NHS TRUST

Nurses have been banned from showing cleavage or baring midriffs after NHS trust warned they must uphold hospital standards. East and North Hertfordshire NHS Trust has issued a strict new uniform policy for all staff after a series of complaints from patients. Doctors and nurses face the threat of disciplinary action if they are caught wearing clothes which expose their ''midriff'' or ''excessive cleavage''. The guidelines also ban the Trust's 5,000 clinical and non-uniform staff from wearing shorts, mini-skirts, denim or leggings while at work.

The six-page uniform policy was agreed in March and aims to establish a ''professional and consistent '' image which reflects the ''Trust's values''. It reads, ''Staff will not dress in ways that undermines the spirit of this policy and clothing that exposes the midriff, torso or excessive cleavage, along with wearing denim, shorts, leggings and mini-skirts, are not acceptable.'' The Trust has also warned staff it will carry out ''audits'' of the uniform policy in every ward, department and service area. Anyone caught breaking the uniform policy, which applies to nurses, doctors and non-clinical staff, will face disciplinary action. (Source: Daily Telegraph, Jun/11)

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Ambulances will no longer be sent to desperately ill patients following a secret review of 999 calls. NHS bosses have axed rules which say victims of serious health emergencies should be sent transport which is able to take them to hospital. Instead, trusts will be able to hit Government targets in many cases by sending out paramedics in cars, even if it means that seriously sick and injured patients are left waiting for hours before an ambulance can take them to a casualty department.

The change was quietly introduced by senior ambulance officials last month following what they describe as an "informal review" of the 999 system. Patients' groups and ambulance staff said they were appalled at the decision by the department's Emergency Call Prioritisation Group, which was taken without consultation in the last weeks of the Labour government as part of attempts to manage rising demand for NHS emergency care.

Katherine Murphy from the Patients Association described the change in the rules as extraordinary and "dangerous beyond belief". She said the rewriting of the rules encouraged ambulance trusts to risk lives in order to meet targets. The Association of Professional Ambulance Personnel expressed "deep concern". In millions of emergencies classed as "serious," including those involving victims of major trauma, the commitment to send vehicles "capable of transporting the patient in a clinically safe manner" has been removed.

It means trusts can hit an NHS target to respond to calls in 19 minutes by sending cars out to patients who are then forced to wait for an ambulance which can safely convey them to hospital. Under the latest guidance, the response required for cases identified as "immediately life-threatening" remains unchanged: a paramedic should be sent within eight minutes, with full ambulance backup in 19 minutes. While rapid response vehicles are able to carry some patients with minor injuries, accident victims requiring specialist equipment and seriously-ill patients in need of monitoring can only be moved in an ambulance.

An additional problem is that most trusts use "solo responders" to drive many of their cars. Paramedics in this situation would not be able to attend to a seriously sick patient at the same time as driving them to hospital, experts warned. Under the old rules, 999 control rooms could only dispatch a car to patients in the "serious" category if they had already assessed that they could be safely conveyed without an ambulance.

A DoH spokesman said the new Government was about to examine “the whole area of NHS targets,” including those in the ambulance service, and would set out plans soon. He added, “Patient safety is the priority. We expect ambulance services to provide the most clinically appropriate response to Category B patients.” (Source: Sunday Telegraph, May/10)

Robert Francis QC's damning report paints detailed picture of failure at Mid Staffordshire NHS Foundation Trust. A lack of compassion among staff. Patients left lying in their own urine and faeces. Others falling, sometimes sustaining a serious injury or even dying as a result, unseen by ward personnel. Meals not provided or put out of reach. Uncaring staff rejecting requests from patients and relatives for help. Lamentable hygiene standards. Family members having to clean, feed or help their loved ones get to the toilet. Too few doctors generally, especially in A&E. Reluctance among patients to ask hard-pressed staff to provide proper care, and fear among staff about the consequences of not meeting targets.

Robert Francis QC's damning report paints an extraordinarily detailed picture of failure, neglect, insensitivity, chronic ineptitude and poor decision-making at Mid Staffordshire NHS Foundation Trust. Many people who went into Stafford hospital expecting to be well looked-after instead "suffered horrific experiences that will haunt them and their loved ones for the rest of their lives". Francis said, "The experience of listening to so many accounts of bad care, denials of dignity and unnecessary suffering made an impact of an entirely different order to that made by reading written accounts. All those who were present at oral hearings were deeply affected by what they had heard."

