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RCN says fall in standards 'inevitable' as posts are cut


The Royal College of Nursing has warned it is “inevitable” frontline care will be affected by staffing cuts, in response to a highly critical report on nutrition and dignity standards.

The Care Quality Commission today published a report on standards at 12 hospitals, which forms the first wave of inspections by the regulator into dignity and nutrition for older people at 100 hospitals across England. Further reports will be published in coming weeks.

In particular, the CQC was critical of standards at three hospitals – the Alexandra Hospital in Worcestershire, Ipswich Hospital NHS Trust and the Royal Free Hospital in Hampstead – saying they had broken the law when it came to providing older people with essential standards of care on dignity and nutrition.

Responding to the report, RCN chief executive and general secretary Peter Carter said: “Some of the concerns raised in this report are truly shocking and we are clear that there is simply no excuse for failing to treat patients with the respect and dignity they deserve.

But he added: “We know that with 40,000 NHS posts already earmarked to be lost, and many more expected to go, frontline care is inevitably going to be affected. In a recent RCN survey, just 17% of respondents said that staffing levels at their workplace were quite good or very good, and a quarter of nurses said they provided last minute cover for absentee staff at least fortnightly. 

“Poor standards of care are often accompanied by an underlying failure in ensuring safe staffing levels and the right level of skill.”

Mr Carter, while noting that there were “relatively small pockets of the NHS that do not deliver good nursing care and this is unacceptable”, said it was vital the three trusts identified as failing acted to rectify the situation. He also called on the Nursing and Midwifery Council as the regulator to act on the findings “as a matter of the utmost urgency”.

He added: “The report also highlights many examples of excellent care delivered by nurses and across the NHS, the majority of patients report that their care is good or excellent. However, this will be no consolation to the patients and their relatives who have experienced poor care.”


Readers' comments (23)

  • No s**t sherlock!!! So why don't you do something about it for a change instead of coming out with the usual banal platitudes and soundbites!!!!!!!

    CALL FOR A STRIKE!!!!!! We want a ballot NOW!!! Do you hear us?

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  • Exactly Mike, I couldn't agree more.

    The horrific stories of the elderly not being helped to eat & drink make sad reading, and in addition to that, all nurses are getting bad press when we are struggling to care for our patients due to massive cuts in staffing. This country can't have it all ways; cut staff, our so called"gold plated pensions' and freeze our pay, and then still expect the same level of care as before. It is not going to work.

    WAKE UP PETER CARTER, AND THE REST OF THE COUNTRY TOO. ( and don't get ill whatever you do, there won't be anyone left to care for you!)

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  • Yes adequate staffing with appropriate skill mix is essential, but these issues have been occuring for quite some time & may not be entirely caused by numbers of staff. A attitude of care & compassion costs nothing. It made me cry with shame listening to the daughter who talked about the neglect of her mother as 1 of the elderly patients (now dead) whose case was implicated in the Ombudsmans report. Nursing has made major advances in professionalizing the occupation, but something very precious has been lost along the way, to an increasing number of patients it is no longer fit for purpose.

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  • Much as I would like to place the blame for the reported neglect on poor staffing levels, etc., I have to agree with Anonymous | 26-May-2011 5:56 pm.

    Recently, I was a patient in a busy orthopaedic ward following a fractured ankle. The 'care' I received was absolutely appalling. On speaking to staff, I was told that, although they were busy, the ward was fully staffed. In addition to being relatively young and otherwise fit, I am a nurse with experience in a variety of settings including orthopaedics; and was a patient some time ago in another ward within the same hospital (where the care I received was fantastic).

    The problems in this ward could not be excused by skill mix or staff/patient ratios. It was all to do with poor management and too many Nurses who simply didn't care. We all know, or have known in our careers, this type of dysfunctional clinical setting.

    I am one of the first to complain about the way we, as a profession, are being treated by this government:- Job cuts, pay and increment freezes, rapidly disappearing resources, threats to pensions, etc. And I believe that to safeguard these, industrial action is necessary. However, when this type of report comes out, it seriously threatens any credibility the Nursing profession has. We are accountable individually for the way we behave, as are those Nurses who contributed to the reported neglect. It is indefensible.

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  • Mags and the above anon, I see what you are saying, and I do agree. However, I do not think that the two issues are completely separated.

    When you get wards that are 'fully staffed', that is still usually far below the recommended safe staff/patient ratio, they are still often highly stressful, dysfunctional wards, and they are still Nurses working in a profession with morale at an all time low.

