'Full' hospitals treating patients in non-clinical areas

9 March 2010 | By Dave West

Patients are routinely being treated in areas of hospitals not designed for care, a Nursing Times survey has revealed.

Nurses are being asked to treat patients in store rooms, mop cupboards, wards that are already full and, in one case, a kitchen area.

In a Nursing Times survey responded to by more than 900 nurses, nearly two thirds said patients at their hospital were being treated in areas not designed for clinical care.

They highlighted threats to safety including patients having no access to call bells, water and suction facilities, missing emergency equipment, risk of infection and fire exits being blocked.

Patients’ privacy and dignity is often compromised and nurses say the situation makes it harder to provide good care.

Of those nurses who had seen the practice, nearly 60 per cent said it happened more than once a week. Two thirds said patients were left in the areas for more than 12 hours – for some the areas are used for days at a time.

A majority said it had happened at their trust for at least a year.

Video

Nursing Times editor Alastair McLellan speaks about the survey (Press Association)

One nurse said patients had started describing an area normally used to store linen and equipment, where beds were being put, as an “overspill car park”.

One said: “There is little room around the three beds and it would be difficult to get a crash trolley into any of the beds. There is no privacy, no oxygen and no call bell.”

Just 3 per cent said nurses were asked whether they agreed with the area being used. Eighty-three per cent said they had raised it with senior nurses or managers but, of those, only 4 per cent said it had then been stopped.

They were commonly told that all other space was full, accident and emergency was under pressure, the move was authorised by senior managers, or the A&E waiting time target was at risk. They were told there was “a temporary capacity issue”, “the hospital does not close its doors” and “unfortunately the hospital is full”.

A small number said complaining had resulted in bullying, being accused of “not being a team player” or told the issue was “none of your business”.

One nurse said: “I carried out a risk assessment on my ward which showed this was a very dangerous and high risk practice, but it still continues as I am told there are just no other beds available and the instruction has come from the chief executive.”

Another commented: “I was advised to find a more appropriate patient for the extra bed, as the bed was needed, and if I couldn’t find a patient then they would.”

NHS South Central chief nurse Katherine Fenton told Nursing Times: “Directors of nursing should be visiting areas and forbidding this kind of practice. This type of practice is always unacceptable.

“You have to make sure that your processes through the hospital are lean and that you are getting patients out at the other end, as you are bringing the right ones in through the front door.

“If you haven’t got good senior management, and this is not just about nursing, you don’t get those fundamental processes sorted out.”

The Department of Health said: “It is for local healthcare commissioners and providers to assess the services needed locally to meet the demands of their population.

“However, every nurse must comply with the standards, performance and ethics outlined in the NMC code. In particular, any nurse who is concerned about any risk to their patients should report their concerns to their manager, in writing if necessary.”

Readers' comments (16)

Anonymous | 9-Mar-2010 10:17 am
One morning in the 1980s I walked onto my male surgical ward to find an extra bed squeezed in. The curtains were drawn around and behind them was a young women with a suspected miscarriage. As the ward sister I raises hell for the next twenty minutes, phoning the on call manager for the hospital at 6.50am, contacting the senior doctor from A&E and the senior surgeon on duty. Within 20 minutes the problem was resolved. The point is that I was enpowered to take action about an issue that was clearly wrong. Hand power back to ward sisters, educate them to think, make logical arguements and take responsibility for thier clinical area.

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Anonymous | 9-Mar-2010 1:44 pm
In the mid-1990s, my husband developed a very rare and life-threatening condition. After 2 years of chemotherapy, he volunteered to take part in a research project, involving monoclonal antibody treatment, at first as an inpatient and later as an outpatient.

The outpatient visits required us to travel over 100 miles to the hospital, each time. His treatment was delivered to him as he sat in a tiny room, surrounded by boxes, files, paperwork and general junk. I asked whether there was not a more clinical room available and was told "you should just consider yourselves lucky that you've being given any room to sit in, so I wouldn't complain if I were you or you may regret it."

I never complained again. My husband was in no condition or position to complain.

So much for care.

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Anonymous | 9-Mar-2010 4:57 pm
With the rising costs of Healthcare, and with the lack of funding Healthcare, institutions are resorting to time managed care. I as a nurse have chosen to remove myself from such situations as I can not practice under a process and situations that require me to jeopordize patient care, and cross the ethical barriers that hold me liable to my ethical beliefs.
I recently, left a job that believed that they were doing a service to the patients by processing them through the Emergency Room within One Hour from the time they entered the door to the time they were discharged. Nurses were not allowed to ask the patients any questions, or do an assessment on them until the physician saw the patient (There were times that patients sat in a room for thirty minutes to an hour, bleeding, in acute asthmaticatus or vomiting) assessted them and gave orders it wasn't until then that the nurse was allowed to do an assessment, and most of the time it was assessing the patient and discharging them and providing them discharge instructions which I felt was constdered to be "backwards nursing" I was embarassed to function in this manner, and felt that if this was the case why bother to pay nursing staff to hang around. There were times that I was called into managements office and repremanded for doing patients assessments before the physicians examined the patients, as "I was not following the process, that patients were not there to see a nurse they were there to see the Physician not a nurse!" so I quit. Why should I stay at a place that doesnt need me, when other places are in need of nurses.
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Mark Procter | 9-Mar-2010 6:04 pm
This is nothing new. Back in 2002 my father's heart was operated on in the ward at Manchester Royal because the operating theatres were full. The damage done from MRSI eventually killed him.
We didn't find out until my father tried to prosecute, that they had left a broken needle inside him in the first operation.

