Tweeting away a couple of days ago I came across @WeNurses #nursestaketen which encourages us to do something a little different, even if just for a short time. It made me seek my take ten moment, and as winter approaches I'll return to some creative activities in the darker evenings. The suggestions also included writing a blog from the heart; a prompt if ever I saw one as my heart has been a cause for concern in the last couple of weeks though thankfully the local rapid access cardiac team tell me I'm ok. My emotional heart has been touched by reminders to be kind to ourselves in David Gilbert's blog and being kind to others in Dr Dharmaraj Karthikesan's blog.
All very well beng chilled about kindness; then I saw references to poor care home standards in the news; in particular what was evidence of an indefensible nursing attitude. The news piece flags up stereotypes of Care homes; whilst there are obviously concerns about the home mentioned it ignores the many excellent and simply good care home there are who can make a difference.
It was the quoted, secretly filmed words of the nurse that struck home to my nursing heart and head. Immediate to be "struck off" thoughts were the initial reaction; the attitude that allows uncritical use of medication for care givers convenience is wrong. But head says how did that person get to that place? Are they so isolated, denied training, supervision and support that they have lost that critical internal voice that says - "stop, think a moment" before you speak and act? I understand from the report the nurse has been suspended; I presume some disciplinary action will follow.
Both heart and head say who was being kind to this nurse and their colleagues? Who was listening if they raised concerns? I suspect no one was. How can we reach out to our colleagues who find themselves in such conditions that they cannot "take ten"; maybe the act of kindness in seeking other professionals working in isolation and offering to share a coffee, tea and cake (nurses know the value of cake) and allowing them to take a break will avoid this kind of headline being repeated.
I realise I'm fortunate in being able to reflect on this from afar; I hope nursing and others will take heed of the calls for kindness not just to others but to ourselves; if we cannot do that our responses to those in distress, in need of kindness, will find no use of head and no gift of heart in those who are expected to care for them.
This morning in the UK we awoke to the news announcing the publication of the CQC report Dignity and Nutrition inspection programme, see it at http://www.cqc.org.uk/_db/_documents/20111007_Dignity_and_nutrition_inspection_report_FINAL.pdf
The media focused on the poor practice and dubious standards the inspection team found, see http://www.bbc.co.uk/news/health-15279796. The inspection teams were formed including CQC Inspectors, practising nurses and 'experts by experience' such as members of Age UK. I like that approach, the latter parts of the report explain how beneficial it was to the process and getting a relatively open response in areas under inspection. My own experience in the first Cancer services review conducted by the the original generation of the CQC line, the Commission for Healthcare Improvement (CHI) used nurses and Audit Commission staff. We didn't use patients to conduct interviews though there was work done with seeking their views. We are at last engaging those who are cared for in the process of inspection and evaluation of services.
There were good practices in place though the consistency varied; it must be acknowledged too that some poorly resourced areas managed to meet the standards whilst others with more resources did not meet them. The report draws attention to the suggestion that mangers are not consistently addressing issues of poor performance (p13).
Alongside this are variations in the application of practice where some managers did not seem to have an accurate knowledge of what was happening, “When we asked about the red tray system there was a mixed response. Some senior nursing staff told us that the red tray system was in use but the junior nursing staff on the ward did not know what the red tray system was. They told us that they had never used it.” (p15).
Another quote was “All the ward staff we spoke to on the stroke unit said they felt the unit was understaffed and the current levels were not appropriate to meet the needs of the patients.” (p13).
What concerns me about these three examples is the theme of management competence. Inconsistency of performance should not be a problem if the managers understand how to address the issues and are supported in doing so. It is time to reclaim best practice - and encourage fellow nurses to speak up when poor performance is seen so it can be dealt with promptly.
