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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)

  • lansley go and take a long walk of a short peer

    you have no idea what a shift on a busy ward entails

    sat their in your ivory tower
    god help the nhs with this idiot in charge!!!!!!!

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  • Did I read somewhere that we should work in a 'no blame' culture in nursing?

    Did I read somewhere, that doctors AND nurses are the highest professional group to attempt suicide?

    Did Andrew Lansley really say that staffing levels have nothing to do with the inability to provide basis care?

    Did my colleague miss finding a dead body of a patient because she was the only nurse on duty her failing, or that of the hospital in not supplying enough staff to support her?

    Was it reasonable for me to make a mistake (thankfully I didn't) when NO staff came on duty to replace me after a 12 hour night duty and I had to choose between doing the morning medicine round or wash the patients?

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  • Senario:
    You are in the loo with Mrs T who is a falls risk and wants to have her bowels opened.You can hear buzzers ans pump alarms going.You cant buzz for someone to take over because you know everyone else is busy.

    You eventually ( 10 minutes in the loo ) get Mrs T back to bed and make her comfortable. ( Buzzers and alarms still going ) Put cotsides up...."whoops Mrs T nearly caught your foot in the cotside....sorry "
    Your drug round is 30 mins late already

    Buzzers /alarms on IV pumps still going

    Buzzer 1 Mr G needs his dressing changing....." Be with you as soon as I can Mr G"

    Nurse 2 collars you as you go to answer buzzer 2..." Can you check a Controlled Analgesia with me...everyone else is busy"?

    You go to answer Buzzer 2 Mrs B whilst the other nurse quickly checks both IV pump alarms...then we can check the Controlled drug. Mrs B wants a bedpan.

    Meanwhile phone starts ward clerk at this time of night.

    Get back to check Controlled drug....someone answered the admission from Emerg

    Nurse 2 states that the IV pump she checked has just run out of IV fluids.
    We do the Controlled drug for her patient.
    ( Drug round is over 3/4 hr late )
    Check IV fluids bag for patient.

    Mr G buzzes again...his dressing is leaking and he has pain.

    Nurse 3 has been with unwell patient. Dr doing pt assesment. Patient needs catheterising and IV access.

    Start to do drug round and Nurse 3 says we have no catheters in stock! Easy to rectify by borrowing but time consuming!

    Nurse 2 can get to do the dressing.
    I can get my drug round done...

    Phone rings....Emergency....Can we bring up the patient now? "Ummmm can you hold for a while"?

    2 Buzzers go!
    Oh Mr G also need pain relief!

    Its 8:25pm and handover to night shift is in 35 minutes.

    A little muddled but a typical real life senario for many., and this is nothing to what really goes on.

    Mr Lansley, you have NO idea about prioritising and time factors that are involved.
    Understaffing DOES cause patient errors, and always will. That is why the 1:4 patient ratios are coming in throughout the world.

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  • oh and I meant to add on top of all of that theatre need a patient collecting,Mrs C has wet the bed,and Mr M is climbing over the cotsides shouting The End is near!

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  • Yvonne...and 15 family members are demanding that you stop what you are doing immediately to speak with them for an hour each, the alcohol detoxer is beating up the others in his bay (and the hospital has no security), the lady with cancer just passed away and her 28 year old daughter was so distraught she wet her self. you have over 38 medications due whilst all this is going on...

    all this is happening at the same time all the time.

    Oh and the OT assistant and phlebs (who cannot he,lp me with any of the above) are hanging out at the Nurse's station having a laugh and everyone thinks that they are Nurse's who are bunking off!!! Argghhhhh

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  • lansley

    come and do a shift with me this weekend in A&E

    see what we have to do with under staffing etc

    you have absolutely no idea your an idiot!

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  • To say that nursing errors have no connection to wards being short staffed is like saying that skin cancer is not caused by the sun!! Just when you think that you have heard it all...

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  • what is the point of addressing all these points here to Mr Lansley when it is highly unlikely that he will read them.

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  • When he says he will put senior nurses with experience on surprise inspection teams (might be better employed on the shop floor), because they have the experience and knoweledge to analyse what is happening. Why does the hpocrite not do the same in the DH. There must be some nurses that have swapped the wards for the corridors of , who would be better placed to comment on the issues facing the NHS.

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  • I am afraid to he is in cuckoooooo land, like most MP's. His wife is a GP. Well lets look at GP's. How many GP's make mistakes in diagnosis, my father in law has finally been diagnosed with oesophageal cancer. He has a family history of it, has been to his GP many times over the last five years, with swallowing issues, indigestion, all the signs of that illness, and his brother has had it. If that was a nurse it would be discipline action, but Doctors have to be really, really negligent before discipline action is taken against them. It is an old boys club I am afraid.

    I work in the NHS. I see how midwives are treated. When they hand over the care of a client to the medical profession, they are still held responsible for that woman's care. Still their advocate, yet if their care deviates from normal it is not their responsibility to plan the clients care. IF things go wrong and it is found care has not been correctly implemented the midwife will often be hauled over the coals, not the doctor. What is that about!! What is fair about that!!

    The NHS is not playing fair by staff. It is not supporting staff, they are having to work harder under more pressure. Of course they are burnt out, of course they are tired, fed up and mostly have gone past the point of caring. Would MP's be able to stand a week working as a midwife or care assistant or Registered Nurse. I doubt it, they swan about having their all important meetings about meetings that are meaningless in the whole scheme of things while the NHS struggles, limps along with more managers, more protocols and rules and less staff on the shop floor.

    I am not impressed with what I have seen regarding the developments thus far. Yet sometimes they perform amazing feats, amazing work and their dedication is out standing, but that is from staff on the shop floor. The ones who work the hardest to secure the care the public are paying for and deserve.

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