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Fitness to practise proceedings launched following CQC inspections

  • 23 Comments

Fitness to practise investigations have been launched into nurses suspected of providing poor care during the Care Quality Commission’s recent dignity and nutrition inspections.

CQC inspection teams, including nurses, visited 200 wards where older people were cared for at 100 hospitals. The regulator found 20 hospitals were not compliant with one or both of the CQC’s “essential” standards on dignity and nutrition.

A final report on the inspections, published this week, identified common failings as ignored call bells, staff speaking to patients in a dismissive or condescending way, and patients going hungry because they were not helped to eat.

In a statement responding to the report, Nursing and Midwifery Council chief executive and registrar Dickon Weir-Hughes said: “We have opened fitness to practise investigations into a number of individuals whose practise may have fallen below the standards expected under their code.”

An NMC spokeswoman would not confirm how many nurses were being investigated by the regulator.

In particular, the CQC spot checks highlighted major concerns at James Paget University Hospitals Foundation Trust in Norfolk, Worcestershire Acute Hospitals and Sandwell and West Birmingham Hospitals Trust.

Worcestershire has since been found to be compliant with the CQC standards in a follow up inspection, but James Paget was issued with a warning notice after a return visit found care was still not meeting the required standards. Sandwell General Hospital has closed the ward where inspectors raised serious concerns about patient dignity.

CQC chair Dame Jo Williams said although inspectors often found big variations between different wards in the same trust, it was clear leadership in some places had allowed unacceptable care to become the “norm”.

Dame Jo said she recognised resources could play a part in the quality of care provided and urged management to make sure budgets were used “wisely”. But said the training of nurses should also be looked at to examine why care was “broken down into tasks to be completed – focusing on the unit of work, rather than the person who needs to be looked after”.

She added: “Care professionals need to strike the right balance between ensuring that people get the care they need in a safe way – recording how much they have eaten and drunk, what medications they have taken and when – while not prioritising processes over people.”

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  • 23 Comments

Readers' comments (23)

  • It is not fair to pick on the nursing staff!!!!!! the ones I work with do a good job but have so many other things to do like reams of paperwork that "hands On care" goes out the window and is left to the HCA'S to do. Should be looking at the Government who keep cutting budgets and setting targets!!!! Its nothing to do with are they fit to practice!!!! People really do need to come and do the job under the pressure staff are under. No onder NHS is one of the highes sickness rates.

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  • I would like the CQC inspection teams to show nurses how to prioritise care when there are many many tasks that need to be done at the same time and are of equal importance. A doctor tells you that this medication needs giving immediately, you have a relative on the phone waiting, a patient falls, another patient asks you for the toilet, there is no other nurse to pass tasks on to as the few staff available are already dealing with other patients. This happens on a daily basis not every day.

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  • Obviously there is nowhere near enough information here (and rightly so) to make comments on whether it is suitable for individual Nurses to be investigated or not. HOWEVER, saying that, based solely on the examples they are giving, I would like to know exactly what the CQC are doing to hold managers and trusts to account for forcing the poor working practices on Nurses that LEAD to things like "ignored call bells, staff speaking to patients in a dismissive or condescending way and patients going hungry because they were not helped to eat". Let's start with the staffing levels for example that are dangerous and should be illegal, how about the fact that staff are often at breaking point, stressed, tired and demoralised, how about the fact that there is often not enough equipment or support, how about ... Hmm. WHAT exactly are the CQC doing to sort THOSE problems out other than 'urging' management to look into it? What a joke. It doesn't take a rocket scientist to figure out that if you sort out the latter problems, the former don't happen!

    What Dame Jo needs to recognise, is that she doesn't have a clue. I can tell her exactly why Nurses often break things down into tasks rather than the individual involved right now, it is out of NECESSITY. We often face environments akin to a battlefield on the ward, where through sheer lack of staff, too many patients and far too many highly demanding and time consuming clinical tasks, we are FORCED (and that is the key word here)to work through processes and tasks.

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  • Too true Mike & very well said.

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  • So the NMC will as a result develop more standards, how many is it now 64/65?
    Mike's comments are to the point. CQC undertake their inspection with an inspection template. If wards had to have mimimum staffing levels at AM/PM and late shifts that was incorporated into the ward mission statement/Ethos as is the case with the National minimum standards for care homes. then managers would not chance their registration with CQC with respect to safety and quality outcomes.
    Seems that NMC should focus their attention on employing NHS Trusts etc to ensure staffing levels.
    some trusts had advertised for lunchtime/teatime voluntary 'feeders' to get around this particular problem to great sucess. Seems that the NMC answer is to create additional standards. I certainly glad not to be a practicing nurse with george Orwell's big brother in the shape of NMC, they are as much support as jelly.

