NHS patients get ‘unacceptable’ care from nursing assistants
NHS patients are receiving an “unacceptable” level of care from a growing army of unqualified healthcare assistants who have taken over nursing roles on wards and in care homes, an independent commission warns.
Basic tasks which were once the job of trained nurses are being carried out by more than 50,000 low-paid and unregulated assistants due to budget cuts and growing demands on nurses’ time.
Putting vulnerable patients in the care of well-meaning but “unreliable” nursing assistants raises “serious concerns about public protection”, a commission led by Lord Willis of Knaresborough, the Liberal Democrat peer, says in a report published today.
Healthcare assistants are employed for simple tasks like keeping patients fed and hydrated or taking their temperature, but are not currently trained to spot warning signs such as dehydration or rapid changes in body heat.
Patients and families who do not understand the distinction between nurses and unqualified healthcare staff often seek and follow the advice of assistants without realising they have no expertise.
The report recommends training all healthcare assistants to at least NVQ level three – the non-academic equivalent of A-levels – to tackle the “widespread concern” about their growing presence on wards and care homes.
“The commission finds it unacceptable that staff whose competence is not regulated or monitored are caring for vulnerable citizens,” the report says.
“It is equally unacceptable that registered nurses must take responsibility for supervising colleagues on whose competency they cannot rely.”
The report was commissioned by the Royal College of Nursing, to examine the training system for nurses amid concerns about their competence and attitude following a string of “stories of appalling care and mismanagement”.
Figures released last month revealed that 43 hospital patients had starved to death and 11 died of thirst due to failures in the most basic levels of care on hospital wards, while 78 died from bedsores. Earlier this year one in three nurses claimed they did not have enough time to help elderly patients eat or go to the lavatory, due to inadequate staffing levels.
By September 2013 all nurses will be required to have degree-level training, which critics have claimed will result in a less compassionate level of care on wards and in homes.
The Willis Commission says there is “no evidence” of a decline in care, describing an all-graduate nursing profession as “not simply desirable but essential”.
But the report also raises concerns over the regulation of unqualified staff after NHS managers claimed the new demands on nurses will force them to rely more heavily on unqualified healthcare assistants for basic care.
Previous studies have found a direct link between a lower proportion of registered nurses and a worse quality of care, and concerns are such that the Royal College of Nursing has led calls for systematic training and regulation of support workers.
In 2011 the NHS in England employed more than 53,000 “Healthcare Assistants”, accounting for about four per cent of its workforce, and numbers are increasing by six per cent each year.
But the report added that their role is “very varied, sometimes poorly defined and lack[s] consistency across employers”, and that the use of alternative titles such as “nursing assistants” or “nursing auxiliaries” means the real total could be higher.
Lord Willis told the Telegraph: “The registered nurses now are doing more highly specialised tasks and it is not good enough to say someone else can do those basic nursing tasks, they are not just add-ons.
“You really have to have people who do not just put food in front of someone, but understand the significance that a patient takes food and hydration. It is not good enough to simply know how to do something, you have to know why you are doing it.”
He added that many patients and their families find it hard to distinguish between registered nurses and other ward staff, which “often leads to them making assumptions” based on discussions with unqualified workers.
The report also calls for measures to improve the quality of placements carried out by nursing students, and for newly qualified nurses to be given additional support and mentoring during their first year in practice.
Dr Peter Carter, chief executive of the Royal College of Nursing, said: “Improvements will need to be made to the profession in the future, notably in the regulation of Healthcare Assistants and the need to make all student placements match the very best.
“However the evidence in this report makes it very clear – the way to do this is to continue with nursing as an all-graduate profession. There is no truth in the suggestion that because nurses receive training from universities as well as on the ward they become less caring.”
A Department of Health spokesman said: “Public confidence is really important, however in the case of healthcare assistants, there is no evidence that compulsory regulation would lead to higher standards.
“They are supervised by professionally qualified staff, and often by experienced nurses. Regulation does not, in itself, change culture and is no substitute for proper performance management, good leadership and day to day high quality patient care.”
A code of conduct and minimum training standards for healthcare support workers will be drawn up by January, he added.
