Sunday 20 April 2014

Nurses at the end of their tether.


 

 

I’m grateful to Carole for telling me about a Guardian article which refers to this UNISON (Health Workers Union) report. Here’s their press release;

 

14 Apr 2014 10:00

NHS nurses reaching danger point

A new survey of almost 3,000 nurses from across the UK reveals a health service under severe strain, with 65% of staff saying that they did not have enough time with patients and 55% reporting that as a result care was left undone.  This is despite the fact that 50% worked through their breaks or beyond their shift.

The survey - undertaken on Tuesday 4 March - shows a typical ‘day in the life’ of the NHS. The majority (60%) felt that the number of staff working on the day resulted in a lower standard of care and more shocking still were statistics showing that 45% of nurses were caring for 8 or more patients 

Despite the many recent investigations into the NHS, the survey report* – Running on Empty – exposes clear failings to improve staffing levels. The impact on patients was plain to see. A worrying 48% of respondents described their organisation as either being at risk of a similar situation to Mid Staffs, or stated that it was already happening inparts, or across their hospital. 

UNISON’s report highlights research that demonstrates the clear link between appropriate patient staff ratios and patient mortality. Independent evidence shows that nursing cutbacks are directly linked to higher patient death rates in hospitals. In addition, when a nurse or healthcare assistant is responsible for eight or more patients, harm is occurring.

Gail Adams, UNISON Head of Nursing, said:

“One of the most damaging findings of this survey is how little has changed since last year.  Despite all the Government rhetoric, despite the Francis, Keogh and Cavendish reports, the spectre of another Mid Staffs still looms large over the NHS. Progress on safe staffing levels has been glacial and that means poorer care and patients still at risk. 

“It’s clear that despite nurses working through breaks and beyond their hours, they simply do not have enough time to give patients the care and attention they need.  That is distressing for patients and for the staff trying to care for them.  The Coalition Government needs to face up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse to patient ratios, and take urgent action.”

The over-use of bank and agency staff is also exposed in the survey with 45% of staff reporting that they worked alongside one or more agency/bank workers. UNISON has always supported their use to cover holidays or unexpected gaps, but the regular use of these staff is not cost effective or in the best interests of patients.

The union points to anecdotal evidence that some hospitals draft in bank or agency staff for the duration when they are expecting a CQC inspection. 

Gail Adams, went on to say:

"Relying on bank or agency nurses because of understaffing is a false economy.  It is frustrating for existing staff because they are often unfamiliar with the ward and it is unfair on patients who experience a lack of continuity of care.  The answer is to ensure that there are sufficient established nursing posts to provide safe dignified and compassionate care."

 Key Findings

·         Three quarters of all midwives and 71% of all nurses (general and mental health) said they did not have adequate time with each patient.

·         59% of all nurses on a night shift said there were elements of care they were unable to give.

·         92% supported minimum staffing levels, with 65% supporting a legally enforceable minimum.

·         45% of staff were looking after 8 or more patients during their shift, this increased to 53% on night duty.

·         Despite National Quality Board guidance, only 24% of workplaces displayed indented number of staff on duty.

·         Just over half (51%) were not confident about raising concerns locally, which, in a post Francis era, is worrying.

Some typical comments taken from the survey findings:

“I have been pressured to take admissions when due to lack of staff it has not been safe to do it.”

“On occasions, staffing levels are bordering on dangerous.  We are in a Mid Staffs situation and I don’t believe we are the only ones.”

“Both my staff and I frequently have to work alone which is very unsafe.”

“I did not feel able to provide the type of care I would have liked to the patients.  It felt more like a conveyor belt.  No compassion, little dignity, I left at the end of my shift feeling distraught and that perhaps I have made a huge mistake training as a registered nurse.”

“My department is running at VERY UNSAFE levels due to inadequate staffing.”

 “I am the only qualified nurse on a 13 hour shift, so I don’t get a break during these shifts.  You get tired. It’s unsafe. 

“Some shifts are now 100% bank staff.”

