The call came as Director Colin Poolman gave evidence to the Parliament’s health, social care and sport committee on the National Care Service (Scotland) Bill. During his evidence he highlighted that the focus on the National Care Service will do nothing to address the current crisis in capacity or tackle the chronic workforce shortages and recruitment and retention challenges within community health and social care services.
Throughout the summer Scotland’s acute hospitals have continued to experience overcrowding, with the number of people waiting in excess of four hours in A&E during July at record levels and almost 2,000 people ready to leave hospital but waiting on packages of care and support in the community.
Many of NHS Scotland’s health boards have implemented continuous flow models in an attempt to reduce the length of time patients have to wait within emergency departments. We have raised concerns about the risks associated with these models with boards, with NHS Scotland and directly with the Cabinet Secretary, Neil Gray MSP.
In particular, we have highlighted the normalisation of this unacceptable practice and the lack of recording and reporting of incidences where patients are cared for in inappropriate areas such as corridors and treatment rooms or when additional beds are added to wards without the necessary staffing or equipment to ensure patient safety and dignity.
The pressures on hospital services are a direct result of the lack of capacity within community health and social care services. We want to see the winter preparedness plan 2024-25 acknowledge and address this.
Over the summer, we asked you to share your experiences of care in appropriate places via the Sensemaker tool. Following is a sample of some of the stories we received.
Staff nurse: “Caring for an end of life patient (who subsequently passed away) in a six bedded busy medical ward. We just couldn't facilitate a side room due to infection control issues. Meanwhile management are still calling the ward to try and arrange transfers of additional patients to the ward - seventh patient in six bedded room. No curtains, no oxygen points, no sockets, no space. Two examples of no privacy nor dignity in care.”
Staff nurse: “Patient sent to the ward and no available bedspace as no discharges evident yet. Patient sat on a porter’s chair for six hours, required oxygen and only had a portable oxygen tank to suffice - which eventually ran out. Patient and relative unhappy but ward staff had no control of said situation. It has become a regular practice to facilitate faster patient flow and outcome is undignified and not person-centred.”
Staff nurse: “Pressured to get patients discharged to get new ones in as quickly as possible. Encouraged to send people home to return later for discharge medication that wasn’t ready. Caring for patients in additional bed spaces without curtains, call buzzers or oxygen ports. Not getting breaks. Not having time to go to the bathroom. No matter what I do, it isn’t enough.”
Senior charge nurse: “Caring for patients in corridors. Assessing people in relatives’ room and makeshift corners with screens in place. Knowing we can’t check patients’ skin or care for continence needs because we don’t have anywhere to do it - the endless daily cycle of this. Our reality every single day - no exception. The indignity and humiliation that our frail elderly population are subjected to every single day. We don’t meet patients’ basic needs.”
Ahead of today’s statement, Colin Poolman, Director RCN Scotland said:
“You have expressed the impact of overcrowding on your patients and on your own wellbeing. There has been no let-up in the pressures over summer, and patient care is being compromised daily.
“No patient deserves the indignity of corridor care. The Scottish Government must set out a plan that addresses the continued nursing workforce shortages across the NHS and social care and that requires the mandatory reporting of care in inappropriate areas to understand the scale of the pressures and how to best target resources to improve the safety and quality of care. We cannot afford to wait for a National Care Service, action is needed now.
"Good care costs but missed care costs more. The Scottish government must invest to get our health and social care system through this winter safely.”
The winter preparedness statement follows the news that the RCN Scotland members voted to accept the delayed Agenda for Change pay offer from Scottish government for 2024/25.
Colin Poolman added: “Paying nursing staff fairly for the safety critical work you do is key to retaining and recruiting the workforce. As is creating a safe, compassionate and rewarding working environment. The Scottish government has much to do to if it is to reform health and social care services, reduce health inequalities and attract the workforce it needs to provide the people of Scotland with the quality of care they should expect.”