Management by walkabout has been talked about in the past; it is one way to observe what goes on in your area of responsibility. It makes one visible to the staff, so they can speak to you as well as the people in your care. That would help improve reduce the dissonance between the presumption that those one manages are doing the right thing, and positively making sure they are doing the right thing. You stop looking quite so foolish as a manager that way. And the final quote about "all the staff we spoke to... " - there were presumably more than two (though this should apply even if only one) left me wondering about the support managers gave to staff to raise concerns and take them seriously. And why were the staff letting this go on without taking it further?
Somewhere managers have to be able to strike the balance that encompasses in the phrase 'the people in our care' not only the people who we are striving to help as nurses, but those in our employ for whom we also have a duty of care. Then we might have a better chance to get things right.
With apologies to Gerald Durrell for the title; it's been a long week and a blog feels well overdue.
First the Care Quality Commission (CQC); they regulate most of health and social care in England so I approached them in a professional capacity regarding a question about a possible new building. The Inspector didn't have any advice to give me - it's out of their experience so I'm told I should speak to the Registration team - there's no-one to talk to directly when I tried via the call centre; when the operator finally got through themselves to the Registration department they came back to tell me I should speak to my Inspector - a Kafka-esque situation - I'm not sure what the operator told the Regsitration department. We'll have to write to them and see how far we get - though I'm sure other people must have built new in recent times?
The family - we're all in one piece despite the car crash this afternoon when no. 2 son wrote off my old Honda; fortunately no-one seriously hurt though we now face all the disruption and expense that is involved. The emergency teams were brilliant; the police team very calm and helpful. We now wait to see how well the Insurance company does.
The theme I have in mind is that of organisations' responsibilities and responses; we do emergency care so well here and the response of the teams on the ground were efficient and willing to go a bit further than they could have done.
The CQC is a behemoth with little presonality and little abilitty to help on the ground; it leaves me wondering abut how much help they could be to a lay person looking to them for help. In addition the CQC would appear to have Inspectors who do not have a sufficient range of expertise - so how can we trust the processes of inspection and consideration of services? Rigour and expertise are required for professionals to value the CQC judgement; it would help us and their political masters to have confidence in them.
Whilst we wait with bated breath to see what happens about Southern Cross and all their care homes, we have had the traumatic scenes of the treatment meted out to the clients of Winterbourne View Hospital for People with Learning Difficulties, near Bristol, and today we're told the CQC have tipped off the police about the Pilgrim Hospital in Boston, Lincolnshire.
What a week; in the meantime I have been working along with 30 colleagues on looking at ways we can further develop the quality of care we deliver using personalisation as a starting place.
I guess we're lucky to be employed by an independent sector charity who want to develop and encourage the staff to do the same. It doesn't always feel like the whole charity are behind us but for those tasked with delivering the care ot our clients that kind of atmosphere is necessary to maximise the benefits to the patients and staff and reduce the risks of something going wrong.
Southern Cross is a classic case of market forces doing their natural thing; it remains to be seen how this will pan out.
Whilst details around the Pilgrim Hospital are lacking it must be serious to warrant police involvement. Whether it is one person or a system that is at fault we'll have to see.
Winterbourne View is in a league of its own; in terms of management failure; cultural failings in terms of acceptable care as well as an apparent lack of diligence by the CQC in the area.
When will people in positions of responsibility for quality and ensuring the safety of the vulnerable in our care take up even the slightest hint of wrongdoing and investigate thoroughly.
The principle of the CQC is OK; it remains to see if it was a local failling or so big a failure to warrant changes ot the way it is run.
My own experiences do not bode well for it's reputation as efficient and speedy to respond in setting up new managers, vetting and the other tasks necessary to monitor the quality of healthcare. Mainly because it does not seem to have sufficient numbers of inspectors to do the unannounced visits we should all be ready for and wary of, lest failings are exposed.
It's like driving - the more police officers about in marked vehicles on the road - the better we all are.
Let us not forget the duty of care we owe to those who use our services; that quality is worth investing in and let us see a thorough investigation into what has occurred with proper penalties imposed on those who are accountable for what has occurred.
