The Royal College of Nursing has forgotten about the victims in their response to Mid Staffs

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

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6 Responses to “The Royal College of Nursing has forgotten about the victims in their response to Mid Staffs”

  1. LesAbbey says:

    Is this New Labour sharing blame, or is it New Labour looking for a scapegoat?

  2. bob says:

    Oh i suspect both, to preserve current MPs like Burnham, who refused a public enquirey to Millburn Hewitt Reid et al. Two of the last three who work or worked in the private health sector after leaving government.

    The RCN is a disgrace and wants to be all things to all men. Needs getting its act together as most of the problems in nursing today can be placed at THEIR door and they need to recognise THEIR responsibility.

  3. uglyfatbloke says:

    LesAbbey and Bob are totally right.
    Despite it being a Tory proposal the nursing assistant thing is actually a good idea. In the days before ‘degree’ nursing courses the patient care thing happened pretty much automatically during your stints onwards, but even in those days (in Scotland at least), it was recognised that there was a lot of value to spending some time as a nursing assistant before you started your training – apart form anything else it gave you the grounding to (occasionally) stand up to tutors who had n;t been on a ward since forever.
    A lot of this is to do with the mania for degrees. it’s even worse with theatre skills stuff…I have literally had to show a lecturer how to coil a cable.
    We end up with well-paid university lecturers who would n’t last five minutes working on a busy ward or on a professional-level production, but they can deploy the right buzz-words at an interview.

  4. bob says:

    UFB, unfortunately you speak the total truth. People who raise concerns are sidelined, not promoted and even squeezed out. Those promoted these days in the NHS, spout the party line, will not rock the boat and are the image of the interviewer. I retired from the NHS but not before rattling the managers cages on a few occasions using the NMC Code of Conduct and even the better reminding the Chief Exec and Chief Nurse of their responsibilities under the Health and Safety at Work Act 1974 Section 3.

    Unions, both Unison and the RCN did not help and even colluded with management to have one case of potential discrimination thrown out, by allowing one of the management people to retire before a hearing.

    A degree, does not give you experience and in nursing that is the big thing, we just need to go back to a three year practically based training system with those after the training period who want to do a degree seconded to undertake the course, which could be reduced to 12 to 18 months in length on a part time basis. Oh sorry forgot that would destroy the nursing degree Taliban’s influence and allow people who want to nurse start at the bottom and work their way up.


  5. uglyfatbloke says:

    Take responsibility? In this day and age? Nobody does that any more…look at Brown, Darling and Balls….they were n’t completely responsible for the financial disaster, but they did have a great deal to do with it.
    Protecting the idle and incompetent is part of the tradition of middle class Unions I’m afraid. Employers can’t get rid of a teacher just because they are useless and damaging the student’s prospects.. It does n’t matter whether it’s the infants of post-grad students, the education Unions will look after anybody, however crap they are and it does n’t help that teachers (and other groups too) tend to look after one another… collegiate back scratching is the order of the day.
    Same in politics…no media outlet and very few politicians will ever say ‘So-and- so is a liar’ even when it is clearly demonstrated..
    They will do or say anything for a good word in the Daily mail,,,Blair on Iraq/Brown on cannabis/all of them on the EU or the ‘Special Relationship’.

  6. MikeTravis says:

    I have been a member of the RCN for over 30 years, as well as being a steward and Council Member.
    This is not an issue of nursing. If you read the Francis Report and not the Daily Mail, then you might start to understand what happened there.
    Francis is about the corporate failure of the Trust Board. At a time when there was 150 nursing vacancies at the hospital-they failed to redress the problem. Together with the PCT there was no recovery plan.
    The regulators failed to take action in spite of knowing what went on there. NMC, GMC, MONITOR, CQC and HSE failed to intervene.
    The senior management failed to be effective and were left wanting.
    The role of HR needs to be investigated because the Trust was swamped with incident forms alerting nurse shortages and breaches of care.
    And the RCN is not the regulator, it is a professional trade union. Why wasn’t UNISON blamed for the failure, or the BMA, or the 16 TUs on site.
    There was incidents of poor nursing and they need to be investigated. Of the 29 nurses reported to the NMC, I think only 8 are being carried forward to hearing.
    As for Hunt and Langsley, and the previous Labour SS of Health, they are to quick to offload blame down the chain of command.
    All in all, this blog is really uninformed of the real story of the Mid-Staffs.

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