Annex A > Chapter 6 - Funding and Resources > Resources > Nursing staff and sessions for cardiac surgery
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Nursing staff and sessions for cardiac surgery
147 In December 1985, the Acting General Manager of the Children and Obstetrics Sub-Unit, Geraldine Martin, wrote to clinicians and the managers at local health authorities. She noted the `particularly acute' staffing difficulties at the Special Care Baby Unit at the Bristol Maternity Hospital. Patients who normally resided outside Avon would no longer be admitted. She continued:
`With regard to the Bristol Children's Hospital, acute staffing difficulties also persist here and by taking the above action additional pressures will be placed on ITU. Referrals to the ITU will however continue as at present but acceptance of referrals will have to be subject to the availability of nursing staff. Before any referrals are formally accepted by any member of the medical staff the current and expected workload on the Unit and within the Hospital as a whole should be checked by the Registrars on duty or On Take Consultant with the Senior Nurse in charge so as to ensure that appropriate care can be given to that referral. If neonatal surgical patients have to be refused then the referring Clinician should be advised to seek equivalent paediatric surgical expertise in either Southampton, Oxford, Birmingham, or London, and Miss Noblett, Consultant Paediatric Surgeon, has already alerted these centres to this situation.
`This restriction on bookings to S.C.B.U. [207] will be operative with effect from 1st January 1986 and will continue until such time as the staffing situation improves on the Unit, and further notification will be made at that time.' [208]
148 On 27 January 1987, Mr Dhasmana wrote to the Chairman of Children's Services, Dr Martin Mott, and the Chairman of the Division of Anaesthesia, Dr Robert Johnson, suggesting that an additional operating session for cardiac surgery at the BRHSC be held on a Monday morning, as the theatre time and space were available. Mr Dhasmana stated that Mr Wisheart supported him in this. [209]
149 On 24 March 1987, Dr Mott wrote to Mr Dhasmana, saying that this could not be accommodated: `... the nursing staff required to support the extra session are not available, and you will be well aware of the fact that our nursing allocation is already used to the full.' [210]
150 The matter was raised again by Mr Dhasmana in January 1989 in a letter to Dr Roylance:
`I am now requesting, through your office, reconsideration of my earlier proposal. There is a space available and if this session could be funded it would provide me one morning session every week. This would help to cut down the Waiting List on my routine cases, and reduce some of the emergency work which I do outside the normal routine hours. I am enclosing a copy of my previous letter for your perusal.' [211]
151 No progress having been made, Mr Dhasmana continued to work outside routine hours. He again raised the matter at a meeting of the Division of Children's Services [212] on 20 February 1990. [213] The minutes recorded:
`Mr Dhasmana raised the need for an additional cardiac surgery operating session at BCH. At present a proportion of cardiac surgery was undertaken out of hours because of the lack of scheduled sessions, both inconvenient and costly. ... Miss Stoneham agreed to look into this.'
152 During his oral evidence, Mr Dhasmana confirmed that, in his letter of 17 November 1988 to Dr Alastair Mason, Regional Medical Officer, he had stated that there was a: `... lack of resources and it was a constant struggle for time, for theatre space, and also for medical and nursing manpower to look after my cases.' [214]
153 In January 1988 the minutes of a meeting of the Division of Children's Services recorded:
`As discussed at the previous meeting of Division, a working group has been convened to discuss possible solutions to the problems caused by the acute shortage of nursing staff. As a result, it had been agreed to close Ward 31 for a period of one month, in order that the situation could ease somewhat, and to allow an intensive programme of training in paediatric nursing for RGNs to take place. Miss Perrett said that it was planned to reopen Ward 31 over the weekend of 23rd/24th January, and, although the temporary closure had partially eased the nursing situation, the previous difficulties would return once the ward re-opened. Although cover had been maintained on the ITU, this had only been done with difficulty, and on some occasions, the Unit had relied on bank staff for cover. However it had been possible to send a number of nurses on an intensive two week training course designed to give them a greater understanding of paediatric nursing, and this had been extremely well received by the participants.' [215]
154 Michelle Cummings, mother of Charlotte, told the Inquiry of her experience in the ICU at the BRI in 1988:
`I do know, when Charlotte was in intensive care, that she had a student nurse looking after her. I think there was a question, being that it was the BRI, it was not the Children's Hospital, it was a mixed intensive care, whether there were actually enough paediatric trained nurses, and I spoke to many of the nurses about this, and it was something they themselves were extremely concerned about. I know they were extremely concerned over the resources that were available to them at that time. So, yes, there were definitely students there, and at times, instead of having a 1-to-1, it was a 1-to-2, so one nurse would be looking after two ...' [216]
155 In the following exchange, Belinda House, mother of Ryan, told the Inquiry of her experience in 1989, when a transfer from Southmead Hospital to the BRHSC had to be arranged:
`Q. So were arrangements made to make that transfer?
