Elderly 'are put at risk by lack of qualified nurses'

RCN says the provision of "basic, safe care" requires a minimum of one nurse to seven patients.

Official data seen by The Herald shows the number of nursing and midwifery staff has dropped by 2190 in two years from 58,428 in September 2009 to 56,238 in December 2011.

RCN also highlighted an "inappropriate" mix of registered nurses to lesser-trained healthcare assistants (HCAs), who are asked to pick up skills as they go along.

The RCA, which had called for much tighter regulation and mandatory training, says a typical 28-bed ward would have a 50/50 split of nurses to HCAs.

However, the Government is not in favour of statutory regulation and has unveiled plans for a "code of conduct" and voluntary training for HCAs.

The RCN said hospitals are leaving too much in the hands of HCAs and recommends a ratio of 65% nurses to 35% HCAs. It is calling for a "patient guarantee" to set out the number of nurses needed on older people's wards.

RCN Scotland director Theresa Fyffe said: "As health boards come under increasing financial pressure to deliver the same services to more and more people, they are saving money when nurses leave by not replacing them or by replacing them with nurses and healthcare support workers at lower paid bands.

"It is time senior charge nurses, who manage hospital wards, are given the genuine authority to be able to decide their own staffing levels locally on a day-to-day basis, to reflect fluctuating patient need."

The RCN was supported by patient groups, some of which thought they had underestimated the problem.

Dr Jean Turner, chief executive of the Scottish Patients Association, believed there was a problem with "substituting" nurses for care assistants.

She said: "I would think that it is optimistic if they think even one in seven will cover everything. The truth is we don't have the manpower."

Jan Killeen, Alzheimer Scotland director of policy, said there had to be more flexibility to cover for older people's wards.

She said: "Our dementia helpline continues to receive regular calls from relatives who are concerned that having too few staff on duty is affecting how often their loved one is given water or taken to the toilet while in hospital. This can result in dehydration or patients being injured when attempting to go to the toilet alone.

"The number of older people being treated in our hospitals is rising and we must ensure that not only do we have enough staff but those staff are appropriately skilled and supported to care for people with dementia in a knowledgeable, respectful and compassionate way."

Callum Chomczuk, senior policy and parliamentary officer for Age Scotland, said: "While it is true low staffing levels on hospital wards can seriously compromise older patients' care and dignity, what we need is a shift in the balance of care in which resources are focussed in the community and on keeping older people healthy, safe and out of hospitals."

An RCN survey found 78% of nurses and midwives said comforting and talking to patients was not done or was done inadequately on their last shift due to low staff numbers.

Some 59% said promoting mobility and self care was left undone or unfinished, while 34% said they could not help patients with food and drink. One-third (33%) said they were unable to fully help patients to the toilet or manage incontinence.

A Scottish Government spokeswoman said: "Older patients are absolutely not at risk in Scottish hospitals because of lack of nurses and to suggest otherwise is wrong – there are more qualified nurses working in our hospitals now than in 2006.

"While the report focuses on nurse ratios, we also need to recognise the contribution of the wider health care team in delivering better outcomes for patients on older peoples' wards."