010 10:07 am
My mother-in law was recently receiving care at a hospital in the centre of Manchester, and I feel that there are many similarities between there and what I have read of mid staffs. She was admitted last year for oral surgery and the state of the place appalled both myself and my sister-in-law (who had travelled over from New Zealand ). I never once saw a clceaner woorking on visits although as a nurse myself always passed cleaners in corridors whilst on shift. The hospital and this ward in partiucular were filthy, and my sister-in-law actually cried at the thought of leaving my mopther-in-law in this place. She was quite recently re-admitted with c. diff amongst other things and the infection control that we wiitnessed was facical, and also the administration and prescibing of pain relief was disgusting. We are talking about a lady that had been requiring paracetemol, ibuprofen and was currently trialing Tramadol to try and control her pain. This was explained in detail to both an SHO and a consultant on admission. Yet when I returned to visit her in ICU the following week,the only pain relief she was receiving was paracetemol!! and she was in agony. I am a qualified nurse and Health Visitor and could argue for more pain relief, but the fact was that she had been there for a week and must have been in agony for most of that time. I must admit this made me feel ashamed to be a nurse and a member of the NHS. What would have happened if I was just a member of the public who would not know what to say and do to elicit more medication. I am in the process of composing a strong letter of complaint to this hospital which I will present through PALS. I know this is not an isolated incident as I have heard since of one family (where ther were NHS workers as relatives) that actually moved there relative due to these appalling conditions. I feel as a nurse that the cleansiness of some hopitals has become worse since domestic staff were employed under contract and not under the auspices of the ward, we will face more cuts (by the look of it) in future, what is to become of our patients then?
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Anonymous | 27-Feb-2010 11:08 am
I have been a nurse for 20 years and dont believe this hospital is an isolated case. Nursing has changed over the years and I would argue that this drive by the RCN and NMC to produce a degree led highly academic nursing force is ruining the care of our patients. I think training and CPD is vitally important but nursing is a caring hands on profession and we are sadly moving away from this.Yes now we have nurses who can research,reference and write a brilliant essay to get them all the credits they need so all the paper work we are bombarded with is perfectly done but unfortunately the care is worsening and I think we will be hearing of more trusts in the same position.
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Anonymous | 27-Feb-2010 12:03 pm
RCN / BMA strangely quiet about this catastrophic failure - and it's not a systems failure - why were nurses and other professionals unable to go public with this abuse? When was the last time you sat down with your manager to talk about your job? Mentorship? Do you recognize leadership qualities in your managers? The NHS is anachronistic employer - it doesn't care about it's workforce, why should they care about their jobs?
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Poh Lin Teh | 27-Feb-2010 12:13 pm
Nursing has indeed changed through the years. I was trained in UK 40 years ago and I must say training in those days were good. Nursing is a practical job and getting a degree in a Uni has nurses intolerant to patient sufferings and also unwilling to soil their hands. This is not a UK problem but a worldwide problem. We are facing similar situation here in Malaysia.
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Anonymous | 27-Feb-2010 1:45 pm
It wont be long before this happens in the hospital I work in
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suzannah hobley | 27-Feb-2010 2:10 pm
I feel comments about the state of nurse training are irrellevant here...

when nurses are given far too many patients to look after, do not have appropriate senior supervision and are working outside of their speciality, (as the report higlighted was the case for most of the nurses in that hospital) care standards will suffer seriously.

This will happen regardless of whether the nurses were trained in the old manner or not, and those people who choose to blame the individuals are shortsighted, every one of us could find ourselves in this sort of situation if we were in those working conditions.

I simply cannot understand why the nursing unions (who clearly had been made aware of the conditions by some those involved in the inquiry) did not get involved immediately and publicly when concerns were raised - they have effectively left their members to shoulder the blame.

