by Peter Watt
One of the lessons of the Mid Staffs hospital scandal should be that those involved in the delivery of health care should show some humility. But humility doesn’t seem to be something that the Royal College of Nursing (RCN) is familiar with.
Let’s face it, if a single hospital can be found to have between 400 and 1200 deaths caused by poor care between January 2005 and March 2009 then something has gone wrong. The fact that subsequently a raft of other hospitals are being looked at adds to the strong sense of a system that isn’t working. As David Cameron rather too eagerly reminded Ed Miliband at PMQs yesterday, this happened under a Labour government at a time of rapid growth in spending on the NHS. This wasn’t a time of cuts – quite the contrary.
The Francis report was a comprehensive review of what went wrong at Mid Staffs and its conclusions were damning. Blame was shared across a number of fronts:
- A bullying culture in the NHS so that those expressing concern were silenced and others were too fearful to speak;
- A focus on healthy finances rather than the health of patients;
- Regulators not regulating properly – in fact not noticing that anything was wrong;
- Managers not managing effectively;
- The disorganisation of reorganisation after reorganisation.
So there were plenty who should be a little humble from the Labour party itself to the department of health. But there is another group who need to take a good long hard look at themselves: nurses. Because one of the other key problems identified was that there were nurses who were not good enough.
Now this obviously does not mean that all nurses are poor or that they do not care about patients. I had a message from a friend the other day who had just finished a 12 hour nursing shift with only a twenty minute break. So there are thankfully plenty of dedicated, caring and compassionate nurses often working many long hours to ensure that their patients are cared for.
But what is also blindingly obvious is that a report into poor care that causes hundreds of deaths will find that some nurses got things badly wrong. And they did. As the Guardian reported of the Francis report:
“Francis cited a litany of failings in the care of patients. “For many patients the most basic elements of care were neglected,” he said. Some patients needing pain relief either got it late or not at all. Others were left unwashed for up to a month. “Food and drinks were left out of the reach of patients and many were forced to rely on family members for help with feeding.” Too many patients were sent home before they were ready to go, and ended up back in hospital soon afterwards. “The standards of hygiene were at times awful, with families forced to remove used bandages and dressings from public areas and clean toilets themselves for fear of catching infections.” Patients’ calls for help to use the toilet were ignored, with the result that they were left in soiled sheeting or sitting on commodes for hours “often feeling ashamed and afraid”. Misdiagnosis was common.”
So we are not talking about the odd mistake here, we are talking about systemic failings in the care of vulnerable human beings. And yet this week the Royal College of Nursing appears to have forgotten this.
It understandably spent much of its conference in Liverpool discussing the implications of the Francis report. And it rightly highlighted the continuing problems of whistleblowing for concerned staff.
But bearing in mind that Francis is the latest in a series of well publicised reports into the abuse of vulnerable patients in healthcare settings you would imagine that a little humility was called for? No, not a bit of it.
In response to Francis, the government has suggested that as a part of their preparation for training, student nurses should spend a year as health care assistants. The hope is that this would teach the importance of feeding, washing and turning patients.
I have no idea whether this is a sensible idea but I do know that I am worried that increasingly nurses do not value so called basic care as they once did. When I was nursing (and incidentally I did spend nearly a year as a health care assistant before starting my training) the quality of basic care was fundamental.
Of course we also learnt and practiced more technical skills but they were always skills that built on and didn’t replace basic care.
But even if this government idea is completely unworkable the RCN needed to be careful in its response. It couldn’t just dismiss it out of hand or it would appear arrogant, dismissive of the Francis findings and quite frankly self-interested and not interested in patients.
Cue Andrea Spyropoulos, the RCN President who said that the plan was as “a really stupid idea” that “will take nursing back a hundred years” thus provoking a very public row with the government.
The immediate focus of the union’s response to the idea was not an understanding of the hundreds of deaths, the suffering and the abuse at the hands of some nurses. It was fury that the government had suggested that nurses needed to be a bit more focused on patient’s basic needs.
So the problem with the plan is that it will set back nursing not whether or not it will benefit patients. Nor surprisingly Jeremy Hunt hit back:
“I think the Royal College of Nurses [sic] has to be very, very careful. They missed what happened at Mid Staffs,” he told Sky News.
“The Francis report levelled some very serious criticisms at that. It said that they basically allowed their trade union responsibilities to trump their responsibilities as a royal college to raise professional standards.
“They have a conflict of interests and I think that, before they start criticising the government for accepting recommendations that are going to improve compassionate care throughout the NHS, they need to answer those very, very serious criticisms themselves.
“What nurses on the frontline are saying, a lot of them, particularly the older nurses, is that this was part of nursing training. Why would you want to become a nurse if you were unwilling to spend time washing patients, feeding patients, doing that really vital experience on the frontline? We need people to go into nursing with the right motives. Actually having that frontline hands-on experience is a good thing to do.”
So we have a row where the government is squarely on the side of the patient and the RCN is very much on the side of the RCN. Jeremy Hunt couldn’t believe his luck!
We are all reliant on the NHS and those who work in it and at some point in our lives we are all likely to need it. The RCN, and the other public sector unions, would do well to remember that the NHS exists for the benefit of us patients not for the benefit of their members.
And I would suspect very strongly that many of their members feel exactly the same.
Peter Watt was general secretary of the Labour party