The adage that a week is a long time in politics has never been as evident as in the last month. With all eyes trained on Westminster, the travails of the NHS, which continue apace, have been quietly shunted onto the back pages.
The latest hospital to be criticised by the Care Quality Commission (CQC), the Health Education England (HEE), and the General Medical Council (GMC) is North Middlesex whose A&E department was not only found to be inadequately staffed by suitably qualified doctors but also to have a shortage of nursing staff. This had a seriously detrimental effect on patient care: the lack of staff meant that the frequency of patient rounds were badly disrupted to the extent that a patient who had died was only found after more than four hours had passed.
It’s all down to leadership - again
The CQC, HEE and GMC have all pointed to the failings of the hospital’s leadership and, as a result, the Royal Free hospital will be supporting the North Middlesex leadership team, in particular A&E. A joint statement by the HEE and GMC stated: “Like The Care Quality Commission, the GMC and HEE continue to have major concerns about the culture within the department, the management of patients and the support provided for staff including doctors in training.” A hospital (rather like a school) is only as good as its senior management, a point proved by Basildon Hospital a couple of years ago which came out of special measures after the (newly appointed) chief executive instigated wholesale changes in the way the hospital was run by putting ‘compassion, care, openness, transparency and learning’ at the centre of their operations. Nonetheless, although good leadership will always find ways of mitigating the effects of staffing shortages, the problems facing many of our hospitals are multi-faceted and endemic.
Where will our nurses come from?
The staffing problems faced by North Middlesex’s A&E department are reflected in a report, recently published by The Institute for Employment Studies for the Migration Advisory Committee, highlighting the severe shortage of nursing staff in the NHS. In response the government has agreed to give visas to 15000 nurses from outside the EU over the next three years. The report gave the following figures: 1 in 10 nursing posts are unfilled; 29% of nurses are aged over 50; and 13% of nurses come from overseas. Immigration was a central campaigning issue in the recent EU referendum and although one might assume the general public would support boosting nursing numbers regardless of origin, the scale of the number of workers we need to recruit from overseas might become a major political problem.
Is there a doctor in the house?
The difficulties at North Middlesex were not confined to nursing staff: a shortage of sufficiently senior doctors meant that their A&E department could not provide adequate training for newly and recently qualified doctors, a major concern for the GMC and HEE. As a result, both bodies will only support North Middlesex hospital in retaining its position as a centre for post-graduate training if there are significant improvements in both the culture and management of A&E which they will monitor via continuous feedback. NHS England, other parts of the North Middlesex Trust and the Royal Free Hospital are supporting the required changes and there are plans in place to make the department safe for both patients and staff.
Patient safety compromised by recruitment difficulties
The threat to patient safety posed by the inadequate care in North Middlesex’s A&E department is indicative of the perfect storm heading for the NHS. A shortage of nurses and doctors, confusion over the UK’s immigration policy and what it will mean for future recruitment of medical staff, and poor leadership, not only of individual departments but whole Trusts too, is undermining the government’s commitment to improving patient safety. It’s encouraging that bodies such as the GMC and HEE are proactively putting measures in place to safeguard the welfare of the professional staff (with the obvious knock-on benefit for patients). Nonetheless, given the scale of the problem throughout the country and the continuing, rising cost of medical negligence claims against the NHS, one can’t help feeling that such measures might ultimately be overwhelmed by forces beyond their control.