The news from Stafford about their failings in emergency care makes horrific reading, the story for those who have not heard can be found here. Central government has as usual taken no responsibility and are blaming the people on site, despite the fact that the hospital appears to have been trying to carry out government policy by saving over £10,000,000 to achieve foundation status. What is the first thing that goes when hospitals are saving money? Staff, and who are the biggest staff group (apart from admin staff who never get paid off)? Nurses. Research has shown that if you have more trained nurses per patients then patients do well, but the corollary of this is that if you have less nurses patients die. Want to know what happens on a ward when you have low staffing levels? Read this, almost anything Anne writes will give you a good idea of how poor staffing affects patients and staff. The blogosphere seems to be united in noting that this is not something that has just happened and should, and in some cases was, foreseen - read Dr. Crippen, read The Jobbing Doctor follow some of the links and read about Dr. Rita Pal. Why were staff not complaining? What was happening to the complaints letters that must have been getting sent? In my hospital people complain that we have the wrong brand of cola in the vending machines, never mind that their relatives are lying in urine and faeces. So were the relatives getting fobbed off with excuses? And who was getting blamed? Actually, I know the answer to this one; every complaint would have been acknowledged and an apology given, the complainer would have been reassured that 'something will be done', this will never happen again, lessons have been learned and staff will be retrained.
My expertise is Accident & Emergency, I happen to think that the 4 hour target for emergency care is a good thing, but it must have a system in place that allows patients to move on to wards, not being moved into unobserved rooms. The 4 hour target is a hospital and community problem, not just an A&E problem. Why should a patient with a sprained ankle wait 6 hours to be seen because other patients keep getting prioritised ahead of them? I read American blogs where they write of patient being in the ER for 9+ hours without being seen, and I remember patients waiting for hours in our own waiting room. At a certain point you are just punishing people for not having a serious enough illness. Targets are good but they must be used as guidance, there has to be room to manoeuvre and there has to be a system to say this patient does not come under the 4 hour target because.........
Why did they only have one A&E consultant? An adequate number of consultants is vital for the good running of a modern department. 25 years ago 1 consultant, who was an orthopaedic surgeon would be in charge of A&E on a part time basis. This was proven to be dangerous, this why there is now a proper A&E training for doctors and A&E is now seen as a specialty in it's own right. The same goes for nursing staff, A&E cannot run without experienced nurses and an adequate number. Being 17 nurses short in A&E is to mind negligent and will cause deaths. It takes about a year to turn an experienced nurse into an A&E nurse, again, we are a specialty in our own right.
My sympathies are with the relatives of all those who have died or who have gone through a horrendous experience in this hospital when they are at their most vulnerable. My sympathies are also with the (front line) staff who have had to work through this and may get some of the blame when it is obvious that staffing levels were decided by accountants and executives.
What happens now? There may well be a public enquiry, there will be pious exclamations to 'never let this happen again' but, it will. Until we can have adequate staffing on the wards, staff are valued and they have proper training for the job they are being asked to do patients will continue to be let down and neglected.