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Anonymous | 9-Mar-2010 7:07 pm
It all comes down to this...

The population is rising exponentially, and so are the number of patients as a result.

Yet the idiots at the top think it is a great idea to cut the number of beds in hospitals, make hospitals into 'polyclinics', and try and turn every bay into 1 bed side rooms.

Idiots.
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Anonymous | 10-Mar-2010 8:39 am
The headline in our local paper last week was that the local hospitals are to lose 9 wards in the next few months.

Perhaps they will re-open them as "cupboards" when they find they need more space for patients ...
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Anonymous | 10-Mar-2010 1:10 pm
i raised issues as fire exits were being blocked yet they still sent more & more pts to meet the 4hr target. Saftey went out the window, god forbid if there was a cardiac arrest the trolley wouldnt have gotten through anyway. I was told it was nothing to do with me even though MY fire escape was blocked!. Patients were needin commodes who were lined up the middle of the ward as all the beds were taken (in the old nightingale style wards) pts were running out of o2 in their cylinders as there were no o2 points. I had to leave that post as i got bullied to hell for whistle blowing. I really didnt know what else to do i asked for feedback from my accident forms but received none
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Roger Hodgson | 10-Mar-2010 3:20 pm
Quote from the Leicester Mercury 5 March 2010

http://www.thisisleicestershire.co.uk/health/wards-close-Leicester-s-hospitals/article-1887929-detail/article.html

Nine wards to close at Leicester's hospitals Friday, March 05, 2010, 07:51

Hospital managers are to close nine wards within the next few months, it has emerged.

It follows news that two wards at Leicester General Hospital are due to merge, probably by the end of the month.
Managers at the University Hospitals of Leicester NHS Trust said it is too early to say which wards will close or when it will happen.

They have denied that moves are all to do with cost cutting.

Julian Auckland-Lewis, deputy director of operations of Leicester's hospitals, said: "As a hospital we adapt to the needs of our patients and we need fewer beds in the summer than in the winter.

"Over the coming months we expect to close around nine wards. "It is too early to say where they will be but will happen naturally as staff leave or retire."

Staff at the city's three hospitals are being urged to consider taking unpaid leave from a few weeks to a number of years.
Unquote.

They are closing about 300 beds yet manage to deny that it is for cost cutting reasons... what next? Treatment by Credit Rating?

The NHS has finally developed into an accountant driven business.

Just a couple more years of New Labour and we’ll be transported back to 1947.
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Anonymous | 10-Mar-2010 3:30 pm
BTW this survey is reported in Pulse GP magazine. The GP's are listening!
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Anonymous | 11-Mar-2010 8:29 am
Its happening everywhere
We are told 3 medical and 3 surgical wards and 'some' main theatres are closing. Our local population is growing. number of admissions is increasing year on year. we opened an extra escilation ward and a half this winter - which is still open - but yet we can close wards ??? Oh - and dont forget the politicians are saying there is more money for the NHS - not less as the CEOs are saying ?? GPs & PCTs dont just listen - DO SOMETHING
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Anonymous | 11-Mar-2010 5:13 pm
Managers, nursing directors, lead nurses and matrons need to be a visable presence on the front line. It is time they rolled up there sleeves and earned the money they are paid. They need to see what is going on in our hospitals. We will be topping and tailing patients at this rate! More front line staff are needed not managers for managers!!!!!!!!!!!! The wards need to stay open people are not being treated in the community there is only funds to pay managers to manage paper shuffling not caring for patients. Government bodies need to wake up vast amounts of public money is being wasted on incompetent hospital managers who never come in to contact with patient care and are paid so much that when they are ill they can go privately.
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Anonymous | 11-Mar-2010 7:00 pm
I echo and agree with the other comments here. I live and work in the west country where bed numbers have been desimated over the last few years, always with the mantra that they are no longer required as people get treatment and care nearer home!! Utter tosh, its money pure and simple - good care is a side effect not the true aim! Year on year lack of capacity is a major problem - hence patients without bed spaces. The winter pressures are now a year long problem, but still we are fed the same old rubbish. I just wish some of our managers would stand up and say enough is enough...but that is a risky stance to take as they only want yes people in this arena.
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Anonymous | 12-Mar-2010 1:23 pm
As a senior nurse it pains me to repeatedly voice my concerns, and yet I may as well talk to a brick wall.

