Too painful to laugh

It’s International Nurses Day 2020 and a motivation to digitally pen this piece. I find this COVID-19 time tough; it is tiring and has been something of an emotional experience. 

And that’s just the last week.

Whilst our team have worked hard with courage and resourcefulness, we’ve seen the impact on those dying and witnessed over the phone or via digital media the separation and sorrow on the part of loved ones.

I’ve wondered if I should scream at the sky, let the tears flow (wondering if they’d ever stop), simply wallow on the sofa (plus or minus alcohol) or find the words for a blog.

Apart from the poem below, tweeted about a week ago this will have to do.

Supporting each other has been critical; one of us is at home and able to work though stuck inside except the daily walk. I’m busy having daily interactions with others though each of those conversations has overtones of concern and uncertainty.

Then, personal loss struck through the death of a schooldays contemporary due to COVID. His family are bereft; and so many of us would like to be on hand to support and celebrate the life of Barry. 

And despite the jollity of VE Day and today being International Nurses Day it’s difficult to laugh and feel joyful.

And yet I am sustained today by the kindness of my team who staged an intervention today over their concern for me. Through social media there have been lots of messages broad and personal that have helped. Family members have been fabulous too. 

It’s good to celebrate the positives of nursing, where I’ve been home since 1978. 

I’m glad we can do this; and yet….

It is a painful time, and despite the rhetoric I’m not a hero. I’m simply doing a job I love. I suspect many of us will be reflecting on what it means to nurse, and to be bereaved at this time. 

I guess I could be accused of pouring cold water on this special day; it’s not what I intend. 2020 will remain a topic of discussion (for some); for others it may be just good to survive.

Thank you if you’ve got to here; I hope I’ve not been too negative. 

And I do look forward to laughing again soon.

Today, Was not just another day; A time when COVID anger and angst Brought so close pain and disbelief. And more pain, for those we’ve lost And those we’ve left alone. Tears don’t seem enough, For now they’ll have to do, Until we hold again. #COVID19. Written 5.5.20.

How will I shape the year of the nurse and midwife?

It’s New Year’s Day and I’ve seen a challenge to take up. Set by @BloggersNurse as we start the Year of the Nurse and Midwife I am planning on trying to write at least once or twice a month in 2020 on the themes suggested. 

January 1st and I’m thinking about how I will shape the year of the nurse (and midwife, please note I mean to be inclusive). 

It’s 41 years since I entered nurse training; my shape and that of nursing and midwifery have altered. Overall, the two professions have fared better shape-wise than me.

I trained to become a State Registered Nurse (SRN) in England, moving into a profession held in high regard. 

There’s been the transition to degree based learning, and recently apprenticeship programs. All routes opening to a career of varied opportunity. 

What shaping influence can I have? The immediate one as a senior and experienced nurse is as an example of being open, kind and flexible. 

I have to be open about how I work, and be prepared to let others lead where they have ideas and strengths that I don’t possess. Be ready to adapt and adopt fresh thinking and take risks to make gains in service improvement.

I want to be kind and even kinder, to all those in my care. This will be patients as well as my team colleagues, and those in the wider care community in which I work and have a social media presence. In particular it’s those who are exploring the possibility of nursing as a career, or already in training, to whom I should be an example. Showing enjoyment and enthusiasm for our work, and giving such people time will help them be great nurses of the future.

I need to be flexible; my career has had twists and turns; some hoped for and some unexpected. This has helped me appreciate the opportunity of being ready to try something new; to allow me to be trusted by people such as team members when they require some wriggle room - flexible working to allow for family issues for example.

Applying this to shaping the year of Nurse and Midwife? 

Being an example, supporting those I come into contact with and reaching out through social media. 

Embracing and getting involved in events to celebrate nursing, and show the value of nursing work to those who question what nursing is.

Supporting those I work with to look at what we do, and see how the work can be done differently. Getting them to speak up, in person, in blogs and engage in further education so they can be shaping too.

Change happens; being prepared to influence the outcome is a way I can contribute to the year of the nurse and midwife in 2020 and beyond.

