Thoughts on the Francis Report
I want to say how appalled and saddened I am at what has occurred. Even as a someone who has worked in a hospital every day for the last 4 years I didn’t for one second think that things could get so so very bad. If my mother went through what some of these patients went through I, well, I can only try to empathise. It is absolutely scandalous.
I just want to air my tuppence worth, though ive never been to or worked inid Staffs, as I have been engaging in a twitter discussion and the word limit was getting very frustrating. This is written as a stream of consciousness so do bear with me. Also my chubby fingers on an iPhone keypad may lead to grammatical errors.
Nurses around the UK will be hurting too today. Most of them ARE compassionate. They are caring. They are incredibly
good at what they do. They are forced to defend themselves and their profession today because the deplorable actions of some. I have read, one one side, of rude, cruel nurses who ignore patients and bully others - to exasperated nurses who have to look after 16 patients at once and go home in tears because they have done their utmost but they feel not quite enough.
I want to talk about 3 things: staffing, regulation, and management.
Staffing:
Nursing is a bloody hard job. Looking after 16 elderly patients - some incontinent, combative, confused as well as being unwell with low blood pressures or breathing difficulty - would be my worst nightmare. Add to that observations, blood sugars, pain relief and doctors orders as well as liasing with family and you have your hands full. Nurses are forbidden to interrupt a drug round to do anything. In places I have worked they haven’t had lunch breaks and many will have a urine output worse than their patients.
I appreciate that you can be well staffed and still be poorly performing. I appreciate that clearly if nurses were, as witnesses state, standing by whilst patients suffer then that is chilling and despicable and i will not sit here and defend that behaviour. But to say that staffing isn’t a key issue in why these failings as a whole came about is, frankly, retarded. You cannot do your job well when the patient:nurse ratio is so unfavourable. Add to this that in the last 10 years we have seen admissions increase by 30% and procedures increase by 50% and nursing numbers have fallen consistently. 36% of nurses have thought seriously about leaving their position. Why? Because they don’t care? No! Because even though they do - they are often overworked, underpayed, bullied, abused and not in an environment where they can do their best.
Regulation
Nurses, HCAs, doctors, anyone in the NHS lacking compassion should not be working in the NHS. In fact, I’d tell them they can earn more money in the private sector where they can look after the wealthy after their routine hip operations: no excrement, urine or vomit there. We simply need to identify these workers and simply retrain, educate, and, when that fails, boot them out as they are not wanted.
Currently, if you make a mistake - as we all do occasionally - or you see something has gone wrong with patients’ care for whatever reason„ we are supposed to fill out an incident reporting form, which takes a nurse away from bedpans for around 20minutes. That form is whisked away to the powers above where there is supposed to be a root cause analysis and then an action plan. Having filled a few of these for various reasons I have not once been consulted about the problem. We need to look seriously into what we do when a member of staff flags up unsafe or uncaring behaviour - and NOT sweep it under the carpet. What happened in Mid Staffs is the result of a tidal wave of isolated incidents that each could, and should, have been prevented.
Management
These guys have taken a beating already. I echo Dr Rant, of Facebook fame when i say that when one nurse/doctor fails, by all means blame them, but when every healthcare practitioner in a foundation trust has failed to the extent that 1200 people have died without due cause then you have to look upwards.
Flags were raised, whistles were blown - at the same time when they achieved foundation trust status - saying that they were performing so well that they could look after their own budget. How oblivious we’re they? Did they listen to staff, patients or families? Did they pop down to the wards to see for themselves? I have never actually seen a manager. I do not know what they look like. Do they wear suits, waistcoats or top hats? Do enlighten me.
Targets were a wonderful thing. Length of stay has shortened. ED waiting times have shortened. We are making inroads with multi-resistant organisms. We should always aim for perfection. But when a trust is able to meet targets and still have a high mortality…you have to wonder what exactly those targets were? I think they were perhaps losing sight of what’s important…a detour from the spreadsheet to the ward would have fixed that.
NHS staff get paid less, and work more than in many countries, except Ireland, where things are at breaking point in terms of doctors’ hours. Our pensions have been slashed to the point where most of us are wondering if it is all some kind of joke. In Australia a junior doctor takes home double that of an NHS doctor, works 10 hours a week less, and actually gets paid for overtime. In a public hospital. But doctors and nurses are still vehemently proud of the NHS. And so is our government, apparently. Yet they are clearly starving the NHS of its lifeblood in order to then point at it and say ‘well we tried but its hopeless, maybe Richard Branson, Pfiser and Bupa can have a go’.
But the public/private debate is for another day. I hope we can learn from this. And change. And no, I don’t mean all the crap I’m reading about ‘in the good old days’ from retired doctors. Those days are gone. Today we treat more patients, we treat more diseases, we order more tests with less staff in less time. We need more front line staff. We need leaders who actually take responsibility for patient care - they should be the ones workers are accountable to and they should discipline properly. Not managers. We need proper training and regulation for HCAs. We need to help workers who aren’t coping and remove those that aren’t good enough. We need an environment where whistle blowers aren’t crucified and anyone at any level of seniority can raise concerns without fear. Targets are helpful but they should be markers of excellence and clinical effectiveness, not funding. Giving more money to the best hospitals and taking away from the worst makes no sense. And above all this is a reminder that we as health professionals should put patients first. It is fundamental to being good at our job:
Do no harm.
Strive to do good.
Put our patient first.
Justice and dignity for our patients.
Autonomy for our patients.
A good manager ensures targets are hit, and that we are working to best practice. A good leader takes the organisation forward, by empowering and encouraging and listening to his audience - and taking action when things are not adequate. The NHS needs both. Mid Staffs had neither, and those poor people suffered for it.
