NHS Staffing

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The content of the recent Ombudsman’s report on care of the elderly in the NHS was, sadly, not a shock to me. All the scenarios described were similar to incidents I had witnessed or could easily imagine happening. But, contrary to what the report says, I do not believe that it is a universal problem with attitude towards the elderly, but that it is all, directly or indirectly, down to staffing.

The situation on my own ward is one that is mirrored across the trust, and indeed across the country. Low morale, high stress levels, short tempers and neglected patients all result from the fact that we do not have enough staff to provide complete and adequate care for our 26 very dependent patients. On a night shift, we have two nurses and two HCAs
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Patients and their relatives have gone on camera, detailing their “appalling” experiences of meals in hospitals. However, what is never taken into account, in the hundreds of damning reports around hospital food, is the fact that meal times are akin to a military operation in their complexity. Evening supper is particularly challenging: One staff member has to push the regen trolley around and serve the dinners (we don't have a domestic for this), and ideally should have another member of staff to help take dinners to the patients. One person then needs to give out puddings and one person to do a tea round. There will always be at least a couple - but sometimes as many as six or eight - patients who need to be fed (or at least prompted/encouraged to eat, either because of reluctance, apathy or dementia). Then, all those patients who are on food record charts need to have their charts filled in - accurately (type/amount of food, action taken if patient refuses food or is unable to take food orally). So really, for meal times to go smoothly, dinners to remain hot and all patients' nutritional needs to be met, you ideally need at least eight staff, concentrating only on meal provision. On a late shift (when supper is served), we have four or five staff. Halfway through the meal, two qualified nurses have to start the drugs round. Add onto that the inevitable fact that several patients will need the toilet during the meal time, and that others may be confused and need to be monitored for safety, and you are realistically left with one or two people having to undertake the mammoth task of serving up three courses to 26 patients, ensuring that they are all well fed, and that everything is documented accordingly. You can see why patients go hungry - or have incontinence problems - at meal times, as it's so often one or the other - dinner or toilet. Wet yourself or miss your

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