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Lansley: understaffing is not excuse for 'never events'


Health secretary Andrew Lansley has issued a stark message to nurses – there is quite simply “no excuse” for the most serious failings in care.

His warning in an interview with Nursing Times follows the publication last week of a longer list of so-called “never events” – preventable care mistakes that “should never happen”.

The Department of Health’s list has been extended from eight to 25, encompassing many areas directly linked to failings in basic nursing care, such as the severe scalding of patients and patients getting trapped in bed rails.

Other new categories include wrongly prepared high-risk injectable medication, maladministration of insulin and misidentification of patients.

There were 261 of these errors – all of which can cause serious harm or kill patients – last year, Mr Lansley revealed.

In an interview with Nursing Times on the issue, the health secretary made it clear he would not tolerate excuses from nurses who blamed life-threatening mistakes on understaffing and being over-stretched.

He said: “Give me one example of one of those things in the never events list for which there is any excuse for it happening because people are understaffed.

“There is no excuse. We’re talking about the incorrect administration of insulin, putting someone into a boiling hot bath or failing to identify a patient using their name identifier.

“That isn’t because you’re understaffed, that is because you’re doing it wrong and because there is no process by which that is properly checked.”

He said nurses had a responsibility to speak out if they were in a situation where patients were being put at risk by a lack of staff or work being done by people “with no skills”.

Recent events, including a highly critical report on the care of older patients by the Health Service Ombudsman, have put the spotlight on standards of nursing care..

Mr Lansley denied there was a crisis in the profession but said things like the ombudsman’s report showed there was “clearly room for improvement”.

He said new nurse-led unannounced inspections, soon to be launched by the Care Quality Commission, would aid efforts to maintain high standards.

He said: “I was very clear in discussions with the CQC that it had to be nurse led.

“This isn’t about inspectors who don’t do the work, who don’t understand what they [nurses] do, going around with clipboards and ticking boxes. This is senior nurses who have practical experience themselves identifying what should and shouldn’t be happening and making it clear where things need to be put right.”

A CQC spokeswoman confirmed the inspections, which will focus on patient dignity and nutrition, will start this month.

Mr Lansley told Nursing Times he was keen to see a rapid reduction in the number of never events.

There were 111 never events between July 2009 and June 2010 under the old eight-strong list, costing the taxpayer an estimated £3.9m.

Based on Department of Health estimates that never events costs at least £35,000 each a year, the 261 never events from the new list would have cost £9.1m.

Commissioners have the power to withhold payment to providers when never events occur to recover costs, which can include ongoing care for the patient involved.

Mr Lansley said the system was designed to hold organisations to account. “This isn’t actually focusing on individual staff, it’s focusing on how the organisation supports them because human error is to be expected,” he said.

The new list follows consultation with health professionals, the royal colleges and the public and includes some that could apply in community as well as acute settings.

Rachel Binks, chair of the Royal College of Nursing’s critical care forum, said: “Most of it is absolutely right but my concern is some things are somewhat ambiguous and are going to be quite difficult to monitor and measure.”

She said nurses should take the list “very seriously”, but added: “Linking it to finance is completely wrong. Doing that means we will end up with having them not reported.”

Royal College of Nursing head of policy Howard Catton warned there was a risk of creating a culture where the focus was on “maintaining basic standards”.

Finding a way of rewarding best practice or services that “go above and beyond” would be more effective at improving quality, he suggested.

He added: “There may be some who’d like to see the list extended into areas like pressure sores and hydration and nutrition – the sort of failings highlighted in the ombudsman’s report. But I think we have to be very careful about that because things like pressure ulcers may not be caused by a break down in hospital care but something that happened before a person came in.”

Midwife educator Sue Jacob, from the Royal College of Midwives, said she would like to see the list applied to different specialities such as maternity, with examples, to make it easier to explain to staff and students. She said at least seven of the 25 were highly relevant to midwifery but it was not immediately obvious.

She said: “A generic list does nobody any favours. It needs to be directed where these incidents have occurred and properly explained. Anyone can draw up a list. But the real issue is what steps are going to be taken to support this and the level of investment in education and cascading it down to frontline staff.”




Readers' comments (48)

  • You see the thing is this. The tories are the govt we've got. We live in a democracy and our democratic process somehow managed to give them and the equally incompetent lib/dems power.

    The public put the govt in power and by god the public will pay for their stupidity via the destruction of the NHS.

    Sympathy? Not a jot.

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  • Yvonne Bates | 2-Mar-2011 1:26 am:
    Hi Yvonne, I think you are missing my point about responsibility. I separated it into different parts for a reason as I think it's important not to take on responsibility that isn't ours but which is often dumped on us...and we take all too easily sometimes! Its the mature and emotionally intelligent thing to do to be able to recognise and accept personal responsibility, but to take on what isn't ours is unhealthy and will end up with illness and depression to say the least. It also allows those whose responsibility it is to abdicate that.

    I wholeheartedly agree with patient ratios, it a must have issue. I think it would be add weight to our argument if we started reporting capacity issues with this as a frame of reference until we get it.

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  • Invite the most honourable Health Secretary to spend a week working all the shifts on an understaffed ward so that he is in a better position to make an informed judgement on mistakes and why they happen.