Feelings of an ad hoc carer and frustrated professional

Just now I'm aware my mum is undergoing a endoscopy and I'm at home after spending a few days with her. In my earlier post about the NHS in November 2017 I laid out my views of what we were experiencing.  
Now it's time for an update and perhaps less positive reading.
After discharge from a 3 week stay in a rehabilitation bed the Friday before Christmas mum was experiencing trouble with reflux from what we eventually discovered (in a post Christmas telephone call with a GP) was a sliding hiatus hernia. This was known about in hospital yet no mention of it was ever made.
Mum has gradually regained her mobility and with support from the family and neighbours was managing just about at home. 
The big problem has been to get anyone to take her painful regurgitation and reflux seriously, along with her weight loss. For a serious cook like mum, who enjoyed a varied diet and particularly going out to eat the reduction in appetite and feelings of hunger have been a depressing downward spiral with no sign of improvement. 
The oral medicines prescribed to improve the situation were having no chance to work.
We've tried all sorts of things; bed head end elevated, mum using the internet to make sure she was using NHS advice for her diet and the variety of medication that was promised to make a difference.
Only this week have we got a GP to call round; the vomiting of almost every fluid and food mum has tried to take was largely ignored because its all 'infection'. Mum has lost half a stone in recent weeks and we believed we were approaching a crisis point that could surely have been anticipated with better community support. The community nurses who visited shortly after discharge told mum they'd keep an eye on her; though hearing impaired mum got the (correct) impression she'd not see them again. 
The senior GP who mum got through to thought she was calling her rehab place; we'd made it clear to the surgery that mum was home...
So between family members and her marvelous neighbours we've tried to find attractive foods and fluids; my catering experience helped here though only marginally.
This week, having been forced to take a frail and low energy mum to the local hospital for a blood test we reached crisis point. The 111 doctor called to say her bloods deranged and needs to go to hospital. So mum is now back in hospital and having her endoscopy. We'd considered getting a private consultation to see if we could get someone to take notice. 
For us, and my experience in the last week this seems unnecessary; felt like trying to keep mum out of hospital (understandable in some way given recent news) though at the expense of ambulance crews and long (overnight) waits in A & E. And we had more than one nurse advocate trying to get help for her. 
Where is the multi professional review and support for older people in the community?
Were mum without family and her support network I dread to think what would have happened. 
It's frustrating and we have some inside knowledge that you would expect to help get us further; it's frightening too.
Right now I have to trust my hospital colleagues and keep faith in the system overall; for Mum and as so many other carers have to do day after day.
As I finishing writing this mum's GP surgery have called me - they're trying to get hold of mum and wondered where she was - her blood results need rechecking... they are surprised (and relieved) she's already in hospital... where's the communication? 

The NHS as I see it just now

This feels a little tough to write; my lovely energetic mum has acquired a chest infection that's making her very ill so she's now in hospital with the NHS team doing its best to help her. We've visited  three clinical areas after A and E, and at the time of writing mum is in the ITU having supportive ventilation. 
An impressive array of clinical staff have been involved in delivering her direct care supported by a larger army of support workers and those whom we'll never see. 
My observations -

• #HelloMyNamesIs has not penetrated everywhere yet which feels disappointing though there have been many who have introduced themselves and wanted to know and use our family's names
• Car parking fees are crippling unless you're eligible for a special deal so ITU admission will save us money (mercenary on my part I know, and I wonder how those with lower incomes manage)
• There's a great focus on finding out about the person needing care and including us in conversations about options for care such a DNACPR
• All this work is being supported by people who are from around the world as well as those locals who are living down the road having been born in the same hospital 
• Limitations on immigration (and the current drop in nursing numbers linked to Brexit) will have dramatic impact in the near future 
• Outsourcing to private companies is increasing; depriving trainee GPs of pay for example; ward cleaning and catering have gone the same way and only personal teamwork based relationships ensure smooth working
• Busy staff can seem uninterested however we don't know how long they been at work that day nor what they have had to deal with so far 
• Cooperation with the caring team helps even in the times of uncertainty
• The gift of a cup of tea or coffee is a sign of caring for individuals and is much appreciated; however if providing tea and coffee making facilities please make it easy to find cups and water for the kettle; we're happy to do the rest
• The estate is often old and can look rough; even so I saw signs that reuse, refurbishment and rebuilding is going on. That said toilets out of use for some days because the drains are blocked is not good and symptomatic of the privatisation relationships 
• A and E queues for ambulance teams are so wasteful of all those resources; let's put money into getting people home and supporting them there
• Link the technology; observations made on one ward and recorded via the handheld device cannot be seen on another ward (?) after transfer. Hand written notes mean we have to repeat the stories
• Please be prepared to repeat instructions to dazed and anxious visitors like the cheerful security desk lady did
• Nursing - so much technological expertise required and this needs mixing with empathy and genuine communication; that combination will win the trust of the person in your care as well as their loved ones

