Interesting to note that the very excellent Professor Anne Marie Rafferty et al., Professor of Nursing at Kings College London has just published research which proves that wards with a lower nurse-to-patient ratio had a 26 per cent higher patient mortality rate. Following her survey of nearly 4,000 nurses in 30 hospital Trusts in England she concludes that had there been more nurses on the wards then 246 more lives could have been saved. This research has just been launched by the Royal College of Nursing. Results:
‘Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient to nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in hospitals with the highest patient to nurse ratios had 26% higher mortality.’
When I trained at South Lothian College of Nursing & Midwifery from 1982-1986, long before the dreaded Project 2000, this knowledge that it was intensity of bedside care that determined the quality and safety of healthcare on any given ward be it acute, psychiatric or, as we had in those days, a ward for the learning disabled, was self-evident and was just one of the reasons why student nurses spent much of their training learning on wards at the bedside with trained nursing staff. Now we need highly trained and gifted academic nurses like Anne Marie to research and prove the case. Doubly so when we have a Government encouraging Trusts to ‘shed staff’ at the moment in the interests of balancing the books of an under pressure NHS their policies have overheated with too many productivity targets.
Those of us who have spent long careers in health and UK public healthcare understand that it really is time for politicians to ‘butt out’ of healthcare as our American cousins would say. Politicians cannot and should not be allowed to manage health services and health service delivery. This important matter should be left to the professional community of health service managers, doctors, nurses, therapists and paramedics. Self-governing Foundation Trusts are a good thing, a self-managing independent NHS, responsive to the consumer-patient, would be even better. Let’s get there as quickly as we can.
Ask a patient going into hospital for a hip operation what they expect of their care and they will probably come up with the following list:
- A bright clean surgical ward with some privacy – a single room or at least a four bedded bay would be a great bonus
- A well staffed ward with friendly competent nurses in clean uniforms and perhaps a lead nurse in the team responsible for their personal care plan, who discusses it with them
- Decent food and some choice of menu
- Polite, attentive and caring medical staff and a consultant that comes to see them on his ward rounds to explain and discuss the treatment options, their operation and the recovery timeline
- Opportunity to discuss their operation
- Opportunites to for structured convalescence before discharge
- The right to see their nearest and dearest when they want to see them
The problem we still have in the UK is that although we have come a very long way from the great variability of NHS care of the 1980’s, this list is still not a guarantee in every NHS hospital in the UK, but it is in the independent sector. Now why is that?