13 Sep 2012

Acute hospitals on the brink of collapse

The new ministers at the Department of Health barely had time to settle into their new jobs when along came some bad news in the form of a Royal College of Physicians report, released today, warning that acute hospitals in the UK are on the brink of collapse.

Hospitals on the Edge reveals the increasing strain affecting patient care. Results of a survey of RCP fellows and members showed one in 10 would not recommend their hospital to a family member or friend “as a high-quality place to receive treatment and care”. One in four were unsure.

While the report covers all aspects of acute care – where a patient is severely ill or injured or recovering from surgery – of particular concern is the treatment of older patients. Evidence suggests that during a hospital stay they can be moved four or five times, often with incomplete notes and no formal handover.

Over the past decade there has been a 37 per cent increase in emergency admissions but there are a third fewer general and acute beds than there were 25 years ago. All of which puts pressure on the system.  But this is coupled with the change in patients’ needs, the report states.  Nearly two thirds of people admitted to hospital are over the age of 65 and an increasing number are frail or have dementia.

Wrong bed, wrong ward

“Research shows that medical and nursing staff often feel that older patients ‘shouldn’t be there’,” the report says.  “Being perceived as the ‘wrong patient on the wrong ward’ has been shown to reduce the quality of care, building attitudes of resentment from both medical and nursing staff.”

Asked if patients were being harmed, the RCP panel said there was no evidence of this.  Yet in anonymous quotes gathered from college members, one said:  “Safety is falling to all-time lows as people get moved to wards after the most superficial of assessments and no treatment plan.”

Another anonymous quote said: “Unsure about whether to recommend our hospital – I fear other hospitals may actually be worse .  The European Working Time Directive and shift working has seriously undermined safe patient care and reassurance to patients.  We never seem to have enough nurses for basic patient care and co-operative working IT systems actually slow, confuse and distract from care.

Dangerous weekends

“Weekends and bank holidays function on sekelton staff of doctors – very dangerous.”

Certainly evidence shows that mortality is higher at weekends in some hospitals and the number of readmissions are rising, especially for the elderly, which suggests they are being discharged too soon or without the appropriate care.

All of this comes a month before the inquiry report into Mid-Staffordshire NHS Foundation Trust is due to be handed to the health secretary. In that case, hundreds of people are believed to have died as a result of poor care.  The chief executive of the NHS Sir David Nicholson described it as a “singular event” but today the Royal College appeared to suggest it was far more systemic, stating that it would be wrong to say there is no evidence of sub-standard care.

And in fact there have been a number of cases recently where patient neglect has led to, in one case, a man dying from thirst and, in another case, staff failing to notice a young girl had died in her bed.  But also, there is a the growing number of hospitals under enormous financial pressure, which is leading to staff and service cut backs.  South London Healthcre NHS Trust, for instance, has been placed in administration and only this week Mid-Staffs was warned it faced being put into special measures.

Patient impact

All of which must have an impact on the patient. Dr Linda Patterson, RCP clinical vice-president a consultant geriatrician,  describes a lack of dignity and compassion.  Because of the rise in the number of people with dementia, Dr Patterson said it was common to see ‘challenging patients scattered throughout the hospital, being moved around like parcels because the right place has not been found for them.”

Dr Patterson added:  “We have been deeply upset to hear stories of patients not being treated well.”

Dr Andrew Goddard, also sitting on the report panel, said that while faced with an ever-increasing tide of admissions, there were serious problems with recruitment.  One in 10 consultant posts and one in five registrar posts for emergency medicine are currently vacant, he said. Half of the consultant geriatrician posts advertised last year were not filled with no applicants for one-third of those vacancies.

The report itself is a precursor to the Future Hospital Commission which is looking at the overall design and delivery of inpatient hospital cre.  But one immediate suggestion from the panel was the need for seven-day hospitals, where expert care is available week round.

3am blood test

Suzi Hughes, chair of the RCP’s patient and carer network. is also a patient with long-term, chronic conditions.  Recently, she said, she had been admitted to her local hospital and during her stay she was moved to five different wards and at one point was woken by a junior doctor at 3am to have her blood test.

“I would have been more furious but for the fact the doctor was so apologetic. It was her first opportunity to do the tests.”  Mrs Hughes also had to ring her consultant’s secretary to tell her where she was so he could come and find her.

Each ward move was also treated as a new admission so she had to go through the whole process five times.  Her stay in hospital, she said, was longer than it needed to be because they could not find the right bed in the right place.

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