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‘Care deserts’ leave 1.4 million people without the care they need

Older people are unable to access residential or home care, regardless of whether they can pay for it or not.

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The number of vacancies for registered social care nurses has tripled.

Age UK claims that many parts of the country have become ‘care deserts’, where older people are unable to access residential or home care, regardless of whether they can pay for it or not.

A new study, carried out by Incisive, an independent health consultancy, shows that 1.4 million older people are missing out on the right level of care due to cuts to social care funding and a shortage staff.

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The charity says the number of vacancies for registered social care nurses has tripled in the past five years, meaning there are 8000 fewer nurses now than in 2012.

This lack of nurses means vast sections of the country, dubbed ‘care deserts’, are suffering from a shortage of care providers, and many older people have to travel a long way to get the care they need.

The study showed that while the situation across different areas the country is wildly different, each place showed a cause for concern, whether that was a chronic lack of care now or the risk of losing care workers following Brexit.

Chaotic and broken’.

Caroline Abrahams, Charity Director at Age UK says: “This new report shows how chaotic and broken the market for care has become after years of underfunding and the absence of determined Government action to ensure the right workforce is in place.

“The end result is laid bare by the authors – the emergence of care deserts and a deeply worrying lack of nursing home places, in particular, leaving some of our most vulnerable older people high and dry. It would be hard to exaggerate how serious the implications of this report are for older people, or indeed for the NHS, which is the place of last resort if no nursing home places are to be had.”

“The report shows what an impossible position local authorities are in; they are supposed to ‘manage’ their local care market, but they lack the levers to do so and the big drivers of the problems in the care industry are way beyond their control.

“Meanwhile, they are desperately short of money to purchase care home places for older people in need, so more and more of the financial burden is being shifted onto those older people who fund their own care, who are paying through the nose to keep the system afloat. This is deeply unfair.

“Incisive Health’s report demonstrates that the situation differs markedly from place to place but in the end the fragile nature of care in our country is a national problem and it needs a national solution. If the awful situation set out in this report doesn’t persuade our Government to finally get a grip and take action I don’t know what will.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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