NHS staff shortages are compromising patient care

New report from the Royal College of Nursing calls for urgent review of Nurse staffing levels to ensure patient safety this winter. 

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Image source: http://www.rcn.org.uk

The Royal College of Nursing (RCN) has today published a report, Safe and Effective Staffing: Nursing Against the Odds which shows the results of a recent staff survey. The survey, carried out in May 2017  reveals more than half (55%) say shifts did not have the level of nurses planned, and that shortages were compromising patient care (53% ).

Nursing staff in all four UK countries were asked about staffing levels on their most recent shift and the quality of care provided. More than a third (36%) report having to leave elements of patient care undone due to a lack of time, while two thirds (65%) work an unpaid extra hour on average.

Seven in 10 nurses (71%) in England said their last daytime shift exceeded NICE guidelines, which states that more than eight patients to one nurse should act as a ‘red flag’. A quarter (26%) reported shifts with 14 or more patients per nurse.

The respondents also reported that:

  • patients are no longer afforded enough dignity, even dying alone;
  • colleagues have burned out and have become sick themselves, unable to come to work;
  • staff leave work “sobbing” at the impact of shortages on patient care;
  • many question their future in nursing and contemplate leaving the profession;
  • they struggle to give their children and families enough support after shifts that can exceed 12 hours.

Full report: Safe and Effective Staffing: Nursing Against the Odds

Royal College of Nursing: Urgent action needed to tackle staffing crisis

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Number of NHS beds more than halved over the past 30 years

The number of NHS beds has fallen by half in 30 years, and plans for further cutbacks are “unrealistic” | The Kings Fund

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A study from The Kings Fund has found that bed numbers – including general and acute, mental illness, learning disability, maternity and day-only beds –  have dropped from 299,000 to 142,000 since 1987.  Hospitals in England now have the least number of beds for their population compared with any other country in the European Union, with just 2.3 per 1,000 people.

The report explains that this decline is in part due to factors such as an increase in care being delivered outside hospitals. It also highlights the impact of medical innovation including an increase in day-case surgery, which has also had an impact by reducing the time that many patients spend in hospital.

The report however warns that there are signs of a growing shortage of beds. In 2016/17, overnight general and acute bed occupancy averaged 90.3 per cent, and regularly exceeded 95 per cent in winter, well above the level many consider safe. The authors state that in this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.

Full report: NHS hospital bed numbers: past, present, future

Adult and older adult mental health services 2012-2016

Adult and older adult mental health services 2012-2016: An analysis of Mental Health NHS Benchmarking Network data for England and Wales | Centre for Mental Health

The number of acute inpatient beds for adults with mental health problems in England and Wales fell by 15% between 2012/13 and 2015/16 while specialist community mental health services also reduced by about 6%, according to a new briefing published today by Centre for Mental Health.

The briefing, Adult and older adult mental health services 2012-2016, analyses data collected by the NHS Benchmarking Network since 2012/13 up to the publication of the Five Year Forward View for Mental Health.

The briefing finds that while psychiatric acute inpatient beds for adults fell by 15% between 2012 and 2016, and staffing levels fell by 20%, the number of people admitted and the time they stayed in hospital did not change. This means that bed occupancy levels have risen to an average of 94%.

During the same time, community mental health service provision fell slightly: the number of people on community team caseloads reduced by 6%, staffing levels fell by 4% and contacts reduced by 7%. By contrast access to psychological therapies rose rapidly, reaching some 900,000 people a year by 2015/16.

Full report:  Adult and older adult mental health services 2012-2016 

 

Children and teens let down by mental health inpatient services in England

Inpatient provision for children and young people with mental health problems. Emily Frith | Education Policy Institute | via OnMedica

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Image source: epi.org.uk

A report from the Education Policy Institute has found that 12% of  child mental health inpatient units failed to meet basic requirements for staff to patient ratios.

Nearly a quarter (24%) of units struggle to employ permanent staff – up from 17% since 2014/15. Temporary bank and agency staff make up 19% of child mental health inpatient pay costs.

Staff shortages affect the quality of patient care, so a sustained focus on recruitment of skilled staff to work in child and adolescent mental health services is needed, recommends the report.

The report also found:

  • inpatient mental health services for young people on average fail to meet 7% of minimum quality of care standards
  • The issue of bed shortages can mean that children with mental health problems are admitted to adult wards
  • Eating disorders were the most common reason for a young person being admitted to hospital in 2015/16
  • Young people are being left in hospital for longer than necessary due to a lack of community services with the trend getting worse – the number of delayed discharge days in December 2016 – February 2017 42% higher than in the same period the previous year

Full story at OnMedica

Download full report: Inpatient provision for children and young people with mental health problems.

Costs of inpatient falls in hospitals

This review provides an overview of the scale of inpatient falls and the benefits to the NHS if the rate of falls was reduced in hospitals.

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As part of NHS Improvements work to reduce harmful inpatient falls and improve patient safety, the review helps answer the following questions:

  • What is the incidence of inpatient falls in hospital in England?
  • What are the estimated costs hospitals incur as a result of inpatient falls?
  • What are the potential cost savings from reducing falls by implementing well-evidenced multidisciplinary interventions?
  • What are the potential savings to hospitals from taking these actions?

Full report: The incidence and costs of inpatient falls in hospitals

Dementia care in hospitals

National Audit of Dementia Care in General Hospitals 2016-2017: Third Round of Audit Report | HQIP

This report presents the results of the third round of the National Audit of Dementia (NAD) with collected data between April and November 2016.

The National Audit of Dementia (care in general hospitals) measures the performance of general hospitals against criteria relating to care delivery which are known to impact upon people with dementia while in hospital.

The previous (second) round of audit, (reporting in 2013), showed that while significant progress in the care provided to people with dementia in general hospitals had taken place, some aspects of care still needed to evolve.

The full report and findings are available to download here

Communication difficulties experienced by deaf male patients during their in-hospital stay

Studies available have described several specific issues affecting healthcare accessibility by deaf people, but to date, no research has reported the experience of deaf patients with in-hospital communication | Scandinavian Journal of Caring Sciences

The aim of the study was to explore the communication experience of deaf patients with regard to their in-hospital stay. A purposeful sample of participants was selected. The data collection process was based on a focus group. The focus groups were conducted in Italian sign language and videorecorded; subsequently, the entire conversation was faithfully transcribed. A qualitative content analysis of the transcription was performed and the findings are reported using the Consolidated Criteria for Reporting Qualitative Research approach.

Four themes have emerged:

  • experiencing a common vulnerability: the need for reciprocal understanding and sensitivity,
  • being outside the comfort zone: feeling discriminated against once again,
  • perceiving a lack of consonance between care and needs and
  • developing a sense of progressively disempowerment.

The experience of deaf individuals during their in-hospital stay may be critical: they are exposed to protracted communication and interaction with healthcare providers and an environment that is not prepared and designed for these vulnerable patients. Two levels of strategies should be identified, implemented and developed to increase the quality of communication with deaf people during hospitalisation, both at the hospital/health system level and at the healthcare professional/clinical level.

Full reference: Sirch, L. et al. (2017) Communication difficulties experienced by deaf male patients during their in-hospital stay: findings from a qualitative descriptive study. Scandinavian Journal of Caring Sciences. Vol. 31 (no. 2) pp. 368–377