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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)

  • really??? is he kidding??? not only that there is not enough nurse there is a lot of bullying and prefential treatment in the so called "equal and fair" NHS. Get a grip!!!! I wish he could be a patient into a ward where there are 28 patients, 2 nurses and 1 healthcare assistance. I don't need to explain, I think at least I hope, he can do the simple math.

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  • what is everybody on about?

    if Mr Lansley's staff in his office were reduced to a minimum it probably wouldn't affect his superman work output in the least - with a little multitasking he would probably still be producing his unpopular bills and telling nurses how to do their work whilst still raking in his vast salary and bonuses just as efficiently as before. The only difference is that he gets support from Cameron!

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  • Never Events are not things which cannot ever happen, they are things which should be preventable - but sometimes circumstances will conspire to allow them to happen, and severe understaffing is obviousy one factor which would make a Never Event more likely to come to pass.

    But nowhere should be so understaffed, as to significantly increase the probability of that type of event from happening - AL et al come out with over simplifications all of the time, as well as some downright lies !

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  • never events - who coined this ridiculous phrase

    bet it was the Americans

    why can't we generate our own ideas rather then always following the Americans like sheep. Might work better. We are not America and we are not Americans.

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  • Anonymous

    Anonymous | 25-Feb-2012 2:27 pm

    Probably was coined by the Yanks.

    I think the term is used, because those events always lead to criticism of the NHS if they are reported to have happened, so the DH feels 'This must NEVER happen - or we get flak !'.

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  • This beggars all belief

    pasted here as no space for comments following article in DT!!!!!

    "Drug shortage as phramacists sell medication abroad

    The lives of NHS patients are being put at risk because vital prescription drugs intended for British use are being diverted abroad for profit by wholesalers and pharmacists."

    "Until a Government crack down even NHS hospitals were wholesaling drugs for profit. The Royal Surrey Hospital at Guilford made £300,000 on sales of £4 million in one year."


    "A teaching and education consultant from Thame, Oxfordshire, she has at times had to tour pharmacies in her area to scrap together the drugs she needs."



    "A Staffordshire pharmacist said a patient had died after it took one week to get the medication he needed.

    He said: "The patient was very ill with an immune disorder disease, and it took about a week to get his medication. By the time we got the drug, he had died,"Louise Bolotin, 50, from Manchester, has struggled to get her epilepsy drugs for several years."


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  • Anonymous

    Anonymous | 26-Feb-2012 3:18 pm

    That story is all over the 'broadsheets' today, it does beggar belief, but it is surely off-topic here ? You need to be careful on NT, about straying too far off-topic.

    Of course, selling drugs abroad and leaving us here with a shortage, SHOULD BE a 'never event' in any type of sane world - but this isn't, any type of sane world !

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  • I'm a bit dim but ... | 27-Feb-2012 3:20 pm

    I said at the top it was off topic but there was no other place following that article in DT to post comments and as it is related to Mr Lansley and the changes in the NHS I wished to draw people's attention to this very serious problem in the NT! I expect an article will follow in NT with an opportunity for further discussion although they always seem to follow the national press a few days later.

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