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Fitness to practise proceedings launched following CQC inspections


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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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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