20 January 2014 — WSWS
Royal Bournemouth and Christchurch Hospital (RBH) NHS Trust, delivering care to a population of more than half a million people, is the latest Trust to be criticised for delivering inadequate care.
A report by the Care Quality Commission (CQC) of a three-day inspection by a team of doctors, nurses and other experts confirms the warnings about the developing crisis in the Trust made in September 2012 by the NHS FightBack campaign, and published on the World Socialist Web Site. At the time RBH was one of a number of NHS Trusts in the south west of England that had set up a Pay Consortium or cartel seeking to reduce wages by 10 percent. Its aim, eventually successful, was for health service trade unions to agree to changes to nationally negotiated wages and conditions. RBH Chief Executive Tony Spotswood cynically claimed the changes were necessary “to drive up the standards of care,” to “provide best services for patients “and “to improve patient care.”
NHS FightBack stated that “in order to meet the government’s targets, resulting in an £8.5 million operating surplus, the Trust has shut down several wards in Bournemouth and Christchurch hospitals during the last two years creating a constant bed crisis. Essential services relating to patient care have been curtailed by reducing staff numbers through natural wastage and recruitment freezes.”
The CQC findings have refuted Spotswood’s lies and claims by the unions that concessions to the employers will help protect public services. Summarizing, its chief inspector, Professor Sir Mike Richards, said, “Whenever we inspect we will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people’s needs? Is it well-led?
“At Royal Bournemouth Hospital, we were told about basic nursing care which was not being given to patients on two medical care wards. We heard from five patients who told us they had been left to wet or soil their beds.
“The hospital had a high occupancy rate and there had been ongoing use of escalation beds when a ward or unit was full–even though these beds could not meet patients’ needs properly.
“The trust did not employ enough staff, even though it was fully aware that nearly all its beds were occupied all the time. Some patients were still not receiving the care they needed in a timely manner, and there was an ongoing high risk of this continuing.”
The CQC revealed that there were 135 nursing and healthcare assistant vacancies at the end of September 2013 and that less than half had been filled by the end of October. The report highlights that “mandatory training for staff was not always delivered on time, or they were not always suitably trained for the areas in which they might work, for example dementia care and assessing whether a patient is able to swallow.”
The inspection found that care was not always safe: both doctors and nurses at times felt unsupported and under too much pressure due to poor staffing levels and unsatisfactory mix of skills in the areas where they worked.
On some medical wards, including those for frail older people, patients were at “risk of harm.” On surgical wards, junior doctors told the inspectors that the medical staffing level at night was not safe. In outpatients there were “risks of cross infection.”
Some of the services that were found to be safe included maternity, critical care, children’s care and end of life care.
With regard to medical staffing in the Accident and Emergency (A&E) department, the report found that it was short of one consultant, five middle grade doctors and six junior doctors. On some days there is not an appropriate paediatric nurse, placing children at risk. Due to lack of beds, patients were lined up on trolleys down the middle of the department.
The CQC findings prove that the Conservative/Liberal Democrat coalition’s funding cuts and privatisation policies have created significant shortage of staff, beds and lack of resources in A&Es. They disprove the attempts by the government and its apologists to attribute the crisis, which has affected many A&E units across the country, to the population seeking treatment in increasing numbers, for getting old, or becoming “confused” about existing services.
Some 26 NHS Trusts are predicting debts of £325 million in 2013/14. More than half a dozen NHS Trusts face bankruptcy and have been placed under “special measures.” Up to 22 NHS trusts are facing serious financial difficulties, as a result of expensive Private Finance Initiative schemes forced on them by the previous Labour government.
The NHS regulatory body, Monitor, has revealed that there are behind-closed-door talks about the current £20 billion “efficiency savings” being increased to £30 billion by 2021–almost a third of the current NHS annual budget.
In an analysis of all 161 acute hospital trusts in England–the most comprehensive ever carried out–the CQC declared last year that it was worried about aspects of care in 44 of them.
The RBH Trust has apologised to patients and relatives who received poor care, appointed two ward sisters on wards 3 and 26, which had severe failings in care, and announced that they have recruited 57 newly qualified nurses in order to appease the public.
Steve Simpson, whose mother died because of poor care in ward 3, said, “After what happened we were told the sister on that ward had been changed but the sister was good, it was the people running the place who were responsible for the lack of staff… It seems to be that they say sorry for their failings but then carry on behaving in the same way.”