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Are nurses and patients still at risk?

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Inspectors have revisited a trust with major failings in infection control, with some worrying findings, reports Emma Vere-Jones

Stoke Mandeville Hospital in Buckinghamshire hit the headlines last July when the Healthcare Commission revealed that, in the worst example of its kind in the UK, 33 patients had died from Clostridium difficile outbreaks over two years.

Since then this ‘record’ has been surpassed by Maidstone and Tunbridge Wells NHS Trust, where 91 patients are thought to have died from C difficile.

The commission has just published a follow-up report on Buckinghamshire Hospitals NHS Trust, which runs the hospital.

The most striking similarity in failings to emerge from the regulator’s inquiries into both trusts was a shortage of nurses.

The original report into Stoke Mandeville was telling.

‘Nurses reported they had little time to spend with patients and frequently went home upset because they had not been able to do their job well,’ it stated.

‘Senior nurses said they considered that the way junior nurses were treated was not good and that the pressure they were under was excessive. One used the phrase that it
was “on the edge of abuse”.’

Compared with the HCC’s Acute Hospitals Portfolio, a review on staffing levels, the watchdog found the average shortfall of nurses on wards at Stoke Mandeville was 16% or 3.9 whole time equivalents per ward.

Unsurprisingly, remedying this problem was one of its 11 recommendations. ‘The trust must work with the strategic health authority and PCT to agree appropriate levels of nursing staff and then ensure that the trust has sufficient nurses to provide acceptable and safe care,’ it stated.

But 18 months later, problems with nurse staffing levels persist. The HCC follow-up report found that, despite efforts to address its nurse to HCA ratios, the trust had not met the recommendation.

Anne Eden, chief executive of Buckinghamshire Hospitals NHS Trust, said that headway had been made.

‘The trust is improving nursing skill mix in areas identified as requiring attention. Skilled to unskilled ratios have moved from a 40:60 ratio in the commission’s 2006 report to 60:40 in today’s assessment, which the trust is committed to building on,’ she said.

The commission, however, is not convinced. It says that although the skill mix had improved on some wards, analysis of further wards shows that ‘the skill mix is outside the national norms set out by the Acute Hospitals Portfolio and a high number of unqualified nurses are employed’.

‘Staff interviews revealed that staffing pressures still persist,’ the report continues. ‘Senior nurses commented that they have not yet recruited to all F-grade [band 5/6] posts and that there were not always enough staff to cover annual leave, training or sickness.’

RCN policy adviser Jane Naish said increasing nursing levels should have been a priority and warned that a 60:40 ratio was not good enough. ‘Even if the level is 60:40 that is still less than the college recommended minimum ratio for safe levels which is 65:35,’ she pointed out.

Like Maidstone, the events at Stoke Mandeville prompted investigation by the police and the Health and Safety Executive. In a report published this month, the HSE said it would not bring criminal proceedings against trust management due to lack of ‘sufficient admissible evidence’.

But Sandra Caldwell, HSE director of field operations, added that disturbing practices had been identified – there had been no system to manage an outbreak and infection control training had not been mandatory prior to the HCC’s investigation.

That trust managers are failing to meet the demands of healthcare regulators is still clearly putting nurses and their patients at risk. ‘Appropriate staffing levels have an impact on infection rates – that’s the bottom line,’ said Ms Naish.

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