NHS Chief Nurse Jane Cummings
Compassion…today’s headlines trumpet a ‘new 3 year strategy’ led by the NHS Chief Nurse Jane Cummings to improve standards of care. Laudable, necessary, but doomed to failure. We know a huge amount about what constitutes good care and the reasons it goes wrong; rarely is it due to the quality of staff recruited or how they are trained. No one really believes that leaving a frail older person in a wet bed is acceptable care, you don’t have to train people not to. Nor is it due to poor recruitment, anyone who has taught trainee nurses will know they go into the profession totally committed and keen to do the right thing.
So what is it that goes wrong? Poor leadership at team level, nurses feeling remote from middle management who in their turn are powerless cogs in a centrally driven machine and under-appreciated, qualified nurses not comprehending that it is their responsibility to train and support the care staff that work with them. Multidisciplinary teams on wards have been destroyed by timetables that cut across the fundamentals of care. Probably the most important factor though is that staff treat patients as they feel they are treated themselves; patients are at the bottom of the heap of power relations in the NHS. And Jeremy Hunt should remember that when he makes speeches about care standards. Of course he is right to identify failures and no-one doubts that there are far too many but they will not be put right by rating nurses on ‘compassion’, rather by understanding how high morale teams are built and strengthened
So what is it that goes wrong?
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1. You’re bumping people off.
Estimates from the NHS for those killed where the NHS contributes stand at 20-80,000 a year.
2. On top there is the deliberate killing.
Liverpool care pathway, to bumping off your errors, to murder, its endemic in the NHS.
On top, you have the disasterous financial management.
What’s needed is this.
1. Split regulator from supplier from insurer.
2. Government supplies emergency care only, sub contracting it out.
3. Compulsory insurance, based on the Swiss model so no one is denied care.
4. For those not buying insurance, they get treated, but we take their assets to pay for it.
Now, I know I go on about how it used to be, but, if you look at these two clips of, Alfie, and you really absorb what they show as the way of life then, a Britain of the sixties, you may get a clue as to what was the difference.
http://www.youtube.com/watch?v=C4dkYaeNLuc
http://www.youtube.com/watch?v=nSJxx_KUEes
He had TB. And the clean NHS sanatorium he was sent to you couldn’t pay for today. Unless you earned at the rate of Phillip Green. Why did that expectation change? It wasn’t money. It was attitude.
The importance of the ‘attitude’ he encountered was the difference between then and now. In reality it was as safe as you could get no matter how much money you had. And it was the standard of genuine care expected without the element of greed we moved into under Thatcher. The nearest you can find to that attitude and atmosphere today is the Edward VII in Marylebone where they have the royals lined up for special treatment. And you can only go there today, as an ordinary man like Alfie, if you have heavy health insurance. This care and attitude still exists in our society, but, it only exists for those who pay through the nose.
It is a difference of expectation and attitude toward the sick. We have moved on to a society of people who have no concept of that world.
All the training in the world will not make up for how they expected, not simply compassion, which many of our hospitals today have no idea or understanding of the meaning of the word, as it is out of their realm of reference. Different cultures and different expectations cannot reproduce a society of care that is not understood or cherished. They simply do not know how to give it today. The basic premise has been lost.
So, the answer is to start with finding those places that remain as close to it as the Edward VII and find out how and what it is they do to keep it going.
And Baroness, I think you are wrong in the presumption you make about compassion in today’s recruits. As a whole, they simply do not comprehend what that it means in reality. Which has to come from the top anyway. And on that level, it is no longer adhered to because they have lost touch with the cause.
Private health insurance is not insurance at all. Except to insure the companies who fraudulently take you money get away with it.
http://bestonlinedocumentaries.com/sicko/
So the state pension isn’t insurance.
Exactly the problem.
26K a year earner would have got 550,000 from investments after 40 year.
State gives then 130,000
Even that 130K forms a large part of the 4.7 trillion debt that won’t be paid, so they will be ripped off for that.
So whose running the biggest fraud? The state.
Section 2 of the fraud act. If you induce people to hand over money by running a hokey set of books, its fraud.
Remember the weasel words from the state. It’s a “CONTINGENT” liability. That means it won’t be paid.
Blagger says there is far too much of the
“Kill the patient to cure the disease” mentality. Amputate the leg because the patient can’t walk.
The term the “Professionalisation of care” is one which has stuck in my memory, as a relevant one. In the nursing trade, and according to quite a few of them that is what it is, there are many who are merely concerned with earning a few pounds and to hell with the patient.
Perhaps there should be far more amateurs, who care about their fellow man and woman.
One general practice I attended the practice nurse was running rings round the GPs, and divulging all the patient information to her copper husband, who then acted upon it, in a thoroughly negative way for the patient.
The auxiliary nurse was a stringer from the local newspaper unbeknown to the GP, who would attach herself to a peripatetic nurse visiting a patient’s home in order to find out all she could about her, for the archives of the press stringer’s office.
It is for reasons like that, the recent commissioning of the computer system may go awry. Any number of people will be able to look in lawfully to the patient’s med record, including the ministers of state.
http://www.guardian.co.uk/society/2012/dec/04/ann-clwyd-husband-died-hen
And another example of compassion.
The regulations about what the patients’ relatives may and may not do around the bed should perhaps be clearer. It is also for the patient to organize his last days in a way which is comfortable for him/herself. Relatives may find it difficult to do it for them, and then blame the “authorities”.
Some people are good at thinking about the end of their days; some are not.
While I don’t broadly disagree with what you say I do think you underestimate the ‘professionalisation’ of nurses – and I don’t mean that in a good way. There does seem to have been a substantive shift among sme nurses with degrees and ‘management’ responsibilities now feel actually caring for patients is beneath their dignity
Whilst of course the core-skills of Nursing are essential,
without a contemporaneous practical-familiarity with those health-building or enhancing other advances, made in the “Alternative”, “Subtle”, and “Complementary” health-and-personal-education fields,
the Nursing (and also the Medical, Legal and Educational) professions will in a very real sense
“have one hand tied behind their back”
in both their Workplace and their personal-off-duty lifeplaces.
I give a brief instantiation list, any one of which will surely “remove blinkers” from the eyes of the beholder:
“Awareness Heals” (Shafarman);
“Six Thinking Hats” (de Bono);
“How To Win Every Argument” (Pirie);
“The New Rules of Posture” (Bond);
“Natural Vision Improvement” (Goodrich);
“Effort” (Laban & Lawrence);
“Relaxercise” (Bersin et al);
“Let’s Do Theology” (Green);
“Mindfulness Meditation(s)” (Zinn).