NHS staff hurt by ratings verdict

In the waiting room, a dozen people sit nursing head cuts, swollen ankles and other minor injuries.

Porters and emergency nurse practitioners (ENP) in their distinctive burgundy uniforms are quietly assessing new arrivals, administering painkillers and offering a reassuring word to anxious patients.

It is a seemingly normal day. But behind the scenes the nursing staff are licking their own wounds.

Despite the long hours, physically and emotionally-demanding roles and their visible dedication, they have been classed as "failing".

Annual government star ratings published yesterday for hospitals, mental health trusts, ambulance services and primary care trusts in England, gave Brighton and Sussex University Hospitals NHS Trust just one star.

The Commission for Health Improvement (CHI), which carried out the audit, said there was "cause for concern" in key areas at the Royal Sussex. The trust failed to meet the target for the time patients wait in A&E and had performed significantly below average with cancelled operations and delayed discharges.

Terece Walters, senior sister in A&E, said the must-do-better criticism was a bitter pill for the staff.

She said: "We don't feel we are working in a one-star department. Some of the staff have taken it to heart.

"We have made vast improvements over the last couple of years. The staff work under a lot of pressure and have given 110 per cent into putting new procedures in place to improve things."

The CHI figures were taken in March. In April, when funding became available, the hospital introduced a "meet and treat" service, which enables walking wounded patients to be assessed by a senior emergency nurse, treated and discharged, speeding up the service and, if appropriate, cutting out the need to see a doctor.

An assessment nurse has also been employed to meet patients arriving by ambulance. It is hoped to extend both services.

Terece said: "On days when these services are in place, there is a significant difference in waiting times. Aggression and violence are also reduced."

The department has also acted on another government target of providing prompt analgesia, training all nurses to prescribe and administer painkillers.

Terece said: "Sitting for four hours is one thing. Waiting in pain is something totally different."

The number of complaints - all of which are read and acted on - are also down.

Terece said: "There are times when we are perceived by people in the waiting room to be quiet. They can't see that elsewhere we are dealing with a trauma or bereaved families. Patients want to come in, be seen and go home. They expect a very high standard. If we had more doctors and nurses, we would put them out there."

However hard the A&E staff work, they cannot operate independently. Even if they get their patients through well inside the target four hours, there may be nowhere for them to go.

If they need admitting, beds may not be available. If they require transport home, there is likely to be a queue.

Behind one curtain, ENP Frank Ainlie was just finishing attending to 96-year-old Constance De Ponte who had wrist pain.

Frank assessed her, ordered X-rays, got her fractured wrist plastered and had her ready to go home in two hours. However, despite her frail condition, Constance had to wait for transport.

The Royal Sussex staff pride themselves in being scrupulously honest in the data they provide. If they breach the maximum four-hour target waiting time, they say so. But a government keen on tables and ratings demands more and more data.

The target timer starts the minute a patient arrives at A&E and continues until their discharge details are entered on the computer by the nurse.

Sister Kathy Steward has worked at the hospital since 1998 and, like her colleagues, is smarting at the Government's assessment.

She earns £21,500 a year and among her many responsibilities is being in charge of A&E at night.

She said: "It is a bit demoralising to be told you are a one-star service. It really doesn't reflect the work we are doing.

"Saying we are one star is meaningless. I think it is more to do with elections and politics than the quality of care.

"We are a really dynamic team and we face challenges. I don't think the staff could work any harder - not just the nurses but the porters and the X-ray staff and everyone.

"The difficulty is the Government has not provided enough money. Expectations have gone up but the money hasn't.

"Data is not our top priority when we are on the shop floor. If all my patients are cared for and nobody has died, that is much better than clicking on the computer."

A&E consultant Carlos Perez-Avila said the department was doing everything it could to provide the best possible service.

He said: "But there is an imbalance between what we can achieve here and the other targets the Government has set. If there is nowhere to put patients, they have to wait. It is as simple as that."

Brighton General Hospital is fighting a constant battle with bed blocking. Although it has won awards for providing patients with privacy and dignity, it too is classed as failing.

Senior ward manager Mandy Taylor said the rating was no surprise.

She said: "We recognise it is a big problem but older people's care is not just a problem for Brighton General. It is one for the whole community - for social services, the local authority, the primary care trusts.

"What we have been doing for nearly the last year is trying to work with other agencies to find more co-ordinated procedures that work."

Initiatives such as intermediate and transitional care and multi-agency HIT teams will continue to build on improvements.

In the meantime, for both hospitals, regardless of star ratings, it is business as usual.

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