In the face of a growing and alarming number of reports on poor standards of care for vulnerable patients in the NHS and the community, the Prime Minister today has launched an initiative to try and tackle the problem in hospital nursing.
This is after yesterday also announcing a move back to integration of health and social services in the community.
The measures all make sense – reduce the amount of bureaucracy nurses are tied up with (devolving it down to ward clerks or other administrative posts), instituting hourly monitoring rounds, etc., etc. These are all sensible measures in and of themselves, and along with reintegration of health and social services, are based on evidence that these measures really can improve patient care.
In addition, David Cameron has announced the launch of Nursing Quality Forum to explore further what measures can be taken to improve nursing care. Interestingly, this is only a couple of years after the previous Prime Minister held a similar Commission on the Future of Nursing and Midwifery in England, which reported back in 2010. Despite Cameron pledging not to tinker and micro-manage the professions, it seems no government can resist the temptation of being seen to do something from the top down.
But today’s announcements do not tackle two difficult issues that I feel lie at the heart of the problem. Firstly, staffing – in an NHS required to make £20 billion of savings by 2015, it is already apparent that most trusts are cutting nursing and administrative posts that would be needed to ensure that today’s measures were properly implemented. With recruitment freezes, and a shifting of skill mixes to reduce the proportion of RNs to care assistants on the ward, it is going to be harder and harder to achieve these goals.
Even more fundamental though is the deeper social attitude that devalues the elderly and disabled as nuisances to be kept out of sight and mind. The recent reports of the CQC, Patients Association and EHRC all suggest that it is the attitude of staff and the culture in some hospitals, wards and care homes that is also the problem. Where the care of the most vulnerable is seen as low status and low priority, and that those providing such care see themselves as doing the least valued roles, it inevitably affects the care that is given. And such attitudes are transmitted from the top of the organisation, particularly in how resources are allocated. And the values that determine such choices come from the wider society and culture – based on what we value, how we vote, how we spend, how we care for those around us in our communities.
Like it or not, as a wider society we are responsible, in part at least, for the standards of care in our hospitals.
Headline grabbing initiatives are one thing, putting in the resources and shaping the values that determine how they are deployed is something totally different.