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  • Instead of standing back and criticising, stating the obvious, that nurses often give poor care because they are overstretched, overpaperworked and overtargetted, how about all these experts roll up their sleeves, put on a pinny and get stuck in for once!

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  • I couldn't agree more with the comments being made here. I'm a senior nursing lead who has worked in the NHS for over 20 years. Watching the effects of "cost improvement" programmes in my Trust has left me with the feeling that senior managers are completely out of touch with the realities of day to day nursing. The complexity of patients needs has increased on my wards, and we still work to a staffing complement that is years out of date. The stock answer is there is no money, despite safeguarding issues (yes they have been reported). I spend most of my time doing audits, providing assurance and attending meetings when I should be out there educating and supporting staff. Whilst there may be many truths in the CQC reports I have seen so far, it appears that some of the assessors are not clinicians, and often don't contextualize their criticisms. They need to find out why something is happening, rather than making sweeping generalisations that nursing staff are incompetent, or that nursing leaders are ineffective. Sometimes when reporting concerns up the ladder, there does exist a very real "ceiling" that prevents you from going any further. Clinicians become frustrated, disenfranchised, and sometimes, cynical. And today, I hear that the pension age is to rise yet again? Bad timing Mr Cameron.

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  • Anonymous | 13-Oct-2011 12:59 pm

    well said

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  • Well said everyone. The NHS is still very top heavy with managers, lets start cutting from the top down not the bottom up so that more staff are where they should be - working with patients to ensure that their basic care is met along with their dignity and privacy.

    On a positive note many patients that I have looked after could not praise staff enough and felt that they had been listened to and that they were well cared for.

    As already mentioned we dont know the details of possible investigations being carried out by the NMC, but those who have been identified having nothing to fear if they can prove that their lack of basic care was because there was not enough staff on the ward and hopefully they had enough sense to document this. This highlights the importance of documenting everything, right down to Mr S needed feeding but due to the x amount of other patients who also needed feeding and x amount of staff available by the time they got to Mr S his food was cold and then document what was done to ensure he got a hot meal. It not easy, we are not trained as lawyers, but we have to protect ourselves.

    Nurses are fed up of being picked on, whilst we are in the limelight the activities of Mr Lansleys wife's company gets forgotten. To say she no longer has dealings with drug companies does not mean she or her husband have contact with them. All this negative feedback about nurses is a smoke screen for other things going on - The Health Bill gets its second reading in the House of Lords - Social Enterprises are emerging, and there was Mr Landsley on Question Time last night saying he is not going to privitise the NHS, someone needs to remind him what Social Enterprise is!

    The majority or nurses do a fantastic job under so much pressure, well done to you all, you should all be proud of what are achieving under such negative circumstances.

    Time the unions made an official statement to stand up for us nurses...........

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  • michael stone

    'Whilst there may be many truths in the CQC reports I have seen so far, it appears that some of the assessors are not clinicians, and often don't contextualize their criticisms.'

    Just to throw this in, I heard the CQC's boss on radio 4, and she pointed out that the CQC 'takes along experts and nurses on its visits to hospitals'.

    But ther emight be something in this comment from an earlier poster:

    'I spend most of my time doing audits, providing assurance and attending meetings when I should be out there educating and supporting staff.'

    I do think there are 'measurement of outcome' issues at play here, which lead to lots of paperwork, much of it measuring things which can be measured, but which are not necessarily the best indicators of good care provision (because some of those things cannot be easily measured, in any standardised top-down way).

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  • Michael, just to throw in even further, not always they don't. Often they are simply civilians (as in non clinicians or experts) with clipboards and tick boxes to fill in, who come for a very short time to get a brief snapshot, without seeing or understanding the wider picture.

    It would be the equivalent of you or I going to say a school (for example, assuming that you have as little knowledge of professional teaching as I do), sitting in one lesson, and then issuing a report that covers every teacher and the entire school, not to mention all the other schools in the area once we issue a statement 'pupils are not being taught x properly'.

    Not very reassuring, is it?


    Anonymous | 14-Oct-2011 1:25 pm well said. I also saw Lansley on QT last night and enjoyed the verbal kicking he got (not that it will make a bit of difference), every single thing he said was shown up to be a lie or half truth or just plain wrong! I was shouting at the telly egging the GP on!!! And did you see the condescending look he gave that woman in the audience when she said she didn't trust him! Ha! Says it all really. Oh, and as for the demonstration outside QT against Lansley and to protect the NHS, I didn't know about that beforehand but bloody good show, well done!!

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  • Before commenting I'd just like to say that I have been a nurse for 25 years and still work on the front line.

