There is much breast beating about this issue, and people asking how can this happen, and who is responsible. Like many things, it is caused by a variety of subtle trends.
Hospitals are gearing themselves up for making profits. That is what the New NHS is all about, and profit occurs when you can keep costs down. The huge majority of costs in any healthcare system is staff costs. The usual way for hospitals to achieve this is to employ less qualified people, and fewer people. The ratio of properly qualified nurses to patients is very bad in UK hospitals, and the nurses there are spread more thinly. This is one problem. As a result of this, the wards are increasingly staffed by Health Care Assistants who cannot perform some nursing duties, but who look like nurses to the lay person. That puts more pressure on qualified staff.
Secondly, as there are fewer hospital beds, all the in-patients are iller, and require more nursing care. Also, as soon as one patient leaves, then another one gets put in their bed,
Thirdly, the requirements of the hospital legal departments are such that the paperwork is phenomenal, and each admission and discharge results in reams and reams of paperwork, much of it 'cover-your-ass' paperwork.
Fourthly, and I believe this is more subtle; there is a change from somewhere being called a hospital, to being called a trust. The management is much more aggressive, and there is much less of a feel of a community of people working for their local hospital, and a feeling of pride in your hospital.
All of these trends will be exaggerated by the latest top-dowm changes.
Hospitals these days are no longer seen to be places where the sick are cared-for and nurtured back to health, but much more a trial to be endured.
This month it is Royal Free, Worcestershire and Ipswich.
Next month it could be a hospital near you.
10 comments:
Well, yes. And no. That is, it's a problem of long standing. And it exists in Wales too, and is likely to get worse as the NHS in Wales loses funds
http://powysweb3.ruralwales.net/~cmsadmin/www.olderpeoplewales.com/index.php?id=16
(I am opposed to privatization.)
-- sorry to be anonymous at 14:02. I find the blogger signin options a bit unwieldy.
There is a distinct lack of evidence here (one link to a blogpost), disappointing given that the author is a medic and professes to study evidence before writing.
I am no defender of the govt's reforms, however quite how you manage to link patients not being given water to drink with a lack of qualified staff is beyond me.
If there is one thing that HCAs can do (and in fact there are many), it is to provide water to patients and attend to other basic hygiene and nutrition requirements. You don't need a nursing degree to do that. The fact that this isn't happening is down to poor clinical and nursing management at the trusts concerned. Many trusts inspected, including FTs, performed extremely well on the CQC inspections.
As your one link demonstrates, the requirements to document properly and clearly are universal. Might be painful, but it is cheaper than being sued and losing because you couldn't be arsed to write things down properly. Nice to see there is more admin support in the US - perhaps because the hospitals there charge more than hospitals here are allowed to.
If you have a link to a proper analysis of nurse/patient ratios across different countries that would be genuinely useful and interesting.
If there might be patients on the ward who were NOT allowed water (e.g. in an adult, hence mostly elderly, medical ward there might well be patients with a degree of kidney failure?), then I dare say the HCA might not be allowed to give water...
...or at least not without being explicitly told it was OK by someone deemed qualified to read the notes or instructions, understand why the regimen was as it was, and make the decision appropriately... like a properly qualified nurse?
Just a guess. Interested to hear if any medical/nursing insiders agree.
Sorry, anonymous, but these are observations based on stories told to me.
This is not based on a close study of evidence - those kind of columns are elsewhere.
I just know that lack of staffing and increased bureaucracy are key factors.
JD
Clearly, JD, you have never heeded anything Militant Medical Nurse has had to say over the years. All down to piss-poor clinical management.
I'm not sure there is any clear-cut economic model that will fix the problem. In the US, any hospital that accepts the federal insurance for the elderly, Medicare, has to see everyone in the emergency room regardless of ability to pay. And that goes for any and all consultants and admitting physicians, during the hospitalization. A compassionate idea that has resulted in markedly decreased availability of specialty coverage, cuts in nursing staff and closure of hundreds of emergency rooms. When that wasn't the rule, some folks were turned away due to lack of money to pay private facilities, and there were obviously bad outcomes. Perhaps a happy medium exists. But perhaps other factors are at play. We we live longer, we successfully manage far more complex medical problems than ever, we have greater (and often false) expectations of medical science, families are less likely to care for the elderly at home and we have, as a civilization, a somewhat confused secular morality for caring for the infirm and vulnerable. It's a tough problem on both sides of the Atlantic, I can tell you!
Anonymous at 16:23 - you make it all sound so simple?
Why haven't the dim nurses worked it out for themselves - there are either a lot of very bad people out there, or other factors (the sort mentioned by JD) seem to be having a profound influence on the way patient's are nursed in hospitals nowadays?
Incidentally, although one of the three shamed hospitals (the Royal Free) apparently has terrible nursing care it was recently voted the best large trust and twice had the countries lowest mortality rates.
Oh, it's all so confusing - I thought low mortality was an indirect reflection on the way patients were looked after on the wards?
http://www.times-series.co.uk/news/8718577.Royal_Free_wins_Trust_of_the_Year_award/
JD is right. The other problem is just how long it takes to get an elderly, frail confused person hydrated. It can take over 2 hours of trying without stopping to get three sips of water into a patient like that, and two of those three sips will get spit back at you. 2 nurses and 2 care assistants cannot pull this off for 30 patients. It takes the care assistants 4 hours just to turn everyone once. They have to answer bells etc etc.
Its not as simple as just sitting with granny for five minutes and giving her a drink. I wish it was.
In order to prevent malnutrition, pressure sores, and dehydration in elderly patients they really need one to one care. That is not going to happen in the NHS. Ever.
"Hospitals these days are no longer seen to be places where the sick are cared-for and nurtured back to health, but much more a trial to be endured."
Well said. There are even patients who told me that hospitals are not fitted for the sick, ironically. Hope that there would be a change in the medical industry with regards to this issue, eh.
Thanks for sharing,
Peny@medical uniforms
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