I complete endless incident forms and yet to no avail. There is not a cyclical process where they communicate back to you, infact I can honestly say I have never had feedback and reassurance that my concerns are being listened to.

There is little room to voice my many concerns today, but to name a few:

The four hourly waiting list in A&E exists to please those who have no hands on clinical experience it would seem. I can pinpoint an extreme case whereby an A&E sister highlighted a late referral to the surgical assessment unit. She described a patient having possible epigastric pain. The constant inappropriate referrals lead me to speak to the oncall registra to confirm if they had accepted this patient. He happened to be in surgery at this point so I was left to liaise with the A&E sister. However, he had made clear that under no circumstances was this patient to be accepted to the unit until her bloods were available, as he believed she was infact not suffering from abdominal pain. That said, the A&E sister remarked "tough, she is on her way now, so deal with it". This patient came to the ward and shorlty after her bloods came back which gave a clinical picture that she was suffering an MI at that present time. Her PC did not echo the symptoms that were described by A&E staff. It was added by the A&E sister that the A&E consultant had agreed the patient was to go to SAU. It appeared that this patient was not infact treated as a patient, and instead of getting the prompt treatment she needed, A&E seemed to be concerned with the 4 hourly waiting time only.

The repeated strains put on the nurse in charge is hard to deal with. For an acute admissions ward, the unit is inappropriately equipped, often meaning little access to oxygen (2 access points for 6 patients). The opening of inappropriate assessment areas leaves every patient nursed or assessed vulnerable with no call buzzers/oxygen or even privacy. Yet time and time again complaints are heard but not investigated or changed.

It will be interesting to see that from the survey where 900 nurses voiced extreme concerns, if anything will be done to increase the safety of patients and nurse them in the ways intended.

It leaves me no option but to move on from the ward that I work. Often being left with limited staff and thus an increased risk of disaster is something I do not want to be apart of. I will with any power I may hold fight all the way.

We should be caring for patients not putting them at risk by closing wards and subsequently re-opening them with minimal resources.

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Abel | 12-Mar-2010 2:00 pm
I would suggest you to read the report from the Economist Intelligence Unit ‘Doing more with less’. Three extractions:

o Total healthcare spending in the UK reached £136bn in 2008, compared with £60bn a decade earlier.
o “Some will find quite quickly that they aren’t achieving big enough savings, and are dropping on quality and patient satisfaction and waiting times”.
o Such policy statements amount to a “quick initial hit”, according to Professor Maynard. “But the quality issues are really quite significant because if you start to cut people’s pay, you may affect motivation and affect treatment.” But one area where money might clearly be saved, he argues, is by substituting expensive physicians with less costly nursing staff in certain situations. “You could bring in nurses to do a lot more functions,” he says. “Can nurses do anaesthesia? In the US, they have nurse anaesthetists. The Royal Colleges have hysterics about it, but the evidence shows not much difference in outcomes. I think it’s already a gradual process and the crisis will catalyse a more rapid change. Hospitals won’t be able to afford so many physicians—they are damned expensive. For £120,000 you can pay for three nurses.”

Some facts (ref. budget 2009, p.239):

o tobacco duties = £ 8.5 billions
o alcohol duties = £ 8.7 billions

Although measures against obesity, tobacco dependence and alcohol abuse have been significant such as the ban of smoking in all public places or taxation increase, I do believe that they are still a lot to do as to reduce the ill-health and social effects ( chronic diseases, injuries, domestic violence, etc…). For instance, the ban of ads on alcohol, further taxes on tobacco/alcohol products and tough regulations on the food industry, especially the fast food industry might be necessary to relieve the healthcare burden. Moreover, this extra money from these excise taxes and the reduction of healthcare demand would be used to recruit more nurses, increase their pay and develop their continuous education.

Equation or Quadrature of the Circle?

o Life expectancy, life-style related illness, shortage of health professionals and Healthcare spending are increasing;
o Hospital beds are decreasing.

With the above in mind, 2 scenarios may occur:

1. the healthcare system collapses with high rate of complaints and prosecutions due to poor care provision and rationing;
2. or it survives and rejuvenates with further investments on health and better management of resources.

The latter may be possible if authorities believe that the best asset is people.
Everything is possible with happy health professionals.
Hence, I would say to government agencies that even in recession time, the best way to fight the beast is to go forward. Reverse the reverse when it is still time to do so!

To my colleagues! I would say one thing: protect yourself, as you might be a side effect or a collateral damage of a drastic healthcare reform after the election.

Abel sidhoum(RN)
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Anonymous | 15-Mar-2010 9:50 am
The question is are these patients infected after the treatments? To me the most inportant thing is they are cared for and problem solved.
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Anonymous | 15-Mar-2010 12:46 pm
As someone mentioned earlier we have a growing population...A GROWING POPULATION Mr Brown........it's not shrinking, its GROWWWWWWWING!

Cutting nurses and Dr's posts will only add to the problem Mr Brown (and Mr Cameron).

The NHS is your political pawn.
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