`A. Well, that was very traumatic. Mr [sic] Joffe told us we had to be at the Children's [Hospital]. The doctor again got on the phone, because he had to arrange for theatre space, at a convenient theatre at the Children's. He spent an awful lot of time doing that, which was very distressing for him. He then found the theatre space and could not find the nurses to staff the theatre. That went on for a very long time, until Julian and I actually suggested, could we pay agency nurses, because we were so desperate, because we knew this procedure had to happen within so many hours.
`Q. Can I stop you there. You say he was having difficulty finding theatre space. That is theatre space at the Children's Hospital?
`A. At the Children's Hospital.
`Q. You then went on to say there was difficulty finding nursing staff?
`Q. Was that in relation to nursing staff at the Children's Hospital, or in relation to nursing staff to manage the transfer?
`A. That was both. That was nurses to look after Ryan in the theatre, and also, Ryan needed quite a senior nurse to go with him in the ambulance with the incubator and they also needed a senior nurse left on the SCBU at Southmead Special Care Baby Unit.
`Q. Were they able to find nurses?
`A. Yes, finally they found the nurses ...' [217]
156 In her written statement to the Inquiry, Belinda House stated:
`It also then appeared that there was no ambulance available in the whole area with the equipment needed for such a Transfer. It was a horrific situation for everyone concerned, until eventually a suitable ambulance was located. This was the beginning of our education to the fact that the NHS, at the time, was desperately underfunded, so much so that Ryan's life was put at risk.' [218]
157 In a letter dated 7 February 1990, Drs Monk, Masey and Bolsin (consultant anaesthetists) wrote to Margaret Peacock. [219] They stated that on 26 January 1990, the cardiac anaesthetists on duty had agreed to do one extra cardiac case in order to enable surgeons to reduce waiting lists. Pressure had then been caused by the admission of a patient with a major cardiovascular problem, on an emergency basis; extra staff were not available. They protested that in future they would not allow more than two cardiac cases to be anaesthetised unless they were given categorical assurances that emergency staff would be available to help with life-threatening emergency cases. [220]
158 Ms Alison Whiting [221] replied on 22 February 1990. She set out the nursing levels and workload, and said that no guarantee could be given that similar emergencies would not take place in future. [222]
159 By a letter dated 12 July 1990, Dr Bolsin recorded his view that, in view of his `experience in this department', it was unreasonable to start major cardiac cases after 3pm, other than in exceptional circumstances. He would not do so in future, and stated that he would instruct his juniors similarly. [223]
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Footnotes
[207] Special Care Baby Unit at Bristol Maternity Hospital
[208] UBHT 0238 0411; letter from Ms Martin dated 30 December 1985
[209] JPD 0001 0001 - 0002 ; letter from Mr Dhasmana to Dr Mott dated 27 January 1987
[210] UBHT 0212 0083; letter from Dr Mott to Mr Dhasmana dated 24 March 1987
[211] JPD 0001 0007; letter from Mr Dhasmana to Dr Roylance dated 20 January 1989
[212] Of the Bristol and Weston District Health Authority
[213] UBHT 0208 0091; minutes of meeting held on 20 February 1990
[214] UBHT 0174 0013 Mr Dhasmana
[215] UBHT 0211 0108; minutes of meeting held on 19 January 1988 (emphasis in original)
[216] T3 p.142 Michelle Cummings
[218] WIT 0025 0003 Belinda House
[219] General Manager (Inpatient Services), BRI
[220] UBHT 0118 0001; letter to Ms Peacock dated 7 February 1990
[221] ITU/Theatre Service Manager, BRI
[222] UBHT 0118 0005; letter from Ms Whiting to Ms Peacock dated 22 February 1990
[223] UBHT 0118 0007; letter from Dr Bolsin dated 12 July 1990