“We have patients that need to be monitored closely following procedures or during therapy, with many needing to be checked on an hourly basis.  That cannot be done when there is a ratio of one nurse to 11 patients.

“I felt I was being bullied to take extra patients from A&E.”

Staffing levels in the NHS will be debated at the UNISON annual healthcare conference in Brighton between 13-15 April 2014. 

ends 

Notes to Editors

UNISON is sharing details of any hospitals named as having failings on a par with Mid Staffordshire Foundation Trust with the Care Quality Commission prior to publication of the survey. 

The areas of care in which respondents worked on 4 March covered the whole spectrum of healthcare.  This included A&E, paediatrics, elderly care, community mental health, critical care, general practice, learning disabilities, medical, mental health (inpatients as well as secure unit) obstetrics and gynaecology, surgical, rehabilitation and theatre.

The report, "Running on Empty – NHS staff stretched to the limit" is available

Neil Harris

(a don’t stop till you drop production)
Home:  helpmesortoutthenhs.blogspot.com
Contact:  neilwithpromisestokeep@gmail.com

Friday 18 April 2014

More worries about NHS wrongly coding Mortality rates.


m

It’s Ok, Boss -

I’ll Cooka Da books

 

I’ve taken this article from The Daily Telegraph today; it deals with the worrying tendency for hospitals to train their ‘coders’ to alter the way deaths are recorded in their statistice. The government requires that certain outcomes (that is patients who who die) so that hospitals can be compared and bad practises spotted.

However if you come in for a hip replacement but you also happen to have cancer, your death can be recorded as ‘palliative’ (you died of cancer) even if it was really a badly performed hip replacement that was the real cause.

It means the hospital can improve its figures even if ‘outcomes’are getting worse.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
Percentage of deaths coded as palliative
2008
2009
2010
2011
2012
Increase
East and North Hertfordshire NHS Trust
9.92%
12.31%
29.05%
38.84%
43.25%
33.33%
Guy's and St Thomas' NHS Foundation Trust
1.18%
13.89%
32.47%
31.25%
31.65%
30.47%
King's College Hospital NHS Foundation Trust
8.71%
17.49%
28.12%
40.09%
38.36%
29.65%
Royal Liverpool and Broadgreen University Hospitals NHS Trust
1.35%
9.91%
20.56%
21.91%
29.23%
27.88%
North Middlesex University Hospital NHS Trust
4.76%
10.04%
17.42%
22.58%
31.48%
26.72%
Ipswich Hospital NHS Trust
2.14%
3.65%
7.77%
9.33%
28.61%
26.46%
Central Manchester University Hospitals NHS Foundation Trust
11.34%
6.25%
10.68%
10.12%
36.63%
25.29%
Buckinghamshire Healthcare NHS Trust
7.56%
8.92%
24.64%
29.28%
32.13%
24.57%
Ashford and St Peter's Hospitals NHS Foundation Trust
0.32%
7.24%
4.00%
17.60%
23.04%
22.72%
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
9.91%
16.77%
32.21%
23.85%
32.52%
22.61%
Hinchingbrooke Health Care NHS Trust
1.48%
4.27%
26.24%
29.96%
22.10%
20.62%
James Paget University Hospitals NHS Foundation Trust
2.44%
4.06%
15.73%
22.63%
22.50%
20.05%
Epsom and St Helier University Hospitals NHS Trust
4.82%
16.06%
21.27%
22.18%
24.42%
19.60%
Aintree University Hospital NHS Foundation Trust
19.24%
20.18%
33.18%
39.87%
38.05%
18.82%
Sandwell and West Birmingham Hospitals NHS Trust
2.76%
0.74%
3.89%
19.24%
21.53%
18.77%
Frimley Park Hospital NHS Foundation Trust
9.51%
18.36%
16.67%
17.88%
27.89%
18.38%
South London Healthcare NHS Trust
8.04%
13.22%
24.46%
26.03%
25.95%
17.91%
Salford Royal NHS Foundation Trust
12.36%
20.89%
25.94%
29.89%
30.19%
17.83%
Peterborough and Stamford Hospitals NHS Foundation Trust
2.79%
15.04%
20.69%
17.44%
20.05%
17.26%
Milton Keynes Hospital NHS Foundation Trust
2.59%
10.98%
13.35%
8.83%
19.59%
17.00%
National Average
9.11%
14.35%
15.53%
16.05%
17.24%
8.13%

