1. Corridor wards
Essex Branch
(R) That this meeting of RCN Congress calls for an end to the use of inappropriate areas as extra bed capacity
Result
The resolution was .
For: 409 (99.51%)
Against: 2 (0.49%)
Abstain: 2
The resolution was passed.
Debate report
Samantha Neville from the Essex Branch asked RCN Congress to call for an end to the use of inappropriate areas as extra bed capacity.
She spoke about her experiences of reconfigured NHS services over the last 10 years, the increase in admissions to accident and emergency services, and the increasing number of older patients.
She highlighted the insufficient number of bed places, reported recently in the RCN Frontline First campaign, and how the stretching of resources had led to a detrimental effect on patient care and the morale nursing staff. As nurses are put under pressure to discharge, she said there was a “revolving door” for patients. “How many more initiatives must we see before this is put right?” she asked.
Samantha said that patients have the right to expect the same level of care, wherever they receive it and in the appropriate physical environment. This would ensure they were given access to dignified care, and avoid distress for patients, their families, carers and for staff.
The resolution was seconded by Marcia Turnham. She said this was not a new problem and called on Congress delegates to be more vocal about patients being nursed in unsafe areas and monitor the outcomes of these patients.
Responding to the proposal, Roisin Devlin said it was distressing that this issue was still being debated eight years after it was first debated at Congress.
Mike Hayward said the system wasn’t right. Sending a message to Secretary of State for Health Andrew Lansley, he showed that he couldn’t fit the contents of a large can of beer into a half pint glass. This, he said, was an analogy of what was happening in the NHS. “Explain... how you expect us to deliver safe, quality and dignified care in the NHS when you insist on cut, cut, cut,” he said.
Zeba Arif and Council Member Mike Travis insisted that RCN members should take action. Zeba said that incident forms must be completed whenever any patient was treated in an inappropriate care area and Mike urged members to tell the RCN when this happens, referencing a previous case when a referral was made to the RCN Industrial Action Committee.
Minty Macleod, a first-time Congress speaker, reminded nurses that their Nursing and Midwifery Council PIN number could be at risk if they did not say no, when inappropriate care areas were used.
Background
Acute hospitals in the UK are under pressure as, against a backdrop of ward closures, the number of patients requiring admission to hospital continues to increase. The Department of Health (DoH, 2012) reports that the average daily availability of general and acute hospital beds fell by 22 per cent (30,514) between 2001 and 2011, while A&E attendances increased by 60 per cent (from 12.9 million to 20.7 million) and the number of emergency admissions grew by 56 per cent (from 2.23 million to 3.5 million).
This demand is being exacerbated by the UK’s rapidly growing population of older people. Currently 1.25 million people are aged 85 or older and this group is predicted to double in the next 25 years (Office for National Statistics, 2008).
While DoH initiatives to implement care closer to home have been shown to provide convenient and high-quality care to patients, in many areas these are being implemented against a backdrop of service reconfiguration, cost savings and a reduction in hospital bed capacity.
In November 2010, the Chief Nursing Officer and NHS Director General wrote to all NHS trusts and PCTs in England (acute, general and mental health) making it clear that NHS organisations are expected to eliminate mixed-sex accommodation, except where it is in the overall best interest of the patient, or reflects their personal choice. They went on to say that while there is some local discretion to prevent disproportionate fines or perverse behaviours, by and large commissioners are expected to impose financial sanctions as directed by the contract.
The Northern Ireland Audit Office recently reported that, “operational performance against measures such as waiting times has declined significantly since March 2009” and that Northern Ireland’s waiting times are now the highest in the UK. The RCN has consistently highlighted members’ concerns over excessive ‘trolley waits’ in Northern Ireland’s acute hospitals and the associated patient dignity issues, the problem of patients being inappropriately detained in ambulances outside A&E departments due to lack of capacity, and the continuing existence of mixed gender ward accommodation.. The RCN has linked these pressures to staffing shortages (the nursing workforce has declined by 2 per cent since December 2009) and service reconfigurations.
In Scotland, the Efficiency and Productivity Framework initiative (Scottish Government, 2011) is attempting to improve hospital bed utilisation. In addition, the NHS Scotland Quality Improvement Hub is currently promoting a programme to improve the patient journey, providing tools to health boards to analyse and address the barriers to appropriate bed use.
Despite all these initiatives the RCN is increasingly receiving reports, via its Frontline First Campaign, that in the event of insufficient bed capacity patients are being cared for in unsuitable environments and with inadequate staffing levels. This is not only unacceptable from a patient experience and safety point of view, but also causes great distress to families, carers and nursing staff alike.
References and further reading
Department of Health (2012) Beds, Leeds: DH (statistics). Available at:
www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Beds/index.htm (accessed 8/3/12).
Scottish Government (2011) NHSScotland efficiency and productivity: framework for SR10 2011-2015, Edinburgh: Scottish Government. Available at: www.scotland.gov.uk/Publications/2011/02/11144220/0
(accessed 8/3/12).
