Health Policy InsightEditorial Thursday 13 October 2011: Nursing a hangover with Lansley's health select committee downbanding 'Camnesia'
The special report from the Care Quality Commission, following their targeted inspection of 100 NHS hospitals on dignity and nutrition, which reveals serious failings in hospital care of elderly patients, puts nursing smack in the spotlight.
Les than half of the 100 hospitals inspected (45) were fully compliant in both dignity and nutrition. 35 complied in one or the other area; and one in five - 20 - did not comply in both areas.
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This is not a surprising problem to find, but its extent takes me aback somewhat.
I remember back in the early part of the decade, working alongside Helen Scott, a long-standing editor of the British Journal of Nursing. She was a lovely, sharp-minded person, and one of her battle-cires was "it's the death of nursing - nurses aren't doing the basic care, which is feeding and watering and wiping bums".
She wasn't unaware of the irony in the move of nurse training to a more academic one: it served BJN well, but she could see the effects on nurses coming into the system. She and her peers observed a less practically-and-vocationally trained generation of nurses, and did not feel hopeful about what they saw.
The constant 'bringing back of matron' must have brought a glad smile to the faces of whoever owns the rights to the photos of Hattie Jacques from 'Carry On Nurse', but it seems clear from this document that it has made no difference in a significant minority of trusts.
Equally, it should concern us all that these trusts have so comprehensively failed to learn the lessons from Maidstone and Tunbridge Wells and Mid-Staffs. NHS CE Comrade Sir David Nicholson's order to all CEs and boards to read the report of the first Francis Inquiry seems to have gone unheeded.
This is basic care, which is not being done. How can it be fixed?
The first thing that I would do is ensure every ward records food uneaten: this can be done on a smartphone by a porter or healthcare assistant. Nursing teams's performance would then be benchmarked and published prominently, with a trivial prize (box of chocolates) for the month's best-performer. I'd also nick the Milton Keynes FT 'red mug and jug' idea, rolled out in every ward where a patient may be at risk of dehydration.
The next thing I would do is get staff from the commissioning organisation to send in an unannounced 'mystery shopper' at mealtimes. No food, no drink = no pay.
The third thing I would do is get a patient complaint about dignity or nutrition read out at the start of every board meeting, including details of the trust's investigation and reply.
The fourth thing I would do is actively start seeking feedback from elderly inpatients while they are there. For good performers, this could be a quality marker. This should be done by someone not directly employed by the trust, an older person who should receive some training.
Of course, none of this will work without getting nurses aligned with the aim of offering excellent care. That is what most nurses start out wanting to do, but as has been seen in Mid-Staffs and elsewhere, a negative culture can over-run even motivated staff.
Culture matters, as does motivation.
That is why it is so interesting that Secretary Of State Andrew Lansley (saviour, liberator) appears to have misled the Commons Health Select Committee on Tuesday.
He was asked about downbanding of nursing jobs, and told the committee that "I'm not aware - my colleagues may be - where trusts are seeking to manage their costs by downgrading of existing staff. If you are aware of that, please, by all means, tell us but I'm not aware of it".
Labour MP Rosie Cooper trenchantly questioned this line in the session, and her office has today released this statement from Janet Davies, Royal College of Nursing executive director of nursing and service delivery: "While we do not release details of private conversations, the Royal College of Nursing has raised the issue of downbanding with the Secretary of State on a number of occasions, alongside other concerns such as recruitment freezes and redundancies in the NHS.
"Through our Frontline First campaign, we know that a range of nursing posts across different parts of the NHS are being downbanded. Our members' survey released earlier this month also revealed that 7% of nurses expect to be downbanded in the next 12 months".
Nurses are the bulk of the NHS workforce. If Mr Lansley heard such evidence from the RCN several times, then that particular listening exercise clearly made so little impression on him that he has been able to forget about it.
Either that, or Mr Lansley doesn't recognise why it would be important to the nurses affected, financially and status-wise.
Politics Home editor Paul Waugh coined the phrase 'Camnesia' to describe the Prime Minister's forgetfulness over Mark Britnell. The PM had a relapse of Camnesia when he over-claimed professional support for the Health Bill recently.
We should fear for our saviour and liberator Mr Lansley: Camnesia appears to be contagious.