Overall I've been deeply impressed with the dedication and commitment of those we've come across; the NHS is an institution that comes in for criticism too easily too often and what I've seen today shows a multi-faceted, multi-talented, multi-national workforce freely available to do their best for those in need. This is to be applauded and protected; it is something that our family is immensely grateful for.

Times for tears

I have recently wondered if had been developing hay fever; I've had ‘leaky eyes’ and perhaps a few sniffles at various times. I'm pretty sure though that there have been times when I've shed tears. As family will tell you simple things on tv will set me off; dare I say it extreme reactions to great acts on Britain’s Got Talent is an example.

At other times though other things have acted to set me off. Frustration at my own actions; delight in others successes; hearing inspirational stories and hearing news of those who have died.
After a busy time at work and recent terrorist acts in the U.K. I found myself suddenly anxious too. This caused me to reflect on what life was like at the heart of the Irish ‘troubles’ when I spent lots more time in central London. As I write I feel much less troubled about risks particularly as I commute by car each day.

What sparks the tears though? As I've reflected on my career in recent times I've recalled times of sorrow and delight. I've said before that my passion is about getting end of life care right for those who are dying. I've also said that in the position I'm in now means I have many people that I care for in our organisation. My actions can have ramifications that are unexpected; to get it wrong as I've owned I might do before, is frustrating though it becomes a vital learning experience. 
A contrast to this is seeing the investment in others resulting in their development; finding ways to study and change their lives as well as simply passing on messages of a thanks for a job well done is another cause for celebration. Yes, a potentially tear jerking time.

Obituaries of people who've been in the public eye, such as Peter Sallis who had entertained me for so long can induce a weepy episode, particularly when set alongside the news of multiple killings on Manchester and London streets. One person I recalled was Lawrence S. Newcombe who died in 1987 (with 30 others) helping another person in the King’s Cross fire; he trained as a nurse at the same hospital as me and I recall him as a force of nature.

My joy at the achievements of others has been filled today as one son, who is proudly part of the NHS has passed his training course and now has heard he has a job in the department he works in. Lastly however the inspirational story telling by people such as Tommy Whitelaw provokes my lacrimal ducts; he reminds me of the importance of knowing something of the person I'm with and finding out about their story. Being able to share our emotional reaction with those around us is powerful and emphasises our joint humanity. Allowing times for tears is as useful as sharing laughter; for me it's important we're open about this too. 

Challenges for the personal and professional

At the end of February this year my dear friend in nursing @agencynurse Teresa Chinn wrote a blog piece about the WeGetogether2016 event, held on the 29th Feb 2016. As ever Teresa gave a thoughtful account of what happened, the build up to it and considered the consequences. One one aspect Tree asked about was "what happened?" Her response was 'nothing' and that concerned me; so I want to challenge that - gently of course. In one way I guess Tree is right - no great single change or movement emerged that sparked a revolution. 
I began to wonder however if I had missed something because I believe there were myriad outcomes, albeit small ones.

I had traveled to Salford where the University Nursing School hosted us, full of hope and expectation; not to mention carrying banners and freebies including home made cookies. 
When I look back on #WGT16 I think of the developing relationships that were bolstered by meeting in person; the thinking and sharing we were encouraged to do. From my perspective it led to a wider range of contacts and networking that influences me today. So let's remember what we experienced at #WGT16 and think of where we are now. Yes times seem to have become ever more challenging in terms of politics, the economy and the Care sector (I like to think across the health and social fault line). That has not stopped people continuing to challenge both personally and professionally. 