    With regards to CQC not being clinicians, it doesn't take a clinician to know when a person's food has been left out of reach, they have no access to water or assisting someone to the toilet with their underwear exposed for all to see is undignified. It is not the job of the CQC inspector to find out why these things are occurring, they are there report on these incidences and to take further action if necessary.

    Don't get me wrong, wards are understaffed and often have a poor skill mix however, surely it is better to highlight areas where care is inadequate.

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  • Anonymous | 14-Oct-2011 7:10 pm

    I agree with you to a point (I too am on the front line and have just totted up my 30th year).

    There is no doubt that, "... it doesn't take a clinician to know when a person's food has been left out of reach, they have no access to water or assisting someone to the toilet with their underwear exposed for all to see is undignified." And it is vital to highlight inadequate care. Equally important is to identify and remedy the reasons for the inadequate care, not just lay it at the feet of the nursing staff (which is what always happens). Until the underlying causes are identified and dealt with, nurses will continue to find themselves in dangerous work situations where their ability to care for vulnerable patients is seriously compromised. Nurses themselves have to take responsibility and act to bring an end to the intolerable sets of circumstances that result in these situations. The problem is that we put up with far too much and allow idiots to dictate how we work, with disasterous results for patient care.

    "It is not the job of the CQC inspector to find out why these things are occurring....."

    Actually, it is a part of their role to find out why these things are occurring and to report upon their findings. However, they don't have a good record of being terribly effective at this.

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  • tinkerbell

    if ever there was a time to stand up and speak out it is NOW. Seize the moment with all this bad press. The managers who allow their wards to be permanently short staffed should be held to account. I hope the CQC take them to the cleaners. If ever there was a time to advocate for the patient it is now, say 'NO' i am not prepared to continue working without enough staff to provide decent care to my patients. I am not prepared to put my registration on the line and pretend everything is OK when it isn't. Once the staffing ratios are establised that allow nurses to provide the care that is needed then there will hopefully be no more excuses for nurses who don't care to spoil it all for the nurses who do. I would rather work with 3 staff who have good attitudes than 6 staff with bad attitudes, it is about having enough good staff that's a definite but it is also about having staff who care. Thankfully the majority do and it is the majority who must now speak out and say 'give me the tools and i will do the job'. Nurses who are prepared to go above their line managers if this does not happen, nurses who are prepared to say 'No' and not 'yes' when patient care and safety is compromised and not just be nodding 'yes' men and women. It is the nurses who have to do this because left to some managers this is never going to change. It has been a management culture for far too long it now has to be a nurse culture. When we were particularly short staffed a manager once told me all the things i should have done before she arrived etc., and added 'you have to be able to do difficult'. I told her 'don't talk to me about difficult, i've done difficult for over 20 years, but coping is not the same as caring. Now i am busy with the patients, excuse me'. I then nearly ran her over with my meds trolley whilst we both stormed off, but the message got through. I wasn't left short again on a regular basis. It's not easy standing up to managers who leave you short on a regular basis but it has to be done. Tell it like it is, ask them to give you a hand, roll their sleeves up, that will give them food for thought. I am fed up to the back teeth of hearing nurses saying 'we coped' because they are not doing our profession any favours if they never took it any further than that. Stop being a martyr. Find your voice. I realise that it is hard to speak out, i realise we don't all have the same confidence levels, but if you never practice being confident no matter how much your knees may be knocking then you will never acquire this skill and will remain a tiny voice in the wilderness. Fake it until you make it. Be Bold, speak up, make a fuss otherwise nothing will ever change. Remember you are doing it all for the right reasons, the patients. The managers are there for the patients too even if they don't realise it. We are all there for the patients, they are not there for us. It has never been a better time to give the managers a run for their money. Just off for the early now with enough staff on my shift to do the job.

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  • It really doesn't matter how well trained a 'qualified' nurse is, if s(he) isn't really interested in her patient's well being, and is only conerned about doing as little as possible while 'on duty'. the NHS will surely become a relic of the past.

    My generation - those of us who were fortunate enough to have been born in 1947 were most fortunate to have, greatly, benefitted from the introduction of the NHS.

    Alas, over the past 20 years or so it has been inciduously degenerating into the present sham it is today.
    Unless you are privaleged to get 'private ' health care, and can 'jump' the long queue of waiting times, by the time you are offered any treatment, it is too late!

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  • Anonymous | 15-Oct-2011 1:40 pm "if s(he) isn't really interested in her patient's well being, and is only conerned about doing as little as possible while 'on duty'", It's a damn good job those like that are in the minority then isn't it? Just as I am sure bad Policemen, or Firemen, or Doctors, or Teachers are in the minority. The MAJORITY of Nurses DO give a damn!

