Incidents of patients not being treated with dignity or not gaining sufficient nutrition are “unacceptable and must stop”, the health secretary has told nurses.
Andrew Lansley told the Florence Nightingale Foundation conference in London that strong leadership by frontline nurses, in particular ward managers, was the solution to these problems - not an increase in staffing.
However, he was also forced to defend his controversial reforms, with nurses at one trust telling him the changes had contributed to “tremendous pressure” on their hospital services.
The speech on Thursday was the first time this year Mr Lansley had addressed a large nursing audience and follows widespread criticism of the health bill by the profession.
In a wide ranging speech, Mr Lansley told delegates failures to ensure dignity or nutrition – like those identified last year by the Care Quality Commission – were unacceptable. He said he “never wanted to see reports like those from the CQC again”.
He said bureaucracy and lack of accountability were the “fundamental” causes of such problems, and said the solution was leadership at ward level, with “responsibility taken by nurses on the ground”.
In a view likely to be at odds with the many in the profession, he claimed poor hospital care could not “simply be blamed on a lack of staff”.
He also repeated the long standing government policy that more services in future would be provided in community settings, rather than hospitals – bringing with an enhanced role for specialist nurses.
“To be frank, the future of healthcare won’t be dominated by hospitals,” he said. “The future is in giving care closer to home.”
But senior nurses from the Countess of Chester Hospital Foundation Trust in Cheshire told Mr Lansley they had experienced a “crisis” in February worse than the severe weather last year, with accident and emergency activity up by 20% alone.
They warned him that cuts to PCT staff who could help them manage the situation meant that “when we’ve pressed the button there’s nobody there, because they’ve gone”.
Lesley Freeman, deputy director of nursing and quality at the trust, also told him the pace of community service development had been slower than the reduction in acute capacity, even though “we’ve been talking about this since the year 2000 and before”.
She said: “We’ve never really seen the community services stepping up to the mark. Over the last month we’ve been under tremendous pressure.”
The warning comes at the same as Nursing Times has unearthed data showing that bed shortages in London are having a knock on effect on A&E departments.
Mr Lansley admitted the previous development of community services had been “deficient” but said the “consistent story at the moment is telling us that patients are being looked after to a greater extent in the community”.
He said figures for April-December 2011 showed referrals to hospitals and outpatient attendances were both down compared to the previous year. Although A&E attendance was “slightly up”, it was “nothing like” as high as some previous years, he said.
Mr Lansley also used his speech to announce the creation of a clinical academic careers training pathway strategy, which will allow nurses and midwives to undertake further education in the field of research.
He said the strategy would provide nurses and midwives “opportunities to advance their careers without having to leave clinical practice”.
“This will lead to more consultant roles, meaning they can take not only a clinical and managerial lead in their organisations, but also an education and research lead, advancing practice for everyone and improving patient outcomes,” he told delegates.
It will be funded by the National Institute of Health Research and not from existing nurse education or training budgets.
- The government announced last week that David Foster, formerly the deputy chief nursing officer for England, had been appointed deputy director of nursing at the Department of Health. It is a new post created under the reforms. His portfolio will include workforce, education and research. He will report to Viv Bennett, who was appointed DH director of nursing with responsibility for public health in January.