And then Teresa has set me thinking again about challenges; this time in her latest blog about professional challenges.  I've found nothing to argue with here; safety and safeguarding are key nursing responsibilities for nurses. It is the anticipated response of others that can block coming forward; I believe that as a senior leader and a manager I have a duty to set an example as a listener and in responding positively when concerns are raised. Likewise I have to be ready to face personal challenges and accept that I have got things wrong. Developing as a leader is about learning about oneself as much as getting to know those around us and that can be a much bigger challenge. 

Heart Head Kindness and other influences

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. 

A challenge or piece of cake? Being person centred in a hospice environment.

 The opportunity to begin the introduction of looking at how person centred our practices is at St Clare Hospice is too good to miss. Starting with the use of my one page profile #Onepp (1PP) as I began my current role I wanted to expose my new colleagues to what is a different way of thinking about care. 

Why bother when we could say we practice the best holistic care with all our patients? 

I am concerned that holistic care is a blanket term for care structures and processes that are uniform. The care cannot be person centred if the same care model is used in the same way for all. Being person centred is about making what is important to the person central to planning and organisingtheir end of life care, and crucially the person concerned is involved in the preparation. So whilst taking the same approach to care planning the result is individualised care that is set up around what works and what does not for each person. 

In the following stage I have begun work with the inpatient unit team to review just how person centred the unit practice is. We are using the Progress for Providers – End of Life tool from Helen Sanderson Associates to see how person centered our current practice is. This is available electronically too. The group are meeting and working through the tool; I am letting them take the lead so they are ready to own the action plan and next stage of work. 

At the same time I’m seeking support from senior managers and our Board to make sure they understand what we are doing. Once we have completed the assessment stage we can use the tool to create the action plans and priorities for action. The intention is to spread the use of the tool across all our services at St Clare Hospice as we take on an increasingly person centered approach.

I find this an exciting time as teams look afresh at what they do and how they perceive the care they give. I believe it will help us see the relationship we have with those who use our services in a new light as we focus on the person who needs support towards the end of their life. I look forward to telling you more as we progress. And at that point I hope we will be ready to face any challenge, and being a hospice be armed to face it with plenty of cake.

Philip Ball

Director of Patient Care, St Clare Hospice, Hastingwood, Essex.

Being a target

Those who follow my tweets and those who access my Facebook page might have seen my posting about my health incident this last weekend. Enjoying a 'self-care' stay at a hotel near mum's prior to the UK Mothers Day, I became unwell during dinner, experiencing severe abdominal pain and feeling feint. Within a few minutes the kind and helpful hotel staff along with Megan decided help was required. The London Ambulance Service crew showed up a few minutes later and took control of the situation. I remained conscious and with my first aid and nursing knowledge realised the possibility of either an aneurysm or heart attack were high on their list of concerns. Dodgy food was  considered though no evidence was seen.

I was soon in the ambulance and wired up to the ECG machine, whilst the crew calmly went about checking me over. Without further discussion we set off for the nearest A & E where after a few minutes wait I was loaded onto a trolley. At this point I'm sure the ambulance reached me inside 8 minutes, and I was dealt with efficiently so the crew were on their way after handover.
It was relatively early on in the Saturday evening so the staff were fresh and not under too much pressure; my vital signs were recorded by a RN who used hello my name is, nice! A cannula was put in my arm and bloods taken; Megan was asking if there'd been anyone in the lab to process them. I was sure there was; some things have changed a lot and I expect there was machinery close by for doing the analysis required; there has to be to aid meeting targets.

I was put into a single room and vitals checked again; different RN and no ' hello my name is ...'. A cheerfully helpful HCA recorded another ECG, and gave me a gown and blanket with an apology for the lack of a pillow. He was another 'hello my names is ...' hero along with the doctor who saw me. The HCA insisted I put the gown on (I kept my trousers and shoes on all through my stay) though I'd have preferred to stay in my T shirt; a curious requirement and no reason from my perspective. Does wearing the gown help differentiate me from visitors and make life easier for staff? Is this a money saving opportunity missed? On a similar point why not have universal ECG stickers so the ambulance ones aren't pulled off and new ones applied at hospital?

