Tuesday, 30 April 2013

Among all the noise about the NHS, a little quiet should be a great improvement

There’s been a lot of noise in Britain recently about the failings of the National Health Service.

Popular anger, or at least anger in the media, has focused above all on the Mid Staffordshire NHS Trust. The scandal has its roots in a study by hospital information company Dr Foster Intelligence, which found that 400 more people had died in the hospital over a three year period than might have been expected given how ill they were. A public enquiry revealed a harrowing string of cases of appalling care: patients suffering dehydration because they weren’t given anything to drink, patients left in their own faeces, patients left to suffer in pain as buzzers rang wildly throughout the wards with no nurses answering.

There’s been less talk about the people who sent flowers and chocolates to the hospital, to thank the nurses for the care they or their relatives had received, though some of those making the gifts have been among the most outspoken in their criticism since. Equally, not a lot is said of the encouragement the Trust was given to opt for the much vaunted status of a ‘Foundation Trust’, even at the cost of economies that left too few nurses to ensure adequate coverage. Nor is much said of the findings, again from Dr Foster, which classified the hospital ninth in the country for quality.

Instead, those orchestrating the media noise seem to be intent on directing outrage against nurses, once universally seen as angels, now increasingly portrayed as fiends.

The truth is that in a professional body of 370,000, there are bound to be a few rotten apples. But, overall, the vast majority of nurses are deeply committed to caring for patients, just as nurses always have been: it is after all the overriding motivation for choosing the profession in the first place. But the government chooses to proclaim that nurses have lost their compassion and demands, for example, that in future nurses have more hands-on care of patients – washing them, feeding them – as part of their training, to teach them the compassion it’s alleged they have lost.

This from a government that has just imposed the deepest cuts for a generation in benefits for the poorest people in Britain. But then I suppose we don’t all have the same notion of compassion.

It should also be said, in passing, that the government has launched a programme of reform of the NHS which seems destined to fragment it and undermine its public service commitment. That will encourage the government's friends in the private sector, who want to take over apparently lucrative parts of healthcare, although few of those who’ve tried so far have made any money from it and the scandals about quality from private providers have already begun.

Against this background, I was fascinated to hear of an initiative in my local hospital, the Luton and Dunstable, or 
L&D as we fondly call it. 

Instead of responding to the problem of patients ringing buzzers to no avail by demanding that nurses answer them more quickly, the hospital is planning to do away with buzzers altogether. Rather than giving nurses more non-nursing duties, as the government seems to favour, they’re recruiting more clerical staff to free up qualified staff to concentrate on nursing.

The L&D: quietly improving where others just shout

The hospital has been piloting the idea of a ‘quiet ward’. The approach is widespread in Germany, which is where the L&D came across it. I believe something similar was tried in Gwent, in Wales. In England, however, it
’s an innovation.

On a quiet ward, there are no buzzers, phones or faxes. There is a nurse and a healthcare assistant for every ten patients. Nurses are freed of tasks such as cleaning, ordering x-rays, coordinating discharges, answering phones or making beds. Instead, that work is carried out by support staff. 

This means that the nurse and healthcare assistant can devote far more of their time to nursing, including simply walking the ward and checking on patients welfare. So patients can expect to see a nurse far more quickly now, without a buzzer, than was ever possible by ringing one before. And without buzzers, phones or faxes the ward is quieter so the patient's experience better.

The pilot at the L&D went so well that the hospital is now rolling out the approach to other wards, and recruiting 105 ward clerks and other staff to support it. 

Without all the recriminations and impassioned debates that surrounded Mid Staffs, the L&D is quietly making radical changes in its approach to nursing, with the profession’s enthusiastic support. The pilot suggests the new arrangements will greatly improve healthcare quality.

It remains to be seen whether our ‘compassionate’ government will support this pioneering initiative by a hospital in the old, public and much-maligned NHS.

Postscript. On Mid Staffs, I was amused to see that 40,000 local people – or possibly 50,000, depending on who you believe – turned out to march through Stafford to try to save the hospital, now slated for closure. The difficulties the hospital experienced were always on the front pages, but the support march  received very little coverage. The march is just boring old news; the high death rates, on the other hand, were a story.


Faith A. Colburn, Author said...

2RWOnce upon a time, I was a proud journalist. Now, I'm embarassed to explain what I used to do for a living.

David Beeson said...

There are, I'm glad to say, a great many fine journalists and it's only thanks to them that we can entertain any hope of blocking the abuses of power. I'm sure you were of their number.

Do you know the doggerel about British papermen?

You cannot hope to bribe nor twist,
Thank God, the British journalist.
But when you see what the man will do
Unbribed, there's no occasion to.