Dial 111 for A&E shambles: Flagship new NHS phoneline actually INCREASES ambulance call-outs…
A new non-emergency telephone number to relieve pressure on 999 has increased the number of ambulance call-outs and failed to reduce the number of people attending A&E departments, according to an official report.
The planned national roll-out of NHS 111 for non-urgent calls has been one of the flagship health policies of the Coalition Government.
It believes the move will shave millions off the health budget by phasing out the costly £123 million-a-year NHS Direct.
The Coalition also hopes the new 24-hour freephone number will save money by directing patients to GPs or urgent care services rather than clogging up casualty units.
But the official independent report commissioned by the Department of Health a year after the first pilot schemes were introduced has found they have not delivered as hoped.
The report also says that NHS 111 could actually increase costs for the taxpayer as, in the pilot schemes, it directed more patients to use emergency and urgent care services.
In the four pilot sites alone, it is estimated the helpline costs the NHS £307,000 a month.
If rolled out nationally – as planned by Ministers for 2013 – it could save taxpayers £2.5 million on the health budget. But – in a worst case scenario – it could cost as much as an extra £7 million, the study said.
The report, by academics from the University of Sheffield’s School of Health and Related Research, said: ‘An expected benefit [of NHS 111] is that efficiency in the urgent and emergency health care system will be improved by directing people to the right level of care.
‘For example, directing people with urgent problems away from emergency services to urgent care services that are more appropriate to clinical needs. ‘There is a limit to what paramedics can do’
‘Otherwise, the expectations that NHS 111 would shift use from emergency to urgent care when appropriate appears not to have been achieved in the first year of operation.’
The study looked at the number of calls to ambulances and attendances at A&E at four pilot sites in Darlington and Durham, Nottingham, Luton and Lincolnshire before and after the introduction of NHS 111.
In three of the four sites, there were up to ten per cent more calls to the ambulance service and more ambulance attendances after NHS 111 was brought in. Janette Turner, who led the research, said: ‘The significant findings of the report were that calls to NHS Direct were going down. ‘But what we didn’t expect was that the number of 999 ambulance journeys was increasing.
‘We don’t know why that is but I’ve recommended it’s looked at in more detail.’
The British Medical Association has previously warned that NHS 111 could put further pressure on health services and said it is still concerned that the helpline is being rushed through to the detriment of patients.
A BMA spokesman said: ‘We need to be certain that patient safety is not put at risk before NHS 111 is implemented.
‘From the conclusions of the report it seems there is still more work to do before NHS 111 is fit for purpose.’
NHS Direct, which currently offers an alternative to 999, was launched in 1998 and costs £123 million a year to run.
Around half of the staff are trained nurses who give health advice to callers who do not believe they need an ambulance.
But the new 111 number employs ‘call advisers’ who have completed a brief training course – leading to accusations that they could fail to identify life-threatening conditions.
There are now 13 pilot sites around the country and the most recent figures released on Friday show there were 92,578 calls to the new service during September.
But the national roll-out, scheduled to take place before April 2013, has been delayed in some areas because doctors warned it was happening too fast.
A Department of Health spokesman said: ‘As NHS 111 becomes more established, we expect patients to use it more for their urgent medical needs instead of emergency services. ‘Clinically trained staff are always on hand to assess a patient’s needs and make sure they get the right care.
‘NHS 111 will only call an ambulance for a patient when it is clinically needed, but where this is the case, then the local NHS must ensure patients have access to an ambulance.’
“Liberation” can be lonely
Marriage undoubtedly requires compromises but some compromises can be worth it
This week the Office for National Statistics (ONS) confirmed that more of us than ever are living alone. This won’t trouble the author Colm Tóibín, who once eulogised the freedom that living alone gives him, likening his solitary existence to that of “a cloistered nun”.
A terrifying image, surely, and not a metaphor for a life most of us would seek to inhabit. Certainly not my friend Helen: successful, well-off, homeowner; but tired of her single life, of the near-constant awareness that she’s running out of time to have children, as fast as she’s running out of the energy to embark on another round of futile first dates. Nor my friend Mark, divorced dad, active in his daughter’s life – but who still, at the end of the weekend, returns the child to her mother, before driving back to his re-emptied house, where he passes the evenings with PlayStation and Sky Sports.