We should be using this enquiry as a springboard to highlight the fact that unsafe nurse/patient ratio's are a national problem - otherwise in the current climate of money saving, many more of us might find ourselves in this type of sitation.
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Anonymous | 27-Feb-2010 2:42 pm
I was recently, unexpectedly, admitted to a large local teaching hospital. I was dismayed at the lack of care I received, particularly in the A&E department. I was bleeding and distressed and was astonished that some of the medical staff were alot more caring than the nursing staff who seemed to have little time to provide any comfort or explanation to me. I only ever saw a nurse when I had to call because I was bleeding again (they came and then left me alone) or if my IV ran out or for the drug round. I was in hospital for a week and felt very weak and unable to fully care for my own hygiene and was never offered any assistance.
It saddens me that this is what has become of nursing care. The care element seems to have gone to a large extent. As a lecturer in nursing, I can only educate, support and encourage my students in aspects of care and showing compassion to patients. The rest is up to them and where they are working. With such a lack of staff, how can things possibly change?..and no, I do not want the government to spend millions setting up another body to look into this. We just need to train and employ more nurses! It's basic common sense! There's been enough money wasted on various management structures that are then dismantled and never fully achieve what they set out to do!
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Anonymous | 27-Feb-2010 3:38 pm
I agree with the comments about staffing levels. During my training (only a year ago) I was told the DH's own recommendations were 1:8 nurse/patient ratio for the lowest dependency patients. This is the best ratio you will ever get in my hospital outside HDU/ITU and my ward frequently has higher dependency patients. When this becomes the norm it doesn't matter how loud you shout, nobody listens.
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Anonymous | 28-Feb-2010 2:00 am
As you walk on to a ward you hear the bleating bleep-bleep-blong from several IV pumps that have discharged their duty and are waiting for attention. Like the patient beside them. But the bleating is likely to go on all night while nurse-call buttons go unanswered. Imagine being a patient.

Imagine a nurse answers a call, and goes back to the nursing station. "No 6 wants a bed pan". "Oh, make them wait." Said in a stage whisper so that the patient can hear. Or "Tell them to go in the bed, someone else will change it in the morning". The patient remains like that until they have a visitor 18 hours later.

Imagine a bed-bound patient who can't move much. Now imagine a nurse wants a bed pan for another patient. Oh, I'll just take the one off his table, I'll replace it. But of course they forget, so he tries the nurse-call, which goes unanswered as usual. The result can easily be imagined.

Back to the IV pumps, oh it wasn't empty. And the piggy-back antibiotic is till there next morning. What to do? Force it in through the venflon? Never mind that the reason the pump stopped was blockage. Most of the antibiotic goes outside the vein. THe patient also gets a PVT and needs 9 months of warfarin treatment after discharge. Silly. Their operation was a success, but nursing care failed them.

Yes, staffing level was a problem, and to be fair, a few of the nurses and all the HCA's did their utmost to help patients. But the majority did not. Meanwhile complaints were rewarded by even worse "treatment." Does this sound familiar?
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Gana Davis | 28-Feb-2010 8:58 am
Dear Po Lin Teh and the person who commented above, I think unfortunately you have seen the few nurses that 'don't want to get their hands dirty or be empathetic', the majority of us however went into this job and endured 3 years of (yes still) tough training whilst holding down families, p/t jobs etc..so we know first-hand what caring for people truly is.
I realise these are observances seen sometimes-but even more unfortunately one episode of bad practice outweighs 10 good ones.
Overall, all of the trainee nurses from my cohort really did and do care alot for their patients- to the point that they would risk a 'bad mark' on their placement to stand up for ill-treatment of patients by certain staff.
Personally I think the way forward is to annually 'vet' staff, not by the usual pen and paper ticksheet standards but by their character and how well they do their job..I feel appraisals seem to be failing at this and staff are being kept on for the wrong reasons when other, more caring staff could be doing those jobs alot better.
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Margaret Stuart | 28-Feb-2010 8:25 pm
I don't believe training nurses to degree level should be demonised for the appalling care given to patients and relatives at mid staffs or anywhere else in the NHS. Most nurses, be they qualified or HCA's, would want to provide the best care they can, wouldn't they? Or am I looking at our profession through rose tinted glasses?

Standards of care have most certainly deteriorated over the past few years and I believe this to be due to the NHS target driven philosophy. The NHS is a business which needs to compete for contracts and bring in revinue, that's an accepted part of life, but in our haste to get patient's through the doors are we providing the fundamental basic needs? I think not.
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Charlotte Peters Rock | 28-Feb-2010 8:54 pm
There are claims in the other comments, that nursing is a 'profession'. In that case, why don't these 'professionals' act in a professional manner?

Where nursing conditions, and patient conditions, are intolerable, why are few nurses brave enough to act in the patient's interest, and whistleblow?

Why, when a nurse does act as a whistleblower, do none of her 'professional' colleagues support her by refusing to allow the Trust's legal people to bully her out of her job?

