Get back on the ward: patients tsar tells nurses to talk less and care more

No 10 adviser says NHS hospitals should consider getting rid of central nursing stations to re-engage staff with their patients

Nurses should be encouraged to spend less time less time talking and more time caring for patients by removing out-of-the-way nursing stations, the head of the Government's review into patient complaints has suggested.

Hospitals should consider scrapping the stations and replacing them with desks in the middle of wards, according to Ann Clwyd, the Labour MP who was appointed by David Cameron in the wake of the Mid Staffordshire scandal to examine how the NHS handles complaints.

She told The Independent that she had received more than 2,000 letters from patients, relatives and NHS staff – and that one area of significant concern was nursing stations where staff can congregate to review patient records, make phone calls and have private conversations.

She suggested that removing the stations completely and re-introducing old-fashioned desks in the middle of wards could have the effect of forcing staff to interact more with patients and ensure higher standards of care.

"A big thing that patients that have contacted me talk about is getting rid of nursing stations," Ms Clwyd said.

"People are incensed by nurses' stations. They say they just gather and chat constantly. They are suggesting bringing back the desk on the ward – not off the ward."

Ms Clwyd said one man who had gone to visit his mother described how he had approached the nursing station, only to be ignored while the team watched the end of an eBay auction.

Another wrote: "We watched in horror as elderly and infirm patients went hungry and thirsty. They were left for long periods in soiled bedding and clothing. Wards were dirty. We turned up at visiting time and saw uneaten meals still left on patient tables. The nurses weren't busy – they preferred to gather round the nursing station and discuss their social lives."

Other examples of poor care that had been raised included:

n A woman who was admitted to hospital with two broken wrists. "No one would feed her when meals were delivered despite the fact she had two arms strapped up in the air," a relative wrote. "My aunt had to travel two hours by bus every day just to ensure she was fed."

n A husband whose wife had undergone a hip operation. "I asked the nurse for help because she was being very, very sick," he wrote. "She announced, 'I am a graduate. I don't do sick' and left me to deal with the situation."

n An elderly woman with hearing difficulties whose mental capability was being assessed. "Nobody had cottoned on to the fact that they were asking her questions but she didn't have her hearing aid in so they came to the conclusion that she was incapable when she just couldn't hear the questions," a relative wrote.

Peter Carter, the head of the Royal College of Nursing, rejected Ms Clwyd's suggestion that the NHS should consider getting rid of nurses' stations. "Doing away with nursing stations is not the solution," he said. "If you really do have nurses leaving people in soiled sheets and bidding on Ebay auctions then that kind of attitude is not going to be changed by re-configuring a ward.

"Nurses' stations are there for a reason. Nurses need to be able to review case notes, work on computers and answer the telephone, and that would not be practical if you just had a table in the middle of a ward."

Ms Clwyd said she would not speculate on what conclusions she might draw for her own report to ministers until after she had had a chance to assess all the evidence.

But she noted that the same sort of complaints had come up "over and over again".

"People feel that they have no way of getting redress," she said. "They have not had responses [from hospitals] where they feel action is taken. There are many apologies but very little action. This level of neglect is played out over and over again."

Ms Clwyd also spoke about the death of her own husband in traumatic circumstances in an NHS hospital and admitted that as a relative she herself felt guilty for not doing enough to protect him.

"I started reading the email from other people who had had experience of poor care and then I had to stop because they were making me feel ill.

"Then you start thinking about your own experience and then you ask more questions. You think, well, did he have food, did he get his medication, was he turned in bed? They were things that I didn't think about asking about because if you hand over to professionals you expect them to do their job."

The key changes

GPs are now responsible for deciding how the NHS spends most of its money. For example if they want to spend more on diabetes prevention for their local communities and less on hip replacements they will have more freedom to do so.

These new GP groups will also be able to choose which hospitals to send their patients to and who to commission services from. This could mean more patients being treated in private hospitals – if they’re prepared to do the work at a cheaper rate.

There will be more emphasis across the NHS in stopping people getting ill in the first place – and trying to prevent them from going into hospital when they are.

Small ‘cottage’ treatment facilities are likely to grow while some big hospitals could close or be scaled down in size.

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