Leaders: Nurses’ fears for the elderly are part of a wider problem

FEW would dispute that among the priorities of a National Health Service is proper professional nursing care and stewardship for older people.

This becomes even more of a public concern with the combination of ever-rising public expectations of care provision and the remorseless growth in the numbers of older people likely to require attention in our hospitals, reflecting our changing demographics.

It is this that gives the warning from the Royal College of Nursing such resonance. It says that old people are not safe in hospital because of a lack of professionally qualified nurses, with research showing that one nurse cares for around ten patients on older people’s wards. The RCN argues this is not enough to provide basic, safe care, which in its view requires a minimum of one nurse to seven patients. It is calling for a “patient guarantee” to set out the number of nurses needed on such wards.

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As the numbers of older people requiring attention increases and pressure grows on hospital services, it is an obvious temptation for financially pressurised health boards to deliver the same services to more and more people, saving money when nurses leave by not replacing them or replacement by nurses and healthcare support workers at lower paid bands.

There is, of course, much to be gained in a constant search for savings and efficiencies: the NHS is no less under a requirement to ensure the most productive use of its funds than other areas of health and welfare provision. That it has been sheltered from budget cuts suffered by other public sector departments does not absolve it of the need to pursue tight professional management of its resources.

The worry is that a policy of gradual but insistent economy could impact on the time required to offer such basic care as help with food and drink. The point that senior charge nurses who manage hospital wards should be given genuine authority to be able to decide their own staffing levels locally on a day-to-day basis is well made.

However, public expectations on how such care is delivered is also changing, with a growing preference for stays in hospital to be minimised and for greater emphasis to be placed – and resources made available – for the treatment of older people in their own homes. Continuing advances in treatment and pharmacology make this possible to a degree inconceivable to an earlier generation. So there are also powerful arguments for shifting the balance of care so that more resources are available in the community, in the home and in the care home sector.

There is also growing recognition of the importance of preventative spending to help keep older people healthy, safe and out of hospital. So, while the RCN warning deserves a sympathetic hearing, it needs to be viewed in the wider context of other calls on NHS spending in this sensitive area of healthcare.

Book festival needs financial muscle

For Scotland’s capital city to continue to be an international centre for literature and a mecca for those who love books, it requires a book festival with the resources and financial muscle to match and exceed global competition. To that end, Nick Barley, director of the Edinburgh Book Festival, is making an appeal to thousands of event supporters to make a financial contribution.

In this, it is no different from successful appeals for private donation by such institutions as the National Portrait Gallery and Scottish Opera: lovers of both come to the rescue. The book festival has certainly fair claim to making such an appeal, given that government and local authority funding come to just £300,000, or less than 20 per cent of its total budget.

Numbers attending the festival can vary through factors outwith its control. Last year’s 10,000 fall in attendances looks to have been due to a combination of circumstances: the move of the Festival Fringe HQ to the south side of the city and bad weather on some days. The re-opening of the Assembly Rooms in George Street should help this year, but Charlotte Square, together with many other festival venues, will have to contend with continuing tramworks disruption.

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Such vagaries make it all the more vital that the book festival has the muscle to market and advertise its attractions well in advance to help lift bookings and audience numbers and thus visitor spending at the event itself. The book festival has long been a great asset to Edinburgh and contributes powerfully to the overall appeal of the city in the summer. This appeal should not go unheeded.

Online frustration that costs retailers dear

We’ve all been there. At the end of your online purchase of that new dress, the latest book, a DVD or a new garden shed, we’re asked to complete the credit- card details and, just when you think the process is over, you are asked for yet more security details.

Cue frantic search for one of the many, many passwords which we now all have to have, usually combining numbers and both capital and lower-case letters. Was it the children’s birthdays combined with the dog’s name? Or our star signs added to our age? Cue frustration. Cue oaths. Cue end of transaction.

There are obviously good reasons for having proper online security. Internet fraud is becoming ever more commonplace. But there is now evidence the card companies are creating a rod for their own backs. Research estimates £1 billion worth of transactions were abandoned last year because consumers got tired of lengthy and complex verification processes. One in five of those cancelled purchases were dropped completely, costing retailers £214 million.

So a plea to the banks. There must be a way to make online transactions more secure but also bit less time- consuming. If the process was faster, we would be less likely to abandon online shopping in frustration.