Old people ‘not safe’ in Scottish hospitals, nurses say

OLDER patients are “not safe” on hospital wards in Scotland because of a lack of qualified nurses to care for them, a hard-hitting report from the body representing the nursing profession has warned.

The Royal College of Nursing (RCN) findings come after it emerged the number of nurses in Scotland’s hospitals plummeted by thousands in just over two years, with further nursing posts lost during the last few months of 2011.

The report suggests there is just one nurse caring for nearly ten patients on old people’s wards.

A survey of almost 1,700 nurses found that 78 per cent said comforting and talking to patients was not done or done inadequately on their last shift because of low staff numbers.

Some 59 per cent said promoting mobility and self-care was left undone or unfinished, with 34 per cent saying they could not provide patients with food and drink, and 33 per cent claiming they were unable to fully help patients to the toilet or manage incontinence.

The Scottish Government insisted that the elderly were “absolutely not at risk”.

The RCN’s UK-wide figures showed that staffing levels on wards for older patients compare poorly with those for adult general wards, where each nurse cares for around 6.7 patients, and a figure of 4.2 patients per nurse for children,

The RCN said the number of nursing and midwifery staff employed in Scotland had fallen by 2,190 to 56,238 – a drop of 3.7 per cent – between September 2009 and the end of 2011.

There were also 71 nursing posts lost in Scotland between September and December 2011, according to the RCN Scotland director Theresa Fyffe, who said the number of nurses employed was at a six-year low.

The report called on the Scottish Government to take urgent action to increase the number of nurses on old people’s wards, which it said should be a minimum of one nurse to seven patients.

The RCN warned there was a danger that “care becomes compromised” and said that many nurses say “they are too busy to provide the standard of care they would like”.

The report said: “Older people in Scotland are being let down by a lack of professionally qualified nurses in hospitals, despite nationally agreed planning for the nursing workforce.

“Despite older people often having the most complex needs, the evidence suggests that they regularly suffer from a severe shortage of nurses and healthcare support workers (HCSWs), coupled with an inappropriate skill mix of HCSWs to nurses.

“Today’s evidence shows that currently one nurse cares for around nine patients on older people’s wards. The RCN says that this is not enough to provide basic, safe care, which requires a minimum of one nurse to seven patients.” The charity Age Scotland seized on the findings to demand dramatic improvements to care services in the community, to keep older people “safe and out of hospital”.

Callum Chomczuk, its senior policy and parliamentary officer, said: “We need a shift in the balance of care where resources are focused in the community.”

Ms Fyffe said the number of nurses employed by NHS Scotland was at its lowest level since September 2006 and said more than 2,000 nursing and midwifery posts had been lost since September 2009.

“Cutting that number of qualified nurses in-post is bound to affect staffing levels and the mix or balance of qualified nurses and healthcare support workers on our hospital wards,” she said.

Ms Fyffe said some health boards were doing better than others. “I would urge those health boards which are cutting the number of qualified nurses, particularly on older people’s wards, to seriously reconsider their actions,” she added.

The RCN’s findings sparked claims from opposition parties at Holyrood that Scotland’s NHS was under “huge strain”, with a damaging effect on older patients.

Scottish Lib Dem health spokeswoman Alison McInnes said: “This loss of skill and expertise threatens the quality of care that patients, especially older and vulnerable patients, can expect to receive. The Scottish Government have a duty of care to ensure that staffing levels are appropriate so the care provided is effective, efficient and equal.”

Scottish Labour health spokeswoman Jackie Baillie said that the levels of care for older patients were “not sustainable” and NHS staffwere “too stretched” with their workloads.

She said: “This report highlights the very real consequences the SNP’s cuts to the health service are having on Scotland’s older people. We are increasingly seeing a negative impact on standards because hospital staff are too stretched to provide the level of care our older people deserve. Low staffing levels will also take their toll on the hard-working nurses who are being asked to do more.”

Meanwhile the RCN called for a “patient guarantee” to set out the number of nurses needed on older people’s wards.

Ms Fyffe challenged Scottish ministers to give “serious consideration” to the guarantee, of a minimum of one professionally qualified nurse per seven patients.

She said: “As health boards come under increasing financial pressure to deliver the same services to more and more people, they are saving money when nurses leave by not replacing them or by replacing them with nurses and healthcare support workers at lower-paid bands.

“Older people often have more complex health conditions so they must be given the best care by an appropriate mix of qualified nurses and healthcare support workers. This is particularly the case if stays in hospital are to be minimised so older people can return home or to a care home as soon as reasonably possible.”

A Scottish Government spokeswoman said the report was based on UK-wide data and “there is no breakdown of Scotland-specific data, so we cannot comment on the implications for NHS Scotland”.

She continued: “Older patients are absolutely not at risk in Scottish hospitals because of lack of nurses and to suggest otherwise is wrong – there are more qualified nurses working in our hospitals now than in 2006.

“Whilst the report focuses on nurse ratios, we also need to recognise the contribution of the wider healthcare team in delivering better outcomes for patients on older people’s wards.”