On continence and bladder and bowel care, he found, "Requests for assistance to use a bedpan or to get to and from the toilet were not responded to. Patients were often left on commodes or in the toilet for far too long. They were also often left in sheets soiled with urine and faeces for considerable periods of time. Considerable suffering, distress and embarrassment were caused to patients as a result." The situation was so bad that some families resorted to changing beds and washing soiled bedding at home. He added, "Some staff were dismissive of the needs of patients and their families. The omissions described left patients struggling to care for themselves; this led to injury and a loss of dignity, often in the final days of their lives. The impact of this on them and their families is almost unimaginable."

Safety was equally slack. Patients fell, sometimes sustaining a serious injury. Many, if not all, took place unobserved by staff and too many were not reported to concerned relatives for too long. The report mentions "a patient suffering a series of falls unobserved, finally sustaining a fatal injury. While misdiagnoses of conditions did occur, including of a serious injury in a young man who later died as a result, most of the failings were human rather than clinical. Some staff did not give mouthwash to patients with mouth ulcers, used the same razor on more than one patient or did not clean patients' teeth.

The report said, "Failure to ensure a proper level of personal cleanliness and hygiene degrades patients, aggravating the feelings of illness, disability and separation from home and familiar surroundings," About half of the patients and relatives who gave evidence to the inquiry singled out difficulty in obtaining food and drink as a major concern. Some patients never received food at mealtimes; some who did found that it was placed too far away for them to reach it and so was removed, untouched. Intake of food and water, both vital to recovery, was not encouraged.

The report concluded, "Frequently the explanation appears to have been a lack of staff but sometimes staff were present but lacked a sufficiently caring attitude. Breaches of patients' privacy and dignity included patients left inadequately dressed in full view of passersby; patients moved and handled in unsympathetic and unskilled ways, causing pain and distress; and rudeness or hostility. However difficult the circumstances, there is no excuse for staff to treat patients in the manner described by some witnesses."

Staff were equally critical about the hospital's management, and described bosses who bred "an atmosphere of fear of adverse repercussions", stressed NHS targets were the top priority and were secretive when things went wrong. The trust's board, which was meant to hold managers to account and ensure high clinical standards were maintained, were aware of the weaknesses but failed to ensure improvements were made, the report says. (Source: The Guardian, Feb/10)

The trust which runs Derby's hospitals is to hire a fund-raising manager on a salary of up to £50,000 a year, having spent £17,000 on a 22-day review to make the decision. Derby Hospitals NHS Foundation Trust hired a consultancy firm to investigate whether or not it should appoint a fund-raising manager.

Sandcliff A B Ltd, based in Wiltshire, was paid £773 a day to carry out a review of the trust's arrangements. The result was a recommendation to introduce the new role. The review looked at all fund-raising activities, including the Evening Telegraph's Magic Million Appeal, which aims to raise £1m for cancer equipment for Derby's hospitals.

A spokeswoman for the trust said the manager would "spearhead the implementation of a proactive fund-raising strategy." She said, "It is anticipated that the person will be full-time. Experienced fund-raisers are at a premium. It is difficult to recruit a fund-raiser for less than £35,000 and a typical head of fundraising can earn around £45,000. This often rises to £50,000."

Don Prime, chairman of the Magic Million Appeal, said, "There is a constant need for more income to supplement that which the Government gives to hospitals. Having said that, if they have to pay a lot of money to a manager, that is a loss." The trust spokeswoman said it was too early to tell if the money spent on the consultancy firm and on a fund-raising manager, who could start in February or March next year, was well spent.

She said, "Sandcliff A B Ltd's report gave the trust guidelines about how much money could feasibly be raised by a fund-raiser over a certain period. The aim is that by the end the first-year costs will be matched by an increase in income and by the end of the second year a minimum of £500,000 should have been raised. It is anticipated that at least this amount will be raised each year."

Brenda Dawe of Chellaston, raised £15,000 for various charities, including the Magic Million Appeal, said, "I think there is a need for a fund-raiser, but £50,000 sounds like a lot of money and I don't know how they will justify that. That money could be spent on equipment or specialist treatment at the hospital." (Source: Derby Evening Telegraph)