Nursing shortage sees too many patients dying alone on understaffed wards

Patients are dying alone in NHS hospitals because there are too few staff to care for them, according to a new report.

A survey of more than 30,000 nurses found many feeling stressed and burnt out, with a quarter saying they care for 14 patients or more at a time.

Nurses described sobbing at the end of shifts, patients being left to die alone when they have no family, and said managing patients was like “spinning plates”.

One nurse said: “Patient care is seriously compromised when there are not enough staff. Patients at the end of life have no-one to sit with them. It is very upsetting when they have no family. Too many patients are dying alone.”

Another said: “Being unable to attend to a dying patient as quickly as they need is soul-destroying.”

The report, from the Royal College of Nursing (RCN), is mainly based on UK nurses’ experience of their last shift.

Some 55% said there was a shortfall in planned staffing of one or more registered nurses on their last shift, while 41% of shifts were short of one or more healthcare support workers.

One in five nurses on a shift are temporary agency staff, while 36% of all nurses said essential patient care is left undone due to a lack of time.

This includes staff being unable to give medicines to patients on time, not having time to adequately manage patient pain or brush their teeth, and not enough time to complete records or give comfort.

One in 10 nurses described the care on their last shift as poor, rising to 14% of those working in A&E.

The report found that 53% of all nurses said care was compromised on their last shift and 53% felt upset or sad that they could not provide the level of care they wanted.

And even when nurses related concerns about the lack of staff, 44% said no action was taken by bosses.

Furthermore, three-quarters of nurses worked an extra hour on average on top of their shift without pay.

One nurse said: “I feel like I’m spinning plates, except the plates are patients – that to me is the worst feeling. A feeling of having no control.

“Going from crisis to crisis continuously is so incredibly stressful. Frontline staff feel like they are working on a battlefield; we don’t know who to go to first.”

Seven out of 10 nurses (71%) in England said their last daytime shift exceeded official staffing guidelines, which say more than eight patients to one nurse should act as a “red flag”.

Yet 26% of nurses reported shifts with 14 or more patients per nurse.

One nurse said: “I drove home from work sobbing today, knowing that the patients that I cared for did not get even a fraction of the level of care that I would consider “acceptable”.

“I would be devastated if my family or friends were in the hospital I work in, as there are just not enough staff to go around and whilst we do our best, it’s not enough.”

Another said: “On a night shift when you’re down to two staff nurses and have to look after 32 medically unwell people, if just one of those patients becomes acutely unwell overnight you cannot effectively look after everyone else.”

The RCN is calling for new legislation across the UK that guarantees safe levels of staffing.

Janet Davies, chief executive of the RCN, said: “When this many professionals blow the whistle, they cannot be overlooked.

“The nursing shortage is biting hard and needs the attention of ministers – this warning comes from the very people they cannot afford to lose.

“The findings in this report are a direct result of years of poor planning and cost-cutting – it was entirely predictable.

“We urgently need assurances from every health and care provider that services are safe for patients, and new laws on staffing should follow swiftly.”

Rachel Power, chief executive of the Patients Association, said: “This report makes for grim and upsetting reading. It confirms that the safety and dignity of patients in hospital is increasingly being compromised as a direct result of policy choices over many years.

“This situation must not be allowed to become catastrophic – but without decisive action soon, that will be the outcome.”

A Department of Health spokeswoman said: “We are helping the NHS to make sure it has the right staff, in the right place, at the right time, to provide safe care – that’s why there are over 29,600 more professionally-qualified clinical staff, including over 11,300 more nurses on our wards since May 2010.

“We have also committed to funding an extra 10,000 places for nurses, midwives and allied health professionals by 2020 to ensure the NHS has the staff it needs both now and in the future.”

KING’S FUND ISSUES WINTER WaRNing over beds shortage

Hospitals are struggling to cope as the number of inpatient beds continues to be slashed across the health service, an influential think-tank has warned.

A report from the King’s Fund found that the health service in England is facing increasing pressure as it goes into the winter months.

At the same time, blueprints drawn up locally but demanded by NHS England – known as sustainability and transformation plans (STPs) – have set out proposals to cut hospital beds even further.

Last winter, hospitals across the UK declared major alerts and closed their A&E doors, with an average of more than 90% beds full across the service.

At various points, hospitals had around 96% of their beds full and regularly went above 95%. Anything above 85% increases the risk to patients from infection and is considered unsafe.

The new study says that with hospitals already full to capacity, STP proposals in some areas to cut beds are “undesirable and unachievable”.

The number of NHS hospital beds in England has more than halved over the last 30 years, from around 299,000 to 142,000.

The report said this is partly because more patients with mental illness and learning disabilities are cared for in the community and patients generally need to spend less time in hospital than in the past.

But it warns that the NHS “now has fewer acute hospital beds per person than almost any other comparable health system”.

And it points to a growing shortage of beds as hospitals struggle to cope with increasing numbers of patients with more complex conditions.

It said: “Today there are signs of a growing shortage of beds.

“In 2016/17, overnight general and acute bed occupancy averaged 90.3%, and regularly exceeded 95% in winter, well above the level many consider safe.

“In this context, proposals put forward in some sustainability and transformation plans to deliver significant reductions in the number of beds are unrealistic.”

The report said cutting beds relies on people being cared for closer to their homes and in the community but current intermediate care – the services to support patients leaving, or at risk of going into, hospital – is only sufficient to meet around half of demand.

Shadow health secretary Jonathan Ashworth said: “The Tories’ refusal to give the NHS the money it needs has put services across the country under strain.

“It means hospitals running over safe occupancy levels throughout the year. Patients deserve better.

“It is essential that decisions about bed numbers are driven by what is best for patients and local communities, not by underfunding.”

An NHS England spokeswoman said: “Hospitals have said that they are planning to open up more than 3,000 extra beds this winter and, in addition, work is under way to free up to 3,000 more by improving the availability of community health and social care.

“We have also introduced an explicit test to prevent inappropriate bed closures while recognising that the right number of beds in any geography will partly depend on the age and number of patients in that area, the availability of alternative community services and also the level of the NHS budget that parliament requires local areas to operate within.”

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