Paul Harrison Interview – The Changing demographic of patients


One of the things that influences care standards up to now is the changing demographics of the patients. The patient today that comes into hospital is nothing like the patient years ago because many of the people that you used to see in the hospital, are the people who we used to think were simple to treat. The people who could assist themselves and the people who were independent are now either managed in day surgery or in the community or in smaller community hospitals.

So, when you have university hospitals, major trauma centers and even the district general hospitals, more or less every ward would say that it is delivering complex care, because the complexity of their care isn’t in the nature of the injuries, but in the nature of the patient.

The patient is generally older and now in some orthopedic wards, you may find that more or less the entire patient population is over the age of 75.  What we are not doing is keeping pace with the resourcing and the NHS struggles to find a decent, accurate, applicable workable tool for indicating work load on patient dependency.

The nature of the need is that we have to have a flexible workforce and the provisioning problem is that we can’t provide a flexible workforce. This is because nobody has come up with a way of matching the two together, without running into things that are really silly. For example, if you handed it over to electronic rostering, nobody who is human could work the shifts that it actually suggests.

If you are a HR manager then you couldn’t  legitimately provide a contract that says ‘we are employing you but we will only use you when we need you and your hours will be this.  You may come to work and be told you are only working four hours and you’ve got to go back home to be rung, to be told to come back in again’.

These are the realities of work, so the challenge is that somehow scientifically or physically or technologically to find a way to match the changing needs of the patient population, firstly against the staffing, which is where the targets set come in. It is not just the actual targets in part, it’s the targets in whole. This is so the patient actually feels better and the staff feel better, so that they can go off saying ‘yes I have achieved all my targets including the ones like talking with the patient, holding the hand and such’.

Many of them have multi conditions which means, what they call multi pathologies, which is also multi pharmacology, or poly-pharmacy. This means that the drug round gets longer, so the average patient can have 20 medicines and that has to be figured into the nursing time meaning the nurse actually spends longer on the drug round so she has got less time to do other bits.

Because you have to be focused on the task when you are doing the drug round, you are not available to do anything else and if you have to leave to do something else, then you have got to stop the drug round. That then brings in the concerns about getting the pills on target on time.

Some medicines have a very low teeter level, which means that if you miss a dose for more than a couple of hours then the patient can actually deteriorate and a lot of these are the behavioral medicines. The national patient safety agency actually said that if you have a dementia patient or somebody who is on medicines for conditions like Alzheimer’s and Parkinson’s, if you miss that medicine time for an hour then the patient’s condition can deteriorate significantly.

Then you may have to spend the next three days trying to get the patient back to the quality that they actually were at. In the home situation, that patient is literally there bang on the dot on the clock, because there is only one nurse and one carer managing one patient at home. When you have got under staffed wards with over dependent patients, then the simple math doesn’t stand up.

What you then have is a nurse who has to then pull out a prioritization and say whatever else happens, this medicine will get to this patient by that time otherwise my workload goes up significantly.

We only get by, by prioritizing. But when you are prioritizing, something has to be missed and we are not interested in the bits that are actually targeted and achieved, we are looking at the ones that are under achieved and should also be targeted.

There is an undercurrent of dissatisfaction in the staffing and these are the things that I consider just as important as the things that are scored, but these things aren’t scored. Really, what we are saying is that in patient dependency and staff workload we should score everything that’s a value to everybody and even things like tidy wards, so, finding time to keep your work space tidy is important.

It’s just a simple thing because that’s front of house and that’s part of the corporate image,  so in other words, the patients are well looked after but the wards look like a tip. Those are the simple things that people say.