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.”