    I believe that the vast, vast majority of Nurses are caring, the vast majority are doing the job with the right attitude. However, many are so demoralised, so tired and exhausted and stressed, that this HAS to affect the care that they give. There is a lot of evidence for compassion fatigue.

    Like I said in another thread, there is FAR too much expectation on us to maintain our standards and levels of care when our profession is slowly being stripped away from us piece by piece and staffing levels and working conditions are getting worse and worse. This is unrealistic.

    When the problems that plague our profession are sorted, when the RCN starts fighting for us and the profession starts standing up for itself, when there are enough staff on the wards, enough equipment and the correct skill mix, when the profession is no longer being threatened constantly with cuts/job losses/wage cuts/increment and pension losses, etc etc etc etc etc, then you may find that those of us who are still on the wards have the time to give real care to our patients and be rested, emotionally and physically healthy enough to give that care.

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  • mike | 26-May-2011 10:17 pm

    Mike, of course I agree in large part with your points. In particular,
    "....there is FAR too much expectation on us to maintain our standards and levels of care when our profession is slowly being stripped away from us piece by piece and staffing levels and working conditions are getting worse and worse. This is unrealistic."

    However, the damning evidence of neglect in this report cannot be ignored. There are reasons and explanations for some, perhaps many shortcomings. But when the absolute basic standards of care are being ignored consistently, over significant periods of time, then 'reasons and explanations', are no longer sustainable and become nothing more than poor excuses. In all of this, there must be personal responsibilty and professional accountability.

    I deliberately did not list the issues that I witnessed during my recent short stay in a hospital ward. But, none of the behaviour could have been explained away by the very real barrage of threats to our standards or morale. It was a damaging attitude that was systemic. And we, as a profession, have to accept that these little enclaves exist, resulting in real danger to patients. I'm pretty sure that, had I been in the ward next door, my experience may have been much more positive.

    I have done many years 'in the trenches' with my colleagues, often under very trying circumstances. No staff, no resources, no support and the pressure of unrealistic expectations from patients, their families, our peers and those on 'high'. And I know, as you say, ".... that the vast, vast majority of Nurses are caring, the vast majority are doing the job with the right attitude." I'm fortunate to work with those people every day.

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  • Mags, fair enough I do take your point and understand. I have to admit I have seen the occasional Nurse (and Doctor and HCA come to think of it) with a complete dearth of caring who should not be in the profession at all. Fortunately these are in the absolute minority (I believe anyway, whether that is optimistic or naive I'm not sure I know anymore). There is never an excuse for lack of care in that sense, I do agree with you. But what about those of us who desperately WANT to give the best care we can but are left screaming and banging our heads against a wall because working conditions will absolutely not allow us to despite our best efforts? Unfortunately we all seem to be tarred with the same brush when reports like this come out, and that is unfair as I think that instead of trying to fix many of the problems that I mentioned above, trusts/management/parliament/the public can all simply point fingers and blame Nurses once again.

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  • Mike, I agree completely that these Nurses are in the minority. Indeed, poor attitudes in Health care are certainly not confined to some Nursing staff. Not by a long way.

    Perhaps the thing that angers me most,(apart from the fact that the rest of us are working our a***s off trying do our best in the face of unacceptable cuts to staff and resources) is that these types of reports damage our cause so much. The government must be rubbing their hands in glee. At a time when our profession and unions are beginning to finally accept that to protect our patients, our jobs and conditions and our pensions, we need to take industrial action......and look what happens. The focus shifts to blaming Nurses for any and all the ills of the NHS. I suspect that there is more to come, as more reports are released over the coming months. And I think that this is a very clever and deliberate government tactic. Or am I just being paranoid?

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  • Exactly mags!!! I completely agree with you on that one. It makes me so angry too. I really despair sometimes, to the point of even thinking is it worth working in this profession anymore? The problem is I can imagine just how great and powerful our profession could be! And you are right I fear, any conspiracy theorists amongst us would certainly be going mad right now! It does seem to be a deliberate tactic to discredit us, the timing just seems too perfect because they know they wouldn't stand a chance if our profession ever got off the ropes and came out swinging!

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  • It is encouraging that Peter Carter is finally acknowledging there is a problem, although he doesn't yet seem to have grasped how significant it is. It is also inappropraite for him to use the cutbacks as an excuse for the inappropriate practice (abuse) that vulnerable individuals are being subjected to by those in whom they place their trust. The issues of poor nutrition and lack of dignity have been around for at least 20 years. It is time for the RCN to stop talking and to be proactive in supporting the thousands of nurses who are struggling to do their best against all odds and help restore the nursing professionals reputation wth the pubic.

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