 

 

 

 

Telegraph.co.uk

 

Friday 18 April 2014

         

 

Fears that hospitals are covering up death rates

 

New data triggers fears that hospitals are 'fiddling the figures' on hospital deaths by increasing the number of deaths recorded as 'palliative' - classed as expected because a patient was terminally ill.

 By Laura Donnelly, Health Editor and Telegraph interactive team

Hospitals have been accused of “fiddling” their death rate figures by claiming patients were terminally ill, after new figures showing dramatic changes in the way mortality is recorded.

 

 

The NHS data shows a five-fold rise in the proportion of deaths being “coded” so that they barely count towards hospital mortality statistics - with some trusts now recording one in three deaths as a “palliative” case.

 

 

Last night experts said they were troubled by the “deeply concerning” trends, fearing hospitals could be hiding the fact patients had suffered poor care which contributed to their death.

 

They said the scale of the misreporting was such that it could even hide “another Mid Staffs” scandal.

 

 

Every NHS hospital has to collect and publish data showing how its death rates compare with what would be expected.

 

Crucially, if a case is coded as “palliative” it barely counts towards the rate, because it is classed as an expected death.

 

The code is only supposed to be used when a patient’s death in hospital is an inevitable consequence of their condition - such as that from a terminal illness.

 

Now new figures have triggered concern that the code is in fact being used to disguise many more deaths.

 

Data from health analysts Dr Foster shows that, across England in 2012/13, 36,425 deaths were coded as palliative. That was 17.3 per cent of the total number of deaths - twice the number recorded in 2008 and five times the 3.3 per cent of deaths recorded in 2006.

 

Roger Taylor, director of research at healthcare analysts Dr Foster Intelligence, which produced the data, said there were “real concerns around the gaming of indicators”, adding: “Whether or not you are doing it deliberately, the end result is that the variation in coding may disguise poor outcomes.”

 

He said: “The trends we are seeing are troubling - they are deeply concerning. Poor quality data is harming patients because you can’t see where things are going wrong. If the data is not being recorded consistently and, moreover, if that isn’t picked up because of a lack of auditing there is a risk that poor patient care is being disguised, and the public misled.”

 

Experts said that in some cases, patients were being counted as “palliative cases” when they had been admitted to hospital for a broken hip, but failed to recover.

 

Mr Taylor said he had called repeatedly on NHS officials to tighten the rules, and to audit such data, so that trusts could not manipulate it, but said nothing had been done.

 

“We’re worried this issue is not being given sufficient priority,” he said. “The bottom line is it could increase the possibility of failing to identify another Mid Staffs and potentially cost lives.”

 

Joyce Robins, from Patient Concern, said: “Hospitals are clearly fiddling these figures and that frightens me. Hospitals are just not open enough to admit what is happening - instead they dream new ways to disguise it. All the talk of transparency is just that - talk.”

 

Prof Sir Brian Jarman, Emeritus Professor of Imperial College London, an expert on mortality data, said: “I don’t think these very extreme changes reflect reality. I don’t think these hospitals have transformed into hospices to treat the dying overnight.”

 

Figures show that among the 20 NHS trusts with the steepest rise in palliative coding, between 2008 and 2012, 17 reduced their published death rate at the same time.

 

At East and North Hertfordshire trust the proportion of deaths which were explained as “palliative” quadrupled - from 9.92 per cent in 2008 to 43.25 per cent in 2012.

 

Over the same time, the trust’s death rate fell from 14 per cent higher than would be expected, to 3 per cent below.

 

At North Middlesex University Hospital trust the proportion of deaths coded “palliative” rose from 4.76 per cent to 31.48 per cent, the analysis shows.

 

Meanwhile, death rates fell from 6.8 per cent higher than expected to 12.2 per cent below.

