Government managed healthcare – scary story

“Nurses to make hourly rounds under Cameron plans

Prime minister wants hospital nurses to concentrate on 'patients not paperwork' to drive up standards

Alexandra Topping and agencies

guardian.co.uk, Friday 6 January 2012 08.40 EST

Nurses will be told to undertake hourly ward rounds while members of the public will be allowed to inspect hospitals, the prime minister has announced on a visit to a hospital in Salford.

David Cameron said most patients were happy with NHS care but there had been well publicised cases of patients not getting good basic treatment or being treated with respect.

The prime minister, accompanied by the health secretary, Andrew Lansley, toured Salford Royal hospital in Greater Manchester, which he called a "model" hospital. He met patients and talked to nurses, sisters and matrons, praising the general level of nursing care in the NHS.

"I think the standard is very high – in the overwhelming majority of cases people rightly revere our nurses in Britain – but it's quite clear in a limited number of cases standards have fallen below what is acceptable. We have seen that in CQC [Care Quality Commission] reports, we have seen it with our own experiences as constituency MPs, elderly relatives not getting the care they need. And so what we need to do is make sure that doesn't happen.

"Here in Salford we are getting hourly nursing rounds where patients are asked every hour about whether there are any problems, making sure we have patient-led inspections of hospitals, making sure we have simple service where we ask patients and staff, 'Would you be happy for your relatives to be treated in this hospital?'

"Making sure that managers of hospitals, the boards of hospitals, look at the quality of care above everything else, simple straightforward things that are done here in the best hospitals in our NHS, but need to be done everywhere else."

The government has pledged to "put right" the problems after the CQC found problems in providing good nutrition and dignified care for patients in hospitals throughout the country.

Cameron said hourly ward rounds, the system already running at Salford Royal, had decreased the number of falls and bed sore complaints by patients and put hospital infections at "rock bottom".

"This is a fabulous example of the best of our NHS by putting care, the quality of care, the quality of nursing, before everything else and we need to do that in every hospital in our country."

Lansley asked nurses what sort of things patients were telling them or asking for during hourly rounds. Sister Jane Kingham told him a regular request was: "Can I have another brew?"

Earlier, Cameron said there was a "real problem" with nursing in UK hospitals, with successive governments lacking the bravery to tackle the issue.

Speaking on BBC Radio 4's Today programme, Cameron said he had "huge respect" for the work nurses did, adding that he had seen at first hand "the very high standards of quality and care that the best nurses provide".

But care was not consistent and the issue had been ignored for too long, he said. "While we know that the vast majority do a brilliant job, there is clearly a problem in some hospitals, in some settings, where we are not getting the standards of care the nation expects. I think politicians frankly have done nurses a bit of a disservice by not talking about this. Such is our respect for nursing that we've hidden away concerns about this."

In October the Care Quality Commission found a fifth of NHS hospitals were breaking the law on care of the elderly. Its study found half of hospitals were failing to provide all-round good nutrition to elderly patients while 40% did not offer dignified care.

Of 100 hospitals investigated in England, 49 were found to generate minor, moderate or major concerns about nutritional standards for elderly people.

Cameron wants nurses to focus on "patients not paperwork" while all hospitals will be expected to implement regular ward rounds "to systematically and routinely check that patients are comfortable, are properly fed and hydrated".

A new Nursing Quality Forum of frontline nurses and nursing leaders is intended to promote excellent care and ensure good practice across the NHS.

Patients will lead inspections of hospital wards, with local people becoming part of teams assessing cleanliness, dignity and nutrition.

A "friends and family test" will ask whether patients, carers and staff would recommend their hospital. The results will be published and leaders of hospitals who fail the test will be held to account.

"If we want dignity and respect, we need to focus on nurses and the care they deliver," Cameron said. "Somewhere in the last decade the health system has conspired to undermine one of this country's greatest professions.

"It's not one problem in particular. It's the stifling bureaucracy. The lack of consequence for failing to treat people with dignity. Even, at times – as we saw with Mid Staffordshire – the pursuit of cost-cutting or management targets without sufficient regard for quality of care.

"Nursing needs to be about patients not paperwork. So we are going to get rid of a whole load of bureaucracy that stops nurses from doing what they do best. And in return patients should expect nurses to undertake regular nursing rounds, systematically and routinely checking that each of their patients is comfortable, properly fed and hydrated, and treated with the dignity and respect they deserve.

"This happens in the best hospitals. In some it has never stopped happening. Now it needs to happen in every hospital. And the Royal College of Nursing support us on this and we'll be working with them to make it happen."

Under the plans, an NHS Institute Time to Care initiative will be rolled out with the aim of cutting paperwork. More than 60% of NHS acute trusts are already implementing the programme, which has helped nurses to spend an extra 500,000 hours with patients in one year, according to information from Downing Street. The aim is to have all hospitals implementing the programme from April 2013.

In another development, hospitals could receive bonus payments of up to 0.5% of their contract income if they use a new NHS Safety Thermometer to improve quality on basic care.

Dr Peter Carter, chief executive and general secretary of the Royal College of Nursing, said nurses chose the profession because they wanted to care for people and would welcome the moves to free them to put care first and focus on the needs of patients.

"In particular, nurses themselves have emphasised the enormous burden of the paperwork they have to complete, day in and day out," he said.

Katherine Murphy, chief executive of the Patients Association, also welcomed the plans. "This is a significant step forward in meeting the demands of our Care campaign, launched in November last year," she said. "But we are disappointed that it has taken intervention at this level to bring about the change that is desperately needed. We have consistently said that nurses need time to care, and we have called for an end to the bureaucracy that stops effective nursing."

The shadow health secretary, Andy Burnham, said: "If David Cameron really wants to help nurses focus on patient care, he should listen to what they are saying and drop his unnecessary health bill."

Jo Webber, deputy policy director at the NHS Confederation, told BBC Radio 4's Today programme that the amount of paperwork required from nurses varied from hospital to hospital. "I think the first thing hospitals will do in any case is to do an audit of what nurses are actually doing and to try and pare away those tasks which are mundane and routine and can be done by, say, ward clerks."”