Clinical Updates
Mental health patients are being ‘treated as second-class citizens’
Patients are being sent to private mental health hospitals often hundreds of miles from home.
Five million people are reliant entirely on out-of-area private sector provision.
An investigation by the British Medical Association (BMA) has revealed a widespread practice of NHS patients with serious mental health issues being sent to private mental health hospitals often hundreds of miles from home.
The doctor union has criticised this move as they claim it isolates patients from family members and means there is no NHS doctor overseeing their treatment.
Research by the BMA’s Doctor magazine found NHS mental health rehabilitation wards have all but disappeared from 18 Clinical Commissioning Groups (CCG) and NHS trusts in England, leaving five million people in those areas reliant entirely on out-of-area private sector provision.
Figures by the union reveal a £21m increased spend by the NHS on the private sector between 2016/17 and 2018 but an increase of just £2m for NHS providers.
No place in mental health care.
Commenting on the findings, the BMA lead for mental health, psychiatrist, Dr Andrew Molodynski, said:
“This practice goes against the very nature of rehabilitation which should be a transitional process, helping to reintegrate a patient back into society.
“As seen in the cases of Whorlton Hall and Winterbourne, the ‘cut-off’ nature of these institutions can be a breeding ground for the development of harsh and abusive cultures. This has no place in modern mental healthcare.”
“As well as the debilitating impact on the patient, the eye-watering sums being spent on out-of-area private providers is a clear sign that the Government must get a grip on this worrying practice. There are no positives here for patients, families, care services, or the public purse- quite the opposite. We need to ensure that care is available closer to home to give patients the best possible chance of recovery and reintegration.”
Safe, therapeutic environments.
Paul Farmer, Chief Executive of Mind, said: “Rehabilitation services play a vital role in helping people to return to living more independently in their communities. They help people get out of cycles of repeat A&E visits and acute inpatient admissions – which is better for them and for the health service. We know good care is possible and that there are places where people are having their needs met in appropriate settings. This should be the case everywhere.
“The lack of NHS rehabilitation services in some areas is further evidence of the need for significant investment to improve the state of the buildings where people receive care – so that wards provide safe, therapeutic environments for people.
“The NHS has rightly committed to improve mental health services and this must include ensuring that people can get the treatment they need, when they need it and close to home.”
Treated as second-class citizens.
Responding to a new investigation by the BMA into out of area mental health placements, RCN Professional Lead for Mental Health Catherine Gamble said:
“The NHS still hasn’t got to the point where people with mental health problems get the same access to care. They still await the same standards of care as people trying to get treatment for a physical health problem.
“At present, people with serious mental illness risk being treated as second-class citizens by the health service. We won’t close this gap until action replaces rhetoric.
“Our members working in mental health understand that their patients deserve better than the situations outlined in this investigation in which people are kept far from home, friends and family.
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.
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.
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.”
Clinical Updates
Nurses’ ‘worry’ better than most early warning scores, finds study
Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’.
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.
Nurses were asked to grade each patient between “no concern” and “extreme concern”.
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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