 

At Guy’s and St Thomas’ NHS Foundation trust, the percentage rose from 1.18 per cent to 31.65 per cent.

 

At Kings College Hospital Foundation trust it rose from 8.71 per cent to 38.36 per cent, while at Royal Liverpool and Broadgreen University Hospitals NHS trust, the percentage rose from 1.35 per cent to 29.23 per cent.

 

Gary Walker, a former NHS trust chief executive who lost his job after raising concerns about patient safety, said the figures looked “very suspicious” warning: “In the NHS, if it looks like a trust is fiddling the numbers it probably is.”

 

Charlotte Leslie, a Conservative MP and member of the House of Commons health committee, said: “This is very worrying data. We already know that at the time of the Mid Staffs scandals, hospitals were fiddling the figures to massage their mortality rates.”

 

“These figures suggest that hospitals are still fiddling the figures to put their own reputation and that of their managers ahead of patient safety.

 

A Department of Health spokesman said: “The NHS needs high quality mortality data. We would expect that all NHS Trusts have robust auditing systems in place.”

 

East and North Hertfordshire trust said it was one of only a handful of hospital groups to run an NHS hospice and that a recent external reviews showed its coding was accurate.

 

North Middlesex University Hospital trust said the increase in deaths coded as palliative was due to better recording, as did Guy’s and St Thomas’ NHS Foundation trust which also said that as one of the largest providers of services for patients with cancer, it was to be expected that it would have higher than average rates of palliative coding.

 

Kings College Hospital Foundation trust said its rise was down to improvements recording palliative care. Royal Liverpool and Broadgreen University Hospitals NHS trust said it refuted any suggestion that changes were a result of any attempt to deliberately improve mortality rates, and said it coded palliative care patients with incurable diseases accurately.

 

In total, twenty trusts saw a rise of at least 17 percentage points in the number of deaths coded as palliative between 2008 and 2012, the statistics (listed in table above) show.

 

Ipswich Hospital said it its coding levels had been lower than average until a review of cases, which found too many patients in recepit of end-of-life care had not been properly recorded.

 

Buckinghamshire Healthcare NHS Trust said it had taken over the running of an 11-bedded hospice and that its palliative care team “work very closely with our acute wards and other inpatient community hospitals to ensure our end of life patients receive high quality care.”

 

Ashford and St Peter’s Hospitals foundation trust said the increase was a result of changes to palliative care coding criteria and improved record keeping and that it was “confident that our current data accurately reflects the trust’s specialiast palliative activity.”

 

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust said “Unlike most acute hospitals in the country, we have a specialist palliative care unit – our Macmillan Unit – on site. Locally more patients will appropriately spend the end of their life in our hospital because of the presence of this hugely respected facility.”

 

Hinchingbrooke Health Care NHS Trust said it became aware it was under-reporting palliative care mortality in 2009, and employed a palliative care consultant to jointly carry out an audit of coding practices with Dr Foster, which led to changes.

 

James Paget University Hospitals Foundation trust said the increases in coding were historical, and that coding had been improved after an external audit found the trust was not recording palliative care coding in line with national guidance.

 

Epsom and St Helier University Hospitals Trust said: “The percentage rise in deaths coded as palliative care since 2008 reflects increased education and training of clinical staff to communicate appropriate end of life care plans for the dying patient and better documentation in the patient notes.”

 

Peterborough and Stamford Hospitals NHS Foundation Trust said its coding department “works extremely hard with our palliative care team to ensure that documentation is clearly marked” and had improved the accruacy of its data, which accounted for the change.

 

Sandwell and West Birmingham Hospitals trust said it “has embarked on a programme of work systematically looking at the causes of death in hospital which has resulted in a substantial reduction in avoidable mortality.”

 

Aintree University Hospital NHS Foundation Trust said: “Aintree has an excellent palliative care service, as recently noted by an independent external clinical review. "

Neil Harris

(a don’t stop till you drop production)
Home:   helpmesortoutthenhs.blogspot.com

Contact: neilwithpromisestokeep@gmail.com