Those of you in the ILC will need no convincing that fundamental care needs to be fully integrated in all care settings. We are often asked – “show us the evidence that fundamental care works”. Professor Alison Kitson, Chairperson of the ILC recently spoke with colleagues in the ILC Strategy & Policy Forum about this question. Her response was that we need look no further than the evidence about what happens when fundamental care is missed, nurses are ignored, or patients are not listened to. There are three recent examples that speak volumes about the negative, and sometimes fatal impact of not providing person-centred fundamental care.

A recent review of international data led by researchers from the UK and Ireland, found that emergency departments with fewer nurses are more likely to experience delays in patient care and have a higher rate of serious outcomes for patients. Fewer ED nurses linked to poorer patient outcomes | Nursing Times The study, published in the International Journal of Nursing Studies, looked at the impact of nurse staffing numbers on the quality of care in emergency departments with data from 16 studies. These studies showed a link between lower staffing levels in emergency departments and increased patient wait times, more patients leaving without being seen and longer overall stays in the department. The other impacts included an increase in time to medications and therapeutic interventions and an increased risk of cardiac arrest within the emergency department.

“The most common negative outcome associated with lower nurse staffing levels was that patients were more likely to leave the emergency department before they had been seen.”

A second example is where a young girl tragically died in the UK after medical staff did not listen to the parents’ concerns about the deterioration of their daughter after a bike accident which damaged her pancreas. ‘Martha’s rule’ granting urgent second opinion to be adopted in 100 English hospitals | Hospitals | The Guardian “Martha’s Rule” has come about after an inquest found Martha would probably have survived if she had been moved to intensive care sooner, which her parents had asked doctors to do. The new rule means patients whose health is failing will be granted the right to obtain an urgent second opinion about their care. “Martha’s rule” will initially be adopted in 100 English hospitals from April 2024.

Martha’s parents said: “We believe Martha’s rule will save lives. In cases of deterioration, families and carers by the bedside can be aware of changes busy clinicians can’t. Their knowledge should be treated as a resource.”

The third is the case of a man who died after not receiving food for 9 days in a UK hospital.The man was put into care after being looked after by his parents for most of his life. After he fell and fractured his hip on his first night at a care home, he was admitted to hospital and was listed as “nil by mouth” because he had difficulty swallowing. There was a crucial lack of communication between hospital teams over the patient’s deteriorating condition, and senior clinicians did not heed “attempts by nursing staff to escalate care”.Poole Hospital patient dies after no food for nine days – BBC News

Although these are all cases in the UK and Ireland, the rest of the world is not immune from such examples. Each year, patients in Australian hospitals experience over 5,400 episodes of

hospital-acquired malnutrition. The rate of hospital-acquired malnutrition in Australian hospitals was 12 per 10,000 hospitalisations in 2015–16. Hospital-acquired malnutrition prolongs the length of hospitalisation, which impacts on patients and their families. Hospital-acquired malnutrition also increases the cost of admission incurred by the health service. This additional cost may be the result of an increased length of stay, or more complex care requirements. While there is an increased financial cost, the most significant cost is the pain and discomfort experienced by the patient.Malnutrition (

The ILC is committed to helping all health and care professionals to integrate a culture where fundamental care is the norm, it is valued, owned by all, talked about and practiced every day, and that metrics focus on it rather than on low value tasks that get in the way of person-centred care.