My main question I suppose is around the need to transfer me without question to A & E? Would a wait a little longer at the hotel have reassured all concerned it was a one off and that resting in the room would have been ok? Maybe with my insight I would have been ready to take the risk that it was a one off episode and did not need hospital intervention. I suspect though that algorithms and risk averse targets played a part in driving my care rather then patient choice and perhaps an application of experience and common sense.

Treated with warm politeness at the hospital, privacy and dignity were only nearly there. Wearing a gown as one carried a sterile pot to the toilet clearly shouted - "he's a patient off to do his urine sample" - amplified by the evidence visible in my hands on the return journey did dent both privacy and dignity. As a nurse its ok to walk about carrying other people's bodily fluids; as a individual carrying ones own, its a whole different situation. Within about 3.5 hours I was allowed out after some IV fluids and pain killers, clutching my blood results sheet - though not sure why I was given it. We dutifully completed the Friends and family test card. So, I was treated and moved on from A & E inside the 4 hours and the ambulance team did their job too in that regard; I was a target met.

Was I safe, cared for effectively, in a responsive manner by a well-led team? Yes, so CQC-wise I have no faults to mention. I am still left questioning whether the expense of resources for me was a good use of what was available that evening. I asked the senior nurse who helped administer my IV medicines about the coming shift; it was clear that my case was a straight forward one; single episode of nasty tummy pain that passed off quickly and simply. Yet to come for the ambulance and A &E teams was an after midnight rush of drunken fighters and fallers, that required an increasing police presence. That makes those public servants targets of a different kind, and a group of people for whom I have the greatest admiration.

Connections with times past

In an office or ward are people I've worked with; an obvious statement given the length of my working life so far. What has come to the forefront for me are the connections I have with so many, and the influence I have had.
Two Consultants in Palliative Care I have caught up with recently, I first met as junior doctors. Their remembrance of my practice has stuck positively;  a relief and a vital reminder of how careful one must be each and every day.
This focus came from being asked about the achievement which might be my best. The nurse in me wants to be remembered by those in my care as good at what I do. My initial response though was to say the people who I had helped developed in their career path;  whether going on to train as a nurse or win awards for influencing government policy in their homeland.  It struck me our connections can go a long way and have an influence beyond our own world. We can affect the care of many more than the people we meet directly. So whatever your role in whatever capacity keep in mind how you will be remembered.

Making a difference - being creative with the environment and your care

Today was scheduled to be a day off; possibly a lie-in then potter about. The news the night before of a older relative having had a stroke a couple of days before led to a busman's holiday drive across southern England to see them. Before leaving I was able to read the leaflet about the relevant stroke unit, and find details about the car parking charges; a plus mark of the internet.
So we set off  and in good time arrived at the hospital though 20 min early. We were ushered to the Day Room - visiting time had not started. Of course this set me thinking, the @wenurses tweetchat had discussed visiting times the previous evening; follow the link to read more, including the pre-chat information from @wlasinclair .

We complied with the request to wait and so entered a room that looked like this in one corner -

the opposite corner housed a large TV playing to no-one.

Not a great first impression and certainly not  a safe patient friendly space; nor welcoming for visitors. The label inevitably said 'broken'; I wondered how long it had been there.

There was no easily readable information for visitors, i.e. a map to show the location of the toilets, tell us where the cafe was and so on.
This notice board was inaccessible.

Inside the door was this notice - 

all nicely ironic and the poor grammar seems to indicate we're all Sisters now.

