Chief speaks frankly on hospital's challenges

Acting chief executive Mary Edwards conceded a new system for admitting patients had led to a high workload for nurses on the wards which have most recently come in for criticism.

Mrs Edwards was speaking after a meeting with Basingstoke MP Andrew Hunter and The Gazette to discuss the crisis in confidence about care for old people at the hospital.

Mr Hunter had threatened to name and shame the hospital in the House of Commons if bosses could not reassure him improvements were being made.

Mrs Edwards said: "The recent spate of complaints is distressing and we want to make sure we work with staff to address any of the issues raised.

"We do need to take complaints seriously and learn lessons where things have not gone well. I'm saddened when I read things like this in The Gazette."

Last month, The Gazette revealed the anger of families disgusted with conditions on F floor and we subsequently reported on the steps to lift standards there, which met with the approval of Mr Hunter.

But two weeks ago, Terry Crame, a nurse in the children's department at the hospital, resorted to poetry to protest about the care given to her 77-year-old mother, who died on E floor on April 15.

Since then, more readers have contacted both The Gazette and Mr Hunter to express their anguish about nursing care for the elderly at the hospital.

Mrs Edwards said she could not discuss specific cases but recognised that many of them revealed similar problems, even though she maintained patients' relatives were not always accurate in what they alleged.

She said the failings were linked to the increased amount of work for nursing staff caused by a "new model" of care which has been introduced over the last year. At the same time, Mrs Edwards said it has been difficult to recruit nurses.

She said: "It has meant dealing with more patients, a lot of whom are very sick and very dependent. When you are introducing change there are always problems. And along with a lot of hospitals in the South, there are problems with recruitment, although we have made great strides there."

She said the hospital has changed to a set-up in which patients are not treated in a particular way just because they are old.

She explained: "Quite a lot of research evidence shows patients benefit from acute treatment and therapy regardless of age."

She said elderly patients with medical illnesses used to go into hospital via the accident and emergency department, and then automatically to F floor.

Now they are admitted to the assessment unit on E floor and referred to the relevant specialist. But if they have complex problems associated with old age, they will still be transferred to the elderly care team on F floor.

One result of this had been to funnel more patients through E floor, said Mrs Edwards. She said the number of emergency patients admitted to the hospital has shot up, reaching a figure of 1,600 in March.

Mrs Edwards recognised many of the complaints have focused on agency nurses, with relatives and patients alleging that some were unsympathetic, idle or difficult to understand for elderly folk because they were from overseas.

She said dependence on agency staff had been reduced by the recent recruitment drive, which increased the number of bank nurses who are more familiar with hospital requirements. These are nurses regularly available for part-time work, including full-time nurses working extra hours.

Gina Lilley, who has led the hospital's recruitment project set up in October, said that on E floor there should be a combined total of 91 nurses and health care assistants, but that 78 are now in post. Interviews are now in progress for some of the unfilled positions.

A programme of "preferred agencies" has also been instituted, and agency nurses have a personal identification number which can be checked against qualifications.

Mrs Edwards said the full-time Filipino nurses employed by the hospital have been a success.

She added: "They are highly qualified, extremely competent and have adapted really well."

Mrs Edwards said she did not accept that British nurses now have a poor attitude towards elderly patients. She said they came into nursing knowing that two-thirds of patients would be over the age of 65.

She said: "I still believe that nurses come to work every day because they believe they can make a difference to the care of patients. Where it doesn't go well, it can be to do with not having time to communicate sensitively. A lot of my staff are frustrated because they are not able to give the emotional care that they know is part of nursing. It's pressure of time."

She said if relatives wanted more clarification about a patient's treatment, they should not be afraid to ask. Nor should they be afraid to complain to the hospital's Patient Advice and Liaison Service.

Mrs Edwards said: "I would rather they try to solve the matter while the patient is here, rather than through a complaint letter later."

Mrs Edwards said the role of the health care assistants - who wear green - had widened in recent years to take on some of what nurses traditionally did. This could include washing and feeding patients and moving them to avoid sores.

Nurses - who wear blue - are now more "technical" in having to plan care and supervise more numerous and sophisticated checks and tests.

Mrs Edwards said it was clear from complaints that the feeding system had not always worked. The solution, she said, may lie in the new role of housekeeper, who would be part of the ward team, performing a support role.

New health care assistants are also being given a six-week course before they start so they have "a basic level of expertise which wards can build on".

Mrs Edwards said hygiene, although criticised by relatives, had improved within the hospital - a fact recognised by a national inspection team. And she said there should never be a failure to supervise the handing-out and consumption of medication, as some relatives alleged.

In response to worries about night-time staffing, Mrs Edwards said a ward of 22 beds should have three staff on duty at night, often working a shift from 9pm to 7.30am. But there was also a team of night practitioners available across the hospital.

She said finally: "The doctors are saying that there are examples where clearly things have not gone well, but an awful lot where they have gone well. I can tell you staff are doing their best."