In discussing solitary lives, we should ignore the Colm Tóibíns – financially independent people who realise that, for them, to live alone brings more advantages than otherwise. Most people of my generation had such a stage in their lives – between university, and settling down – but we didn’t want it to last forever. In any case, with property prices as they are, such self-selected solitary living is not an option for much of the succeeding generation.
Set aside, too, those figures pertaining to the very elderly; not because there aren’t real problems faced by those (usually female) “survivors”, but because their existence is a function of the uneven impact of medical advances and lifestyle changes on the longevity of each of the genders.
It’s not the relatively young, or the very old, who are the main drivers of this demographic change. As the ONS makes clear, the largest increase in solitary living is down to the 45-64 age group. Almost two and a half million Britons in that age category have no one with whom to share their home, an increase of more than 800,000 households since the mid-Nineties. Even allowing for the increase in total population size, that’s still a noticeable change, and they don’t all enjoy the experience. I suspect there are more divorced parents, like my friend Mark, poking about their fridges for an M&S meal for one, than there are cloistered Irish novelists.
Which would be fine, were this phenomenon merely to affect matters as concrete as housing. But evidence suggests a link between solitariness and poorer health outcomes (mirroring, bleakly, the evidence about the outcomes for children raised in single-parent households). One paper I read showed a significant increase in the prescription of antidepressants to the solitary, compared with cohabiting couples. Correlation doesn’t prove a sociological theory, of course, but it’s hard to ignore the link between living alone, and other deleterious life choices.
Which demands a political response: marriage is the most important institution to act as a bulwark against loneliness, and the Government should promote it. Iain Duncan Smith is unwinding the insidious “couples penalty”, the financial cost to setting up a home with your partner, and the other probable cause, after divorce, for the change in living habits. His Centre for Social Justice discovered that the people most penalised for living together are – surprise – among the poorest. This must be fixed (and couples who “live apart together” shouldn’t be demonised for rationally navigating the snares of the benefits system).
But if it’s understandable that a financial penalty can cause the poorest to avoid marriage, why assume that monetary considerations don’t affect the better-off? First, because politicians are scared to reward marriage in the tax system, and second, because our divorce laws so scar those who endure them that, I suspect, we’ve produced a generation with the motto “once bitten, twice shy”. The changes to child benefit for the well-off hardly help: a middle-class “couples penalty”.
Michael Howard deployed a powerful phrase in defence of his criminal justice policy: prison works. It’s time we used a similar phrase, in defence of social justice: marriage “works” too. It works for most people and definitely for civic society, yet we find it hard to say this, and shy away from its political implications. What started as a desire not to judge “lifestyle choices” has bred a generation living in lonely, quiet despair. Loneliness is a much harder political issue to tackle than, say, house-building, but – if we believe in “society” at all – hardly one of lesser significance.
More petty nastiness from bureaucratized Britain
A grandmother of four has been threatened with jail for sweeping the leaves outside her home. Barbara Ray, 82, was accused of ‘causing a hazard’ by brushing the fallen leaves into a ‘large heap’ for roadsweepers to collect.
She was warned her simple attempts to keep the neighbourhood tidy could leave her facing prosecution for fly-tipping, punishable by a £50,000 fine and a 12-month jail term.
When Mrs Ray queried the letter, she was astonished to discover council contractors had photographed her gardener, who visits once a fortnight, sweeping the leaves into the street.
And the council even defended its stance by claiming that her behaviour was ‘unacceptable’.
Mrs Ray, who worked as the financial director of a printing business she ran with her late husband, branded the council officials ‘petty bureaucrats’ as she told of her anger over the letter’s threatening tone. She said: ‘It’s bureaucracy gone mad. I’m not a person who wants to make a fuss but it was a shock to read that letter.
‘When I challenged the district council officer and asked him how he knew I’d cleared the leaves into the road from the front of my house, he said they had photos to prove it.
‘I like to keep my house neat and tidy. The council told me to use my green bin – but that is soon full of garden waste because they only empty it once a fortnight. I’m just annoyed that the council can treat me like this.’
