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CQC attacks NHS hospital care for older people


Inspectors have raised serious concerns about the way some NHS hospitals treat older people.

Three health trusts have broken the law when it comes to providing older people with essential standards of care on dignity and nutrition - a quarter of those reviewed. There were concerns about another three.

The Care Quality Commission (CQC) published the first 12 reports from an England-wide inspection programme into standards of care at 100 hospitals.

Only half of hospitals were providing essential standards of care as set down in the Health and Social Care Act 2008.

At the Alexandra Hospital in Worcestershire, part of the Worcestershire Acute Hospitals NHS Trust, inspectors expressed “major” concerns about nutrition.

They found “meals served and taken to the bedside of people who were asleep or not sitting in the right position to enable them to eat their meal”.

Hot dinners and puddings were left for 15 minutes to go cold before staff found time to assist patients.

While guidelines stated people should be offered a choice of food, one person’s meal was taken away because they did not want it and no replacement was offered.

Staff said they sometimes had to prescribe drinking water on medication charts to “ensure people get regular drinks”.

One older patient was noted as malnourished on admission but they were not reassessed until 16 days later.

Patients were also not weighed when they should have been.

The inspectors concluded that patients were “at risk of poor nutrition and dehydration”.

At Ipswich Hospital NHS Trust, inspectors found patients left in night clothes all day and not always taken to the toilet away from where they slept.

Records were not always up-to-date and staff spoke among themselves when caring for patients rather than to the patient.

Staff reported being too busy and over-stretched to provide the care they wanted to, inspectors noted.

Some patients were put to bed at 6pm even though they did not want to be.

At the Royal Free Hospital in Hampstead, west London, inspectors found staff did not always make sure people had enough to eat and drink.

While many patients got help with eating, some did not and had their trays taken away, and staff rarely asked patients if they had enough to drink.

Food and fluid charts were often “inaccurate, not completed and not up-to-date”, inspectors found.

Less major concerns were found at Imperial College Healthcare NHS Trust in London, Homerton University Hospitals NHS Foundation Trust in London and the Wye Valley NHS Trust.

Six trusts met all essential standards: Clatterbridge Centre for Oncology NHS Foundation Trust, Wirral University Teaching Hospital NHS Foundation Trust, Countess of Chester Hospital NHS Foundation Trust, Mid Staffordshire NHS Foundation Trust, Plymouth Hospitals NHS Trust and Sheffield Teaching Hospitals NHS Foundation Trust.

A national report on 100 hospitals will be published in September.

All the hospitals that are the subject of concern must now tell the CQC how they intend to improve.

The three hospitals failing to meet essential standards could face enforcement action if they do not show improvement.

Jo Williams, chairman of the CQC, said: “Many of these reports describe people being ‘cared for’ in the truest sense.

“Sadly, however, some detail omissions which add up to a failure to meet basic needs - people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

“These are not difficult things to get right - and the fact that staff are still failing to do so is a real concern.”

Michelle Mitchell, charity director at Age UK, said some of the anecdotal evidence, such as medical staff having to prescribe water to ensure patients are hydrated, was “wholly unacceptable”.

Patients Association chief executive Katherine Murphy said the “tragedy of contrasting experiences continues unabated”.

The CQC report covered pensioners over the age of retirement.

The Royal Free said it was disappointed by the report, adding: “As part of the action plan, we are rolling out a programme of ‘nurse rounding’ which ensures that every patient is reviewed by a nurse at least once an hour to ensure their comfort and needs are met.

“A comprehensive staff training programme is being introduced which includes thorough training in documentation standards.”

Siobhan Jordan, director of nursing and quality at the Ipswich Hospital, said it was also disappointed by the findings.

“The trust is working with families and carers to work in partnership with the hospital to maintain independence and encourage rehabilitation, asking family members to provide clothes for patients to wear,” she said.

Sir Keith Pearson, chairman of the NHS Confederation, said: “We in the NHS cannot tolerate the failure to meet minimum standards in any way, shape or form.”


Readers' comments (16)

  • I see the CEO at the Alexandra Hospital has stated that his ward staff have 'learned a lesson', in this so called 'no blame' culture!
    I suppose he is so consumed with targets and strategies to really care.Where is the Head of Nursing AND what is she doing about it? Sitting in HER ivory tower, I expect.
    As ever- the nurses are to blame. Well what nurses there are left on wards these days.
    When oh when will somebody stand up and face facts. THERE SIMPLY ARE NOT ENOUGH NURSING STAFF ON THE WARDS TO CARE PROPERLY!!!
    Pity the Doctors cant prescribe nursing staff Mr Rostill!!

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  • When will people understand that it is occasionally necessary to be on bedrest-it is unfortunate that bedpan are still required but people with unstable fractures cannot be mobilised until they are repaired? Orthopaedic nursing we see people with spinal, hip, multiple fractures permanent disability would result if we were to mobilise them to a toilet. Curtains offer minimal privacy, once people have undergone repair surgery they are mobilised as soon as possible to ensure their dignity maintained.

