Time to Care, Dignity and Nutrition - a mixed result for nursing and management

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.

Ageism, the NHS and 'no more just 'elderly services'

In this week's Nursing Standard editorial the problem of ageism in the NHS is given an airing, see http://nursingstandard.rcnpublishing.co.uk/resources/editorial/editorialv25n27.asp

What struck me is that we have services that tend to reinforce this approach; the elderly have been categorised into a group it is easy to discrimnate against. It is right in the past that our attention has been directed to the particular needs of older people but the 'post 65 years' marker seems so out of date now. I do not wish to denigrate the important research done in the past, nor the clinical practice that led to the development of older people services. Nor should we abandon the ongoing work about ageing and its effects; dementia however can strike before you are in your 60s so lets get real about this.

It is not safe to assume everyone will have finished work by 65; nor is it safe to presume retirement means some kind of slowing down and an end of usefulness. Indeed I suspect David Cameron hopes many retired people, of whatever age will help prop up the 'Big Society' or bs idea of his. He'll need to hope that this group remain in robust mind and spirit to sustain their contribution. The volunteers I meet regularly have often given many years of service; and have an energy and vitality that can be used for the community good. On occasion though they may need health interventions such as surgery and so long as their individual needs are taken into account it can return the person to the same situation of enjoyed contribution as before.

So, presuming getting older, and indeed approaching retirement is not a sign of an end of usefulness we should surely be looking at developing health and related services (idea - why not combine health and social services into 'Community life services' including libraries, schools etc?) into places where your important health concerns are addressed before anyone gets to see your birth date. In recruitment best practice the birth date has dropped off the list of things automatically seen; let us focus on a name and NHS number for identifying people and step away form the use of birth date - unless critical for safety - once a considered decision has been made on the care approach to go forward with.

Yes we need a change of approach to those in our care, and somehow we have to take the best of the work on ageing and weave it into all our services to help improve the care of those who are getting older.