Letters An unsafe ward

Fragmentation of basic and nursing care may be to blame for unsafe wards

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f1949 (Published 02 April 2013) Cite this as: BMJ 2013;346:f1949
  1. Judy Shakespeare, retired general practitioner1
  1. 1Oxford, UK
  1. judy.shakespeare{at}virginmedia.com

I have received more than 30 supportive comments on my article about the death of my father.1 Many people were not surprised by my experiences and described their own sad stories. This suggests that poor basic care for older patients is endemic within the NHS, with mid-Staffs just a scapegoat for a widespread institutional malaise.

Food, water, cleanliness, and simple human kindness are cheap and effective treatments for older inpatients. The modern NHS seems to have separated the concepts of basic and nursing care; catering services are part of basic care and have been subcontracted out to private companies, so nurses may no longer see eating and drinking as “their responsibility.” This fragmentation may explain some of the problems. But expensive interventions and treatments are wasted unless the basics for human life are supplied.

Useful suggestions on how to deal with the problem included the “butterfly scheme” (www.butterflyscheme.org.uk/) and “intentional comfort rounding,”2 but neither has been evaluated scientifically. Evaluating projects that could reduce suffering and harm in NHS hospitals should be a priority.

The suggestion that relatives could help with basic nursing care was recently endorsed by the think tank 2020health.3 I was happy to help with my dad’s care during the day. As I said, I wish I had stayed overnight, then he would not have fallen. But the structure of wards often makes this difficult, with beds too close and too much “clutter.” I also did not feel that I would have been welcomed by the nursing staff.

The core of any change needs to be with nursing culture and practice. All clinicians need to feel able to challenge and improve poor standards without blame or reproach. I hope this is recognised before many more elderly patients die unnecessarily.


Cite this as: BMJ 2013;346:f1949


  • Competing interests: None declared.


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