The mother of two first moved to her part of Stratford-upon-Avon, Warwickshire, in the 1950s with her husband Tony, who died of cancer in 1997 at the age of 71.
Following his death she moved round the corner to her three-bedroom bungalow, which is in a road lined with lime trees.
In a letter sent last week, an official from the district council warned Mrs Ray: ‘You were seen removing leaves from your front garden and depositing them in the road channel in front of your property.
‘Abandoning material in this manner constitutes fly-tipping under section 33 of the Environmental Protection Act 1990, which is punishable by a fine of up to £50,000 and/or 12 months’ imprisonment.’
A spokesman for the authority told the Daily Mail yesterday that during the autumn, road sweepers are sent once a week to 100 of the worst roads for leaf fall in the district – one of which is Mrs Ray’s.
But she claims the sweepers do not come ‘for weeks’ at a time, so she frequently has to sweep up the leaves from her garden, driveway and the footpath.
Mrs Ray said: ‘I’ve lived through the war and have been in this town all my life. I pay my council tax and should receive this service. I’ve got better things to worry about at my age than this.’
Her family have also played a significant role in the town. Her husband acted as mace bearer for the mayor, while his brother, Malcolm, and father, Ernest, were both mayors in their time.
Mrs Ray said the council has now dropped its threat to prosecute after she promised to stop the sweeping. She turned down the authority’s offer to supply her with a second green bin – for a £35 charge. She will now put the leaves into refuse sacks, which a friend will drive to the council waste disposal centre.
A council spokesman said the ‘very large heap’ of leaves from Mrs Ray’s lawn which had been left in the ‘road channel’ were a ‘hazard’, which caused cars to move further into the road.
He added: ‘Moving the leaves in this manner is unacceptable and can cause additional problems with blocking of drains. The District Council would like to apologise if the letter sent to Mrs Ray caused any concern.’ He added that the letter had been addressed to ‘The Household’, not Mrs Ray herself.
Her local MP, Conservative Nadhim Zahawi said he was ‘disappointed’ about the council’s action. He said: ‘As Mrs Ray’s Member of Parliament it’s my job to represent people like her, particularly in dealing with local bureaucracy and issues with the Council and as such it’s a shame I wasn’t able to get involved in this case.
‘I’m particularly disappointed that the Council’s Officers seem to have chosen such a confrontational approach from the outset rather than perhaps asking her local Councillor to intervene or simply sending a less threatening warning letter.’
Japanese teaching methods heading to the UK as British pupils look to play catch up
Japanese children can perform mathematical calculations far in advance of their British counterparts just by mastering the abacus, new research has found.
School children as young as five are able to add up five numbers, each running into billions or trillions, in just half a minute – and some Japanese teenagers can add so quickly that scientists are at a loss to explain their skill.
Now British experts, including former Countdown star Carol Vorderman, are saying schools in this country could develop similar techniques to boost Britain’s ‘disgacefully’ low levels of numeracy.
In Japan, use of the abacus – parallel rods each strung with five beads – is taught to all six years olds, and it is widely used in China and other countries in the East which regularly head world numeracy league tables.
Millions of Japanese children also attend the country’s 20,000 after-school clubs, where they learn to add, subtract, multiply and divide much faster than they could with traditional pen and paper – and advanced users can compete with calculators.
The head of the Academy, Chie Takayanagi, said that whereas people could resort to calculators nowadays, using an abacus sharpened their concentration and memory.
In Japan, the best abacus users can enter competitions and some children do not even need to finger their beads as they can picture the abacus in their heads to make mental calculations.
Japanese teachers said that children in the West often found numbers hard to grasp because they were presented in too abstract a way, while the abacus provided a concrete picture of them.
One said the Japanese method of counting also helped because when children came to words such as eleven, twelve and thirteen they said ‘ten one’, ‘ten two’ and ‘ten three’, which was far more meaningful.
They also learned their times tables like nursery rhymes, and sang them to tunes they remembered into their adult lives.
Ms Vorderman, who was known on the Channel 4 Countdown show for her fast calculations and who has written numerous books on maths, said numeracy in Britain was ‘disgraceful’ partly because schools under-emphasised the visual elements of teaching maths.
