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Regulators 'must have teeth' says RCN as hospital vows to cut death rates


Healthcare regulators must have teeth and be seen to emphasise patient safety, the Royal College of Nursing has said in the light of care failings at Basildon and Thurrock University Hospitals Foundation Trust.

A damning Care Quality Commission report has instructed the trust to work with foundation trust watchdog Monitor to cut death rates, tackle infection control lapses, and improve quality of care.

RCN chief executive and general secretary Peter Carter said: “The regulators are following due process but the public need confidence that they have teeth to take prompt and decisive action where necessary, including more unannounced inspections.

“It is clear that failures in leadership have resulted in patient safety being compromised at Basildon,” he said.

In its response to the CQC report, Unison called for the Basildon foundation trust to be taken back under NHS control.

Unison head of health Karen Jennings said: “The Health Act, which received royal assent this month, gives the health secretary the power to take a failing foundation trust hospital back into direct NHS management. This new power must now be used.

“To help restore public confidence in the hospital, we need a public enquiry, to give staff, patients, and their families the opportunity to help improve standards of care,” she added.


Readers' comments (3)

  • Gretchen LeFever

    This story parallels a recent news report in the U.S. Read my op-ed that was published in a newspaper in New York state:

    Wrong site surgeries must be reduced

    By Gretchen B. LeFever, Special to The Clinton Courier, November 25, 2009 Web Edition Guest Column

    After another wrong site surgery at Rhode Island‘s largest hospital, the state health department levied precedent-setting sanctions against
    the hospital.

    According to a Nov. 3 Associated Press story, the hospital was fined $150,000 and was required to have all surgeries supervised by a non-participating clinician for one year, to install video cameras in the operating room, and to shut down for a day of patient safety training.

    The dramatic health department response signals the need for more active consumer involvement in the delivery of safe care. Wrong site surgeries are one of the most devastating patient safety events and they shake public trust in the health care system.

    Five to 10 wrong site surgeries are reported across US hospitals every day. Because wrong site surgeries are obvious and easily prevented, they can serve as a bellwether for a hospital’s patient safety culture. When surgical teams consistently use an established pre-procedure checklist (i.e., the Universal Protocol), wrong site surgeries are virtually eliminated.

    Unfortunately, surgeons often disregard the Universal Protocol as unnecessary and time consuming even though it takes only minutes to complete. So long as devastating and easily preventable mistakes like wrong site surgeries are allowed to occur due refusal to follow proven error prevention techniques, less dramatic violations of safety standards such as inconsistent or improper hand washing techniques will also continue.

    A 2009 Consumer Reports poll revealed that 18% of Americans reported they or an immediate family member acquired a dangerous infection following medical procedure. The risk of acquiring an infection nearly doubled if the patient stayed overnight in the hospital. In nearly a third of these cases, the infection was reported to be life-threatening.

    Other commonly reported problems involved errors with lab work, diagnostic testing, and medications.

    In 1999, the seminal Institute of Medicine (IOM) Report entitled To Err is Human illuminated that the number of patients who die in US hospitals every year due to preventable medical errors was equivalent to a jumbo jet airliner crashing and killing all passengers every day. The report called for a national effort to make health-care safer and to reduce medical errors by 50% over five years.

    Subsequently, the topic of patient safety has received extensive media coverage, the health-care industry has implemented a wide range of patient safety initiatives, and the federal government has appropriated millions of dollars each year for patient safety research. Despite a decade of increased focus on patient safety, an estimated 283,000 patients continue to die each year in US hospitals with an estimated $8.8 billion in excess health-care costs between 2006 and 2008.

    Hospitals that feel compelled to tolerate surgeons’ disregard for the universal protocol, may benefit from more active involvement of health care consumers to improve patient safety.

    Dr. Donald Berwick, president of the Institute for Healthcare Improvement and renowned patient safety expert, says engaging consumers in the delivery of safe care is essential and will necessitate some shifts in control and power from those who give care to those who receive it. Such shifts in the health-care industry, although foreign and uncomfortable initially, can be accomplished through the work of community-based patient safety coalitions.

    Community-based coalitions are an integral component of most comprehensive health promotion initiatives, but few have been established for patient safety. Such coalitions are urgently needed to ensure consumer representation for developing and delivering realistic, patient-centered, and sustainable patient safety initiatives.

    Human error is inevitable. The most dedicated and skilled doctors and nurses make mistakes. The goal of patient safety initiatives is not to eradicate all human errors, but the goal is to reduce errors and prevent them from reaching patients by erecting a series of protective barriers. Involving patients and their loved ones in designing and delivering safe care represents one of the critical protective barriers necessary to achieve the ultimate goal of zero events of harm.

    As hospital administrators worry whether their health department will begin delivering harsh sanctions for medical mistakes, patient safety advocates can encourage hospitals and their communities to increase public awareness, transparency, and accountability by establishing community-based patient safety coalitions.

    Currently, hospital-acquired infections sicken 1.7 million and kill 99,000 people every year, so woe be tied to patients or their loved ones who idly hope for safe and affordable hospital experiences.

    Gretchen B. LeFever, PhD, is President of Safety and Learning Solutions and adjunct faculty at Old Dominion University. She graduated from Clinton Central High School. She can be contacted at

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  • Poor old Gretchen, things must be tough when you have to resort to posting your articles in comments columns to increase your readership.

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  • Does nursing representation/ regulation really avow punishment rather than support. Perhaps the NMC, RCN and Unison should look at the impact their bombastic negativity has on the profession. Could you get improvement s in standards of care by supporting instead of punishing?

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