Healthcare: Who's Nursing The NHS?

Unison recently published a damning survey which identified that NHS hospitals were failing to ensure that adequate numbers of staff were deployed to deliver the standard of care required. 

Over the past three years, Unison members have been asked to provide a snapshot into conditions on their wards in a single 24-hour period. 

Understaffing is now so acute that over half of the respondents identified that patient safety at their hospital is at risk. I was a patient in a North Yorkshire hospital when the survey was undertaken. 

Over the course of my three-week stay, I witnessed first hand the impact of understaffing. After a routine procedure, I collapsed at 11pm on a Friday evening into the arms of a nurse who had another 16, mainly highly dependent, patients to care for. 

Despite the best efforts of the staff, no doctor could review my condition for a further 36 hours. By which time I required a catheter, four blood transfusions and constant rehydration. 

My blood pressure was dangerously low and I could neither sit, stand or walk without losing consciousness. 

I could see how anxious and frustrated successive nursing teams had become. My nurse suspected an internal bleed but there were no doctors, not even the most junior, to attend to me. 

Eventually, a panicked consultant arrived to tell me what I had known for days. I was seriously ill and no-one knew why. 

The hospital I was at is a so-called flagship unit with good ratings and low mortality rates. Registered nurses were responsible for caring for 12 patients during the day and 17 at night — one of the lowest staffing ratios in the country. 

Just weeks before my admission, a coroner’s report held that the death of a patient on my ward could have been avoided if weekend hospital staff had had sufficient time to recognise she was seriously ill. 

Consultants had raised concerns about staffing levels just weeks before the woman’s death. The coroner was assured that staffing levels on the ward had since been increased but I could see no evidence of that. 

I watched a ward full to overflowing shudder and often grind to a complete halt because of lack of staffing. The pressure on beds was acute. 

Beds would be filled within hours, sometimes minutes, of being vacated. 

The system was suffering because of a lack of respite care for elderly patients with medical needs — too well to remain on the ward, but still highly dependent due to infirmity, these women would sit patiently and quietly in their chairs waiting for God or care in the community. 

Rehana Azam, a GMB health organiser in Darlington, has been campaigning to raise awareness of the impact of cuts to community nursing services. 

She says: “You only have to spend time with a community nurse to see first hand the pressures they are under. Burgeoning and growing patient numbers just don’t have enough community staff to go round. This is impacting on patient care.” 

Unison general secretary Dave Prentis told Morning Star: “Despite the fact that nurses are regularly working through their breaks and beyond their hours, many of them simply do not have enough time to give patients the care and attention they need.” 

“NHS staff are dedicated and compassionate people who work tirelessly every day to save lives and treat patients with dignity and respect. 

But there is a clear link between inadequate staffing levels and patient mortality, and it is simply inexcusable for nurses to be forced into a position where patient care is compromised because they are caring for too many patients.” 

Unison is campaigning for legislation and enforceable staffing ratios which would guarantee that no nurse is placed in the position of caring for more than eight patients. 

 It is taking a lead from nursing colleagues in Australia and the United States who have successfully built up public confidence in the argument for responsible patient-staff ratios. 

Yet in Britain the Unison surveys demonstrate that, year on year, staffing ratios are cause for concern, despite the warnings voiced after the inquiry into failings at Mid Staffordshire which resulted in the loss of thousands of lives unnecessarily. 

Prentis has warned that “the human cost of stressed, exhausted and overstretched nurses paints a very grim picture — the consequences for patients are potentially life threatening,” but hospitals continue to set dangerously low staffing levels. 

The lessons of Mid Staffs have not been learned. Yet amid the chaos, there is real dignity afforded to patients by dedicated staff. 

At the hospital I was in I felt as though I was witnessing a religious ceremony as an elderly woman was gently helped by loving hands that convey to her that, at least for a moment, there is time to extend the care she deserves. 

Her movement is non-existent and the nurse compassionately removes her slipper, lifts her into bed and gently removes her glasses. 

She carefully ensures that the woman is covered with an additional blanket — just in case the night cools. A glass of water with a straw is placed within the woman’s reach. 

What is so remarkable is how this nurse conveys without words an almost pious respect to her charge. Somehow, this nurse creates a moment of peace, relaxing her patient, making her feel she is safe. 

This nurse is worth a thousand bankers but earns less than £20,000 a year. Her movements are slow because by this time, at the end of her shift, she has walked miles, lifted tons and has barely slept between shifts, worrying about how much longer she can cope. 

The staff on the ward battle on exhausted, hungry. There’s not enough time for meal and drink breaks. They would snack on chocolate and whatever was quick and easy to wolf down in between tending patients. 

The 12-hour shift stretched into 13, but without pay. A few hours later they would return, bleary eyed, to begin it all again. There is a relentlessness to the hospital day. 

Ward rounds, admissions, discharges, meals, drug rounds, observations, treatments, handovers, the arrival of the tea trolley a welcome interlude. Life in a hospital is routine, ordered and unyielding. 

I experienced first hand just how quickly a patient can deteriorate. I walked into that hospital and was grateful to crawl out. There is always risk. 

Death rates in British hospitals are highest at weekends. Staffing levels affect pain management. Delayed drug rounds disrupt the careful balance of multi-drug response to acute pain. 

I watched as the patient in Bed 23 would become unable to speak or move when drug rounds were delayed by as little as 30 minutes. As the medication was administered, she would quickly gain control of her agony. 

For months, Bed 23 has been admitted, discharged and readmitted without any idea as to the cause of her symptoms. Finally, she refused to go home until a diagnosis was reached. 

Her notes were transferred to a nearby teaching hospital for opinion. One morning, Bed No 23 sat alone awaiting their findings. She had asked that her husband be present but there was no time. 

Her consultant was needed elsewhere. In any case, having read the notes, there was nothing he could do and already his attention was elsewhere. The only gesture towards privacy — the flimsy curtain around the bed was hastily drawn. 

The woman in Bed 23 emerges with eyes as wild as any beast sent to slaughter. She has less than a year to live. The consultant leaves as abruptly as he arrives. 

This woman, who I have known less than 10 days, fell into my arms, shaking in disbelief, desperately trying to process what she had been told, confiding her greatest fear to a stranger. 

Two nurses rush to her side, visibly shaken by the stark and uncompromising pronouncement. The curtains remain drawn almost all day. 

A stream of visitors rushed to her side and slowly trudge out, heads bowed, relieved to finally be able to drop the pretence of optimism. 

Pancreatic cancer has one of the lowest survival rates. It’s the nursing staff who are left to support her, to explain what her options will be in a journey towards death. Bed 23’s resolve is remarkable. 

Within hours, heavily sedated, she is plucking her eyebrows and applying her face for the world. Life goes on — at least for a while. But what of the NHS — just who is nursing an NHS in terminal decline? 

Or will we, like Bed 23, eventually learn that nothing can save the patient? 

Details of Unison campaign can be found at www.unison.org.uk/our-campaigns

Rehana Azam is one of the organisers of 999 Call for the NHS who are staging the People’s March for the NHS.

Over 800 women have promised to march 280 miles from Gateshead to Parliament in the footsteps of the Jarrow Marchers. Details of the campaign and march can be found at 999callfornhs.org.uk.

by Ann Czernik

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