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  • It is all very well for Andrew Lansley to point the finger at nurses; they are after all everyone's scapegoat. Well that's how it feels anyway. How can he say that reducing the number of staff drastically would not be a valid reason for never events occurring. The man is an arse; and an ignorant one at that.

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  • hahaha the man is a baffoon!!! what tosh to say understaffing isn't responisible! It IS a huge factor that cannot be swept to one side because this so called govt elect wants to put the final nails in the coffin of our precious NHS. Privatisation here we come....

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  • What a jackass. He has no understanding whatsoever does he. Gosh. So glad I left the UK. We have a lot less "never events" on my new ward in the USA. The nurses are no better than British nurses. Not at all.

    We have less mistakes over here because we have strict one RN to 4 patient ratios. We always have a charge nurse on the ward without an assignment to back us up. We have 24 hour pharmacy, housekeeping and 2 ward clerks from 7AM to 11PM every day. IF a patient goes downhill or we get more acutely ill patients than usual we get more RNs straight away.

    This is why we have less mistakes. NHS RN's are on their knees. They are trying to do too many things at once. They are trying to do the jobs of pharmacy and everyone else. The clipboard bastards are the ones that have done all the cutting. The senior nurses in the NHS have no control and no power to facilitate change and it is the government and the non clinical managers who have done that.

    What surprises me is that British/NHS RNs do not make more errors. It is a credit to them. The RNs I work with now in the States would run away SCREAMING if they had to take on more than 5 patients at once.

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  • How dare this fundamentally ignorant person say this.

    Practically all the events that are 'never events' ARE related to a lack of people available!!!

    It's not about mistakes all the time.
    To be honest i think we don't make that many.
    What the media are trying to do in league with the government (or more truly the forces behind it) is to denounce the NHS as some kind of failure despite its clear and cost-efficiently overwhleming success.
    They are trying to swing the public against us, but it only half works because they are doing this in the absence of strong government or a core of support from the public due to their rank illegitimacy.

    We just need to talk the NHS up.

    It would help if our Nursing leaders and leaders simply didn't parrot empty apologies and make promisies for work that in reality, money and more people fix rather than self-prostration and placation.

    If we had ANY head of the RCN PUBLICLY
    say that actually we do a good job and what you see in the media really are isolated cases.

    It is no strange coincidence that the spread of media output is national and not restricted to areas LIKELY (via funding or complexity) to have poorer outcomes
    The nationwideness of the stories and the lack of any rebuttal, publication of readers defensive letters regarding their success within the system or genuine scientific and professional explanations goes a long way to show that we are in the middle of a campaign rather than a real epidemic in nationa-wide all-out substandard nursing care.

    Adn the worst thing is we're taking the blame for things that don't even concern us.

    Residential homes??? Do they have qualified Nurses. No!! Yet the RCN has not insisted on differentiation between the two.

    Nor does anyone question the legitimacy of why patients even come to hospitals within the current system from primary care. Much of the therapy could be done in nursing homes, half the time they are admitted merely for the pleasure of the Consultant - who let's face it, does not really see (thus need to see).

    Adaptations of a good servicemust always be made, but every government fails to see thebig picture or even get a scientific and professional opinion that is independent of the career and political leanings of that person.

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  • Dear God, has this gentleman ever read the Nursing Times or any of the online comments we post?! If he had he would surely have recognised how we as a profession have been fighting for extra support in our workplace!
    We remain the backbone of the NHS and are still struggling for the merit and support we deserve.
    How have the editors responded to his comments?

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  • To Anon:2March 3:39
    Yes I fully understood what you were saying " I think its important to not take on responsibility which is not ours but often dumped on us" true that it happens all the time, but how would you really stop that apart from working to rule? Of course taking on added responsibilities add so much extra pressures to staff which results in low moral and sickness...and ofetn fast turnovers, although I would think at the moment staff are not too willing to leave their present positions at the moment with such uncertainty at job losses .

    As I said Patient Ratios I believe is one of the prime topics you should all be focusing on with Government simply because it is PROVEN patient and staff benifit . It is becoming law in so many states, countries now with positive outcomes .
    Only nurses can get the ball rolling on this, and sadly with a union that appears not to work with nurses FOR nurses, the NHS in turmoil and funding that does not seem to exist it would be a fight. But what a gain!

    Anna Lincon:
    I agree absoluatly, but we are the ones that have had the good fortune to be able to work in a place that recognises nurses for their worth much more, and thats what UK nurses deserve....recognition for who they are , what they do and what they believe in
    I am English and trained and worked in UK. I would not go back there to be treated as they are being treated now, and taking the brunt of whatever is lashed out at them.

    As far as Mr Lansley is concerned...he appears to have no insight whatsoever....and he is your Health Secretary??

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  • This either shows that the secretary of state is either incredibly arrogant or incredibly naive.
    Of course adverse events occur if staffing is insufficient, either because the number of staff on duty is insufficient for the number of patients (on a ward) or in an ED the inflow is greater than outflow causing crowding, (for a discussion on the latter see Collis J.(2010) "Adverse effects of overcrowding on patient experience and care", Emergency Nurse, Volume 18, Number 8, pp 34-39).

    I would suggest that most problems are due to systemic failures, e.g. mid Staffs being driven by their ruthless desire to be a foundation trust and thus had to meet the four hour target and the problems in the aftermath of the 7th July bombings due to poor communication

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