Is it because of the mortgage, the food, the fear of being sacked? If so, then such nurses are not professionals, and should be downgraded, to the status somewhere beneath caring people, such as cleaners and tea dispensers.
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Margery Mary Hawkins | 1-Mar-2010 2:51 pm
Lack of care is not new. All these things happened occasionally in 1956-59 when I trained (won't say where). Most student nurses were kind and conscientious (they were the workforce in those days), but some were horrors on the sly.
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Anonymous | 1-Mar-2010 6:52 pm
Ms Hawkins - thanks for that, it is encouraging to hear that it's not only recently things seem to be not that great!

There will always be the odd horrible wretch who you have to work with - when it gets really bad, I hope the furthest I have to go is to have a few words with said horrible wretch in private (if we ever get the time!), I accept you have to risk a lot and blow the whistle if things get beyond this, but the evidence for what happens to those who speak out brings on a cold sweat (there's a lot of evidence in the literature!)

What I want to know is, why has no one who was in charge at the time, and paid a huge salary to reflect that responsibility, been taken to court? I think the board should face prosecution for the pressures put on (staff cuts for example), I guess we will never know, but surely that could be corporate manslaughter of those 400 or more patients?
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Eddie Newall | 1-Mar-2010 11:01 pm
When Andy Burnham, Secretary of State for Health, was asked why the ex-Chief Executive wasn't being held to account, he replied that he was 'ill'. Doesn't that say it all? When the shit hits the fan it never seems to reach the boardroom or polititians.
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Beth Young | 1-Mar-2010 11:05 pm
Too many patients help!
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Anonymous | 2-Mar-2010 11:31 am
recently i underwent surgery at a local hospital. the anaethesist was very kind and considerate explained what was to happen and so forth - the anaethesist on three seperate occasions presented himself to me and offered reassurance and information. the opd nurse was also very friendly and pre-operatively provided good care... however the consultant and the nursing staff on the recovery ward left a lot to be desired... their irritation at my pressence was noticable and i was told if i was not off the ward they would place me in a departure area till someone could collect me... this was less than 18 hours after major surgery and i was bearly able to mobilise and was still very off due to the pain relief... i wonder who comes up with these protocols for removing patients from their bed as it is at that time to somewhere wholly unsuitable till they are collected. as a nurse i am delighted to be of service to the patients i serve i think its high time that medical and nursing staff remember what they are being paid for and who is paying them - I pay massively into the tax system surely like everyone else who requires care art entitled to a kind and generous tone and attitude when they feel most vulnerable...
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marilyn binks | 2-Mar-2010 12:54 pm
I have to agree with much of what has already been said.
I am a junior sister at an acute trust in the North East where they have just announced the closure of up to 150 beds in a bid to save 6.5 million just to stand still! They have frozen nurse vacancies but are still advertising for managerial roles and other jobs at band 8 and 9!. We are overun with modern matrons who pass on all of their work to the ward based staff.
It wont be long before the bed closures hit home and they come running onto the wards shouting for discharges because the wards are heaving with acutely ill patients.
The ward based nurses are overworked and stressed, sometimes running wards by themselves without a break, but the management only seem to care about reaching their targets and impressing the quality control commision (they are nice to us when their visit is due). They dont care that the nurses are frequently abused because thre media constantly portray us in a bad light. They just care that the job gets done so they can reap the financial rewards. The NHS is dying and has been for a long time.
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Anonymous | 2-Mar-2010 1:08 pm
What happened to leadership, Accountability and Responsibility and the Code of Professional Conduct? Have these nurses (including the managers) forgotten the very foundation of Nursing and what about Patient Advocacy and good old 'common sense?'
Where are the modern matrons and senior nurse managers? Do they not flloor-walk to monitor the wards and departments within the remit of their responsibility? If the answer is no, then how can they possibly justify being paid the elevated salary they recieve to fulfil the role?
More importantly, what are they doing that is so much more urgent that managing basic patient care standards?

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Anonymous | 2-Mar-2010 3:41 pm
I am absolutely sick to death of hearing the usual whingeing about degree qualified nurses not caring! It is absolute tosh and probably comes from those too thick to obtain a degree.

It's quite possible to be uncaring and not have a degree as well!

There is no excuse for a nurse to be uncaring. Compassion is crucial to the role.

Extrenuating circumstances don't help. Chronic understaffing, chronic underfunding and yes Dr's who don't care (and there are plenty of them within the NHS and hospitals). . . . .plus successive govts who couldn't run a corner shop never mind the NHS.

Some of you are like a stuck record banging on about degree nurses...give it a rest please.
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