3.91 Both the Hospital Advisory Service and the Regional Advisory Team in their reports of November 1971 and March 1973 respectively, referred to the dissatisfaction and irritation expressed by the nursing staff at St. Augustine's Hospital about the requisitioning system. This system, in most essentials, was still in operation at the time of the opening of our Enquiry.
3.92 Briefly, the requirements of the system were as follows:
3.93 The ward nurses put requests for normal replacements and for additional items to their area Senior Nursing Officer, and he, if he agreed with the request, would enter it in a standard requisitions book. This was passed, usually weekly, to the Sector Administrator (formerly the Group Secretary). There was normally no difficulty with the majority of requests, and the goods concerned were delivered to the wards without unreasonable delay. Additional or high cost items would be discussed by the Sector Administrator with the Divisional Nursing Officer or Senior Nursing Officer, and frequently would be marked "Noted and Deferred" by the Sector Administrator. The requisitions book showing the action taken on each item would then be returned to the Senior Nursing Officer. The Sector Administrator also maintained a list of all outstanding requisitions which were kept in reserve, until money became available, when the Senior Nursing Officers and the Senior Medical Staff in each of the clinical areas would be asked to Place the outstanding items in order of priority.
3.94 In practice, however, unless the goods were actually delivered, the ward staff were frequently left unaware of the outcome of their requests as there appears to have been no instruction that they should be told if and why a request could not be granted, or had to be deferred. It was not uncommon for a ward nurse who had submitted a requisition to hear nothing more, even after numerous enquiries.
3.95 Whilst recognising the need for strict controls on the sanctioning of new equipment due to the amount of money involved, it seemed to us that the existing procedure had been designed to impede rather than facilitate effective communication between the nurses and the supplies department. We thought that basic supplies and routine replacements, at least, should have been more freely accessible and that the paperwork should have been streamlined with, for instance, more responsibility for economy and the allocation of resources vested in Senior and Unit Nursing Officers and, indeed, the ward staff. The system for fixing the priorities between various requisitions did not function satisfactorily because insufficient use was made of the practical experience and knowledge available in the wards.
3.96 The System as outlined has been the subject of criticism for a number of years and Mr. CX, the former Principal Nursing Officer, tried consistently to persuade the Group Secretary to consider simplifications; but this approach proved unacceptable to a man who, to quote the words of the Hospital Advisory Service, "gave too much time to details usually delegated to other staff". It was widely believed within the hospital that the control of the supplies system, and any decisions about priorities, rested with the Group Secretary.
3.97 In consequence of Mr. CX's representations, the Group Secretary eventually agreed to allocate £2,000 a quarter for specific types of expenditure to the nursing staff, who would be left to agree their own priorities within this limit. The Group Secretary took this decision shortly before his retirement in March, 1974, hut at the time of our Enquiry, eighteen months later, it had never been implemented, partly, no doubt, because it had never been recorded in writing. However, we were informed that a new requisitioning system had been put into operation and in the Autumn of 1975 there was no restriction of any kind placed on normal replacements. Additionally, the sector which includes St. Augustine's had been given a block allocation for additional furniture and furnishing textiles. The new system was not perfect but we are satisfied that the District Management Team Will make necessary improvements.
3.98 Examples of the old system in operation are to be found in paragraphs 2.47-49.
09 February 2025
