This site is intended for health professionals only

Has the public lost faith in the NHS?

A recent report on Clostridium difficile outbreaks in an NHS trust makes disturbing reading. Are nurses really the ones to blame?

Marilyn Eveleigh
Consultant Editor

Have you read the recent report on the Investigation into the Outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust?* It makes uncomfortable reading, and the national press have already picked up the most sensational elements. It is a clear and systematic report, identifying elementary factors that contributed to the outbreaks. Photographs of ward sinks and soiled commodes complete the sheer disbelief that in this day and age we subject sick and vulnerable people to such standards and risk.
A significant element in the report on the 90 deaths was the role that qualified nurses played in providing safe patient care. It indicates that the trust management did not act upon a series of complaints, incidents and concerns about patient care, and failed to provide realistic staff levels.
It illustrates why an increasing segment of the public may have lost faith in the NHS to care for them safely. Patients and families had long complained about the attitudes of nurses who did not provide a proper level of care. The report records allegations that nursing staff:

  • Did not respect patient privacy and dignity. Some patients reported that they were shouted at and left unattended. Some alleged they were told to "go in the bed", and then left in their excrement for long periods.
  • Did not help with feeding and drinking. Dehydration was a material factor in two non-C difficile deaths in an internal performance report.
  • Did not complete charts and records accurately. An internal audit indicated that 49% of patients had no/incomplete fluids charts, 80% of food charts were not completed, and stool charts were used in under 15%.
  • Failed to give medication promptly and appropriately and ensure it was taken.
  • Failed to take proper precautions to prevent the spread of infection. Handwashing and use of protective equipment was not always adhered to.
  • Contributed to the development of bedsores by giving scant attention to skin care.

 Patients and staff considered the poor quality of care a consequence of overworked staff in understaffed teams with insufficient time to implement standards and monitor infection control processes. Patients and families reportedly recognised "exhausted nurses in despair, with their heads in their hands".
The trust relied heavily on bank and agency nurses that offered little continuity of care and made record keeping difficult. The national average for agency staff expenditure is 4.82% of the total spend on nursing; this trust's level was 9.22%.
Nurses reported having to work in addition to their contracted hours with a poor work-life balance and a workload that was more than they could cope with. The trust was in the worst 20% of all trusts for reporting high stress levels.
Posts were kept vacant to accommodate nurses from wards scheduled to close. However, closure delays prolonged understaffing and pressures.
Out of 40 comparable trusts, this had the highest levels of complaints about clinical care - demoralising for already despondent staff.
In addition, these nurses worked in hospitals with poor facilities. On some wards beds were too close together and with inadequate storage space, clean utility rooms were used as kitchens, and there were insufficient hand basins so infection control became increasingly difficult. The 90% bed occupancy meant that patients could be moved a number of times during their stay further fragmenting care and monitoring.

Lessons to be learnt?
Nurses were a key element in this investigation. The profession cannot ignore the implication on our reputation. The report makes it clear - achieving financial balance and hospital targets must not compromise staffing levels and the quality of patient care. Nurses and nursing leaders must act upon this.
You should read the report for yourself - it reminds us of our role as the patient advocate in a huge healthcare system that often exhausts us to silence.

Your comments: (Terms and conditions apply)

"I have just read the very interesting article in issue 39 of NIP.  I must agree that the standard of some nurses appear to have dropped from when I was working in hospital. Admittedly times have changed and I have been nursing 30 years, I do not like what I see or hear! I am fortunately working in a GP practice and am so glad not to be working in hospital. I would not beable to look after the patients the way I was trained to. I don't know what is going wrong, is it the way they are trained now? More emphasis on degrees and diplomas not people, sick people! I have heard so many stories from my patients of their experiences in hospital. Not getting washed, not being fed.  Relatives looking after patients always having to check on things etc..  Perhaps we need to go back to the way nurses were trained, or the type of people that are going into nursing  need to be selected better. Or perhaps it is the way people are becomming in general. But something needs to be sorted out as it is quite frightening to think you may need to go to hospital." - Teresa Hooper, PN

"I work in Raigmore Hospital in Inverness where standards remain extremely high compared to trusts south of the boarder. I notice that because of comments from staff previously employed in England and now relocated in Scotland. Wards are busier and busier and the role of the manager is continually changing with them having a patient workload also leaving them unable to assess, guide and support staff." - Name and address supplied

"As a practice nurse I frequently come into contact with people recently discharged from hospital. Nearly always they tell me how poor the nursing care was and at times how they felt that "no-one cared". Where is the ward sister in all this? I can understand that staffing levels are often poor and I believe that morale is at rock bottom but dear Lord, someone has got to ge  a grip and get nursing back where it should be.... caring" - Name and address supplied