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  • Nurses owe a duty of care...........
    Stop whinging and excercise it.
    You are also on a register to practice and are fully accountable for your actions and non actions.
    You can only hold yourselves responsible for the shortcomings in the delivery of good care. Stop blaming uncle Tom Cobbley and all.
    Identify your priorities.....THE PATIENT...and their needs....meet those needs and refuse to do the "paper work" you all find so unnecessary and time consuming.
    Look at the NMC code of conduct, work within it and wave it under the "managers" noses.
    I wish you all luck, 'tis no easy task to refuse to do extraneous work and concentrate purely on nursing but it is possible. You have to be tough, brave and gutsy
    To give good nursing care to a high standard will never bring your fitness to practice into question.
    So go sock it to them.
    And you "managers" hang your heads in shame. For surely your meek compliance is a major contributory factor.
    And who am I you may be asking...???
    In two weeks I retire after 43 years nursing. I have loved almost every minute. If I had to go back in my life I would do it all again.
    (I can hear you Mike..silly old biddy your'e saying) but I am still a go getter.
    During my career I nursed and nursed well. I was teaching for a few years and then returned to clinical practice. I then entered nurse management and during those years I fought tooth and nail for nurses ( I always won)
    In the end my love of clinical practice won through and I returned to that arena and have loved it.
    I am still a force to be recond with, I give good care, I play patient advocate right down the line and have EARNED respect from my colleagues at all levels.
    I am not wanting to "blow my own trumpet here" I am just trying to point out, from personal experience, that what you want can be achieved. You have to be TOUGH, BRAVE and GUTSY.
    I wish you all luck in your pursuits...judy

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  • Anonymous | 17-Oct-2011 2:32 am

    Nurses owe a duty of care...........
    Stop whinging and excercise it.

    Quote "Identify your priorities.....THE PATIENT...and their needs....meet those needs and refuse to do the "paper work" you all find so unnecessary and time consuming".


    Unfortunately the NMC CofPC clearly states;

    Record keeping: Guidance for nurses and midwives

    42. You must keep clear and accurate records of the discussions you have, the assessments you make, the treatment and medicines you give and how effective these have been

    43. You must complete records as soon as possible after an event has occurred

    44. You must not tamper with original records in any way

    45. You must ensure any entries you make in someone's paper records are clearly and legibly signed, dated and timed

    46. You must ensure any entries you make in someone's electronic records are clearly attributable to you

    47. You must ensure all records are kept securely

    So its a loose/loose siutation, however....... perhaps every nurse should adopt the NMC's CofPC # 34. You must report your concerns in writing if problems in the environment of care are putting people at risk"

    With a plethera of concerns in writing perhaps nurses could tie institutions "the NHS and the NMC" up!

    Just a thought

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  • Anonymous | 17-Oct-2011 2:32 am

    You made an assumption that people are doing nothing other than expressing their opinions here. In 43 years, I would have thought that you might have been a bit more enlightened and realistic. Apparently not. Many of us are raising our voices in our workplaces on a daily basis,have been doing so for years and will continue to do so. There is nothing wrong with letting off steam on these threads. So why don't you give the hard-working, courageous individuals on here a break. And it isn't about blaming Uncle Tom Cobbly and all. It is about identifying the issues, policies,individuals, etc which cause the problems in the first place.
    As for not wanting "to blow my own trumpet here", an incredible amount of blow-bagging was evident throughout your post. Points deducted for that I'm afraid.
    However, I do wish you well in your retirement.

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  • 19 October 2011

    Dear Nursing Times

    I am a grateful patient, and am not a nurse or healthcare professional or anything to do with medicine at all.

    The debate ongoing has much to do with the burden of care provided by overstretched staff having to cope with several issues at once. It appears that many more people are needed in order to provide care to the vulnerable patients in hospitals than are currently on duty at any one given time in our National Health Service.

    Mistakes can cost lives and I agree that nurses do not go into the profession in order to be careless. Unfortunately mistakes can and do happen - I have firsthand experience of this with a relative.

    In order that mistakes do not happen so often, I believe that there should be a NATIONAL policy on ALL care provision because at present there is not just one policy, for example, for "Do Not Resuscitate".

    In consequence a nurse might be working as a bank nurse in, say, 3 different hospitals in any 3 weeks, and find him/herself bemused by what the EXACT DNAR specifications are for that particular Trust.

    This surely is so serious an issue that policy-makers should be urged to have just one standard Department of Health DNAR policy across the whole of the NHS and across the whole country irrespective of whether it is private or NHS policy. Yet the DH seems reluctant to look into such a National Policy. Why not?

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