She said scientific tests carried out in China using a brain scanner showed those who had been schooled in the West just used the computational side of their brains while those from the East used the visual parts as well,
She said she had learned maths using cuisenaire rods, a Western version of the abacus. ‘That’s how I learnt very very quickly,’ she said.
‘From the age of three I was doing what a lot of six year olds were doing. But everything was simple because it was visual. ‘Schools are trying to do it with words now, and giving word problems to very young children is completely pointless. ‘I don’t use an abacus but I wish I did. All aspects of the visual should be encouraged, and the abacus is one.’
Two portions of oily fish a week is associated with a slight reduction in risk of stroke
Just more “correlation is causation” speculation and the effect is vanishingly small anyway. Wholly ignorable
Scientists have found that eating two helpings of oily fish – such as salmon, trout or mackerel – every week could moderately reduce risk of a stroke.
However, fish oil supplements do not have the same beneficial effect as oily fish such as kippers, sardines, fresh tuna or whitebait, the study found.
An international team of researchers, including Cambridge-based academic Dr Rajiv Chowdhury, examined the association between oily fish, which are a good source of omega 3 fatty acids, and the risk of strokes or mini-strokes.
They looked at 38 studies involving almost 800,000 people across 15 countries, and examined participants’ fish and long chain omega 3 fatty acid consumption. During the studies, a total of 34,817 strokes and mini strokes were recorded.
After adjusting for several risk factors, participants eating two to four servings a week had a 6 per cent lower risk of stroke compared with those who consumed one portion or less every week, the study found.
Fish oil supplements were not significantly associated with a similar reduced risk, according to the paper published on bmj.com.
Eating oily fish has already been linked to other health benefits such as reducing the risk of heart disease.
‘From past research we know that eating plenty of fish is good for our general health,’ said Dr Peter Coleman, deputy director of research at the Stroke Association.
‘This research shows that it could also help to protect us against stroke. However, it’s interesting to see that taking fish oil supplements doesn’t have the same beneficial effect.
‘People who eat lots of fish may have healthier diets in general which could go some way to explain the results. However, a lot more research is needed in this area before we decide to eat fish every day of the week.
‘You can reduce your risk of stroke by exercising regularly, consuming a healthy, balanced diet and getting your blood pressure checked.’
Everyday drugs ‘can help fight dementia’ as developing new medicines is too costly and slow
A remarkable bit of optimism. Good if it turns out, I guess, It’s a poor substitute for accelerating the approval process, though
Everyday medicines could be used in the battle against dementia as developing new drugs is too costly and slow.
Experts believe antibiotics, acne pills and other routine treatments already in bathroom cabinets could double as dementia drugs. They said it is time to re-examine medicines already in circulation as cheaper, quicker alternatives to new treatments.
Many have multiple effects on the body, so some could be able to ease the effects of Alzheimer’s and other forms of dementia which affect 800,000 people in Britain.
There are only four Alzheimer’s drugs in use which can help relieve symptoms but do nothing to stop damage to the brain.
Professor Clive Ballard said: ‘Defeating dementia is one of the biggest challenges facing both medicine and society as a whole.
‘Developing new drugs is incredibly important but it comes with a huge price tag and, for those affected by dementia, an unimaginable wait.’
Everyday drugs will have passed multiple tiers of expensive safety tests and so could be prescribed for dementia in five to ten years.
It can take up to 20 years and £600million to create a drug from scratch. Hopes of quickly adding to available treatments were recently dashed when several promising new ones failed the final stage of testing.
So Mr Ballard, professor of age-related diseases at King’s College London, and other experts turned to the possibility of using everyday drugs.
They drew up a short-list published in the journal Nature Reviews Drug Discovery. One of the most promising is liraglutide, a diabetes treatment that also acts on the brain.
Others include minocycline, an antibiotic for acne, and acitretin, which treats the skin condition psoriasis. There is also a family of blood pressure drugs called calcium channel blockers. Some of these medicines cost less than 50p a tablet.
Rebecca Wood, chief executive of Alzheimer’s Research UK, said: ‘The idea that drugs for other conditions could fight Alzheimer’s is appealing. ‘But it’s not yet clear that such a drug exists. Alzheimer’s is a complex disease with many risk factors.’