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  • In 1973 when I started my training, the elderly were the poor relations with lower staffing levels and where staff were poached from to cover other areas .... and alas little/nothing changes. Instead of pointing out the shortfalls, why don't the CQC oversee that care improves. With the culture, even more so these days, of saving money, the elderly are less likely to survive long enough to complain. We have sort have come full circle in that 'guidelines' have replaced 'procedures'. The difference being that 'procedures' were enforced, be it task orientated, and 'guidelines' leave too much to 'adhere to or not', whatever suits the budget at the time. Either way the notion of professional judgement (down to experience) is being eroded too. As for 'caring' for patients there needs to be a clear emphasis on whether staff are 'doing for' or 'facilitating' where the latter can be more productive to recovery, yet often perceived as 'not caring'. ....and lest not forget that doing for is less time consuming that 'facilitating self care'....uh, maybe requiring more staff....and money....umm again!

    You have probably come to the conclusion that from 38 years of working as a qualified nurse that we are still not getting it right. I think by 'we' it is mostly out of our control, and up to the excetutive level to get their finger out.

    And there's another thing relating to documentation, we used to document what we actually did for our patients, then we had 'named nurse' and 'individualised patient care plans', which left too much to individual staff interpretation' of what the -at patients needs were, then care plans that we 'supposedly did' unless varients were documented and now we have 'prescriptive' care plans related to 'essence of care'. The era of 'named nurse' and 'individualised patient care plans' in my experience was the only time we sat with patients and actually devised the care plans with their input. Please prove me wrong. The no-blame culture ' is becoming more of a 'blame culture' which in my opinion should become a 'solving problems'culture before all these shortfalls are identified.

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  • What happened to MDT working, Team work.

    No just blame the nurses.

    I agree with the 1st comment Pity the Doctors cant prescribe nursing staff.

    Not sure about a no blame culture. I think it may be a good idea to start blaming people, BUT THE RIGHT PEOPLE. not the care giving staff, nurses doctors, physios all other PAMS.

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  • michael stone

    The findings are not exactly anything new, are they ?

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  • Once again nurses are berrated for not providing adequate care. Has anyone heard of route cause analysis. Surely if this was applied the powers that be would realise that the route cause would be not enough nurses on duty to provide adequate care. I work on the community and it is difficult enough, but I have had cause to visit relatives in hospital recently and there is a distinct shortage of nurses on the ward I visited. I felt my mother in law suffered as a consequence of this and this is at a hospital the CQC said met all essential standards???????

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  • ...did anybody notice that buried amidst this article there was a list of Trusts who met the standards...and guess what - Mid Staffordshire NHS Foundation Trust is there - so why no publicity about this? Good news for the staff and the management teams there at last - well done.

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  • 27th May, Anonymous 00:54
    I agree with your comments. We as a profession have to start thinking creatively as befits a mature profession. Displacement of issues to other areas of hospital management
    doesn't address the problem sufficiently. Nursing can always use more staff and more resources and more money but these are thin on the ground at the moment and not likely to get any better in the
    foreseeable future.

    There are some really interesting developments in care of older people in the areas of research and development. Patient /person centred care, acute on chronic care, emphasizing the specialised and highly skilled nature of care including the specialised psychological needs of older people when they are ill and at their most vulnerable. (Dementia studies at Bradford University is an excellent development in nursing and worth a lot more interest from nursing as it transcends age and makes us respect humanity at all stages of development).

    To treat patients in an ageist way i.e any one passed the age of 65yrs, doesn't help our professional image at all nor is it very far sighted .
    The demographics forecast that the population of older patients will increase means we need to be addressing the cultural and attitudinal problems in nursing now!
    I appreciate that older patients demand nurse intervention with greater intensity. More education and skill development at practice level seems more sensible than employing more & more staff who may or may not have any real interest or
    motivation to nurse older people.

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  • We need to show that staffing levels are to blame. We need a government that will take note of developments in the rest of the world where nursing ratios are protected by law.
    Baby steps mind. How about the CQC saying that all wards have to declare on a daily/shift basis just how many RNs are on duty....on a board at the front of the ward. Big letters and numbers please...then everyone can see that the ratios are dangerous. Even the Daily Fail and its readers would not be able to spin this one...then again I'm sure they would find a way. How many of them work a 12 hour shift without a meal break I wonder?
    Stop wasting money on new documentation and "falls prevention" mats etc...what is the use in a buzzer going off to say a patient at risk is trying to get up if there is no-one around to do anything about it? I have been saying this for years but nobody listens.

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  • Anonymous | 28-May-2011 1:18 pm

    27th May, Anonymous 00:54

    I agree with these comments and somehow these challenging but fascinating and highly rewarding areas of study and care have to be presented in a way which will attract more highly qualified, motivated, creative and innovative professionals to the job.

    I would also add my first impressions on reading such articles as these, that there appear to be more inspectors and mangers spending time looking at what is happening and writing reports than there is nursing hours spent on basic and essential care of this vulnerable group. How about some of them rolling up their sleeves and doing a proper job instead of writing these reports to be pondered over at endless managerial meetings and in the media and then filed where they will gather dust and be forgotten about!

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