Once we were at the appointed kick-off time we ventured to the Reception desk, and it took a few minutes for us to be asked 'are you OK?' This despite a plethora of staff around the central station; none had easily readable badges. I just had to go on who was wearing fob watches or stethoscopes; a staff nurse did help and showed us where our relative was.
Of course we were limited to two visitors at a time; within minutes though this became problematic when their friends arrived; this is after all a very sociable person who enjoys a good party even though they're 90 plus! I suppose I wouldn't mind the limited visiting and two relatives at a time if the rationale was clearly explained in the literature, by diagrams or by someone tasked with ensuring visitors knew the 'house rules'.
Getting to the bedside we were able to begin to chatting and having taken my drawing pad, we made progress with communication. Of course were relieved to see our person dressed and sitting up; there were a selection of leaflets for them to read - left out of reach on the bed. A nurse on duty for the afternoon passed the #hellomynameis... (thanks to @GrangerKate for this idea) test; as did the speech and language therapist.
Here we were shown the three side of A4 that had been left earlier asking questions about our relative; the SALT team wanted to know more about them. 
Oh how I wished I could have shown them a one page profile; we had fun however altogether completing the form, though were left wondering how widely it would be shared. I hope it will be; there has been a lot of life lived by our relative, around the world. The developing #facetoaname idea would help here too.
During the visiting hiatus caused by the physios - (why restrict visiting?) I had a look at a notice board that showed safety data graphs from a year ago; a 'You said ... We did' poster that was blank and some quotes with codes numbers that were meant to be patient and visitor feedback. Opposite at a drunken angle as its Blu Tac was wearing out was a certificate from 2009 given to the ward team from the hospital management team.
l must acknowledge my bias and perhaps more detailed knowledge than the usual visitor; none-the-less what appeared to be a well staffed ward was not looking at the details. At least not always the right ones; whilst we went back to the Day Room during the physio session, a tidy soul put away our visitors chairs: we had to retrieve them. 
I would ask, and I think I will have to pass on this feedback to the ward, that someone looks again at how you present yourselves as a team, your environment, and demonstrating newer ways of working. 
For a lively mind now hopefully only temporarily caged by impaired speech a one page profile would make a difference; give them a relief from the frustrations of their situation as others can share their life. In looking at the ward environment I hope the ward team can demonstrate how their commitment, courage, care, competence, compassion and communication makes a difference to those they are looking after.

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.

What a week for healthcare

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.

Creaking care market

I've seen a report today that says the UK's leading residential care provider is having to restructure its finances, Southern Cross Healthcare. Refinancing is a fashionable thing to do - Ireland and Portugal spring to mind. Not surprisingly the Department of Health are said to be watching the situation and are concerned that standards of safety and quality are maintained in the care the residents receive. I suspect too they are concerned at how a potential market leader collapsing would look for the current health care reforms.
I have had a look at the Southern Cross website http://www.schealthcare.co.uk/News-and-Events/2011/Message-from-Jamie-Buchan-Chief-Executive-of-Southern-Cross-Healthcare/ and the message from their CEO; it is the closeness of SCH to Local Authorities and their finances that is the real problem. If Southern Cross are struggling who else is? Are we going to see more care providers struggling and those without sufficient critical business mass go under? Where will residents end up? At the end of the day what would happen if there was no local capacity in the sector - is the UK ready to have residents shipped about the country as there is nowhere locally to house them?
Is this the kind of result the government expected from market reforms? Markets have to allow for failure - are we prepared to accept this kind of failure in the care sector? Failure here is not an option - not if we are to avoid a return to a workhouse scenario.
It sounds like Southern Cross have a plan; indeed have been working on their plan for some time and I wish them well; not just for those with a financial stake in the company (I wonder what my bank has lent them?) but mainly for their people - the staff and residents and their families who will need to have faith that the system will sustain them.

Care and compassion? Time to think and act.

Care and compassion?
I must start by saying  the Ombudsman's website itself deserves praise for its layout, clarity and ease of use.
This report from the Health Ombudsman's office is difficult reading for a nurse; however I feel it should be compulsory reading for all in the health care business; particularly those in training. Not only have the patients and families been let down; the behaviour of 'front line ' clinical staff and management alike have led to this situation. They have let their professions and colleagues down too.
I must acknowledge the good work that goes on within the NHS day by day; but the numbers of complaints the Ombudsman has to deal with leaves me wondering about the frequency with which health care professionals are getting it wrong.
Yes, nurse and doctors are getting it wrong too often - leading to standards of care that fall far short of best practice that are rightly exposed in the report.

The reasons may be varied - but unless staff speak up about pressures on them (e.g. staffing levels, poor practice of colleagues), using written reports copied to unions, there will be no evidence that they noticed the pressures and acted to bring them to the attention of managers and others who are responsible.
Whatever the reasons staff may have for poor standards - it would seem individual clinical staff are not applying the principle of putting the patient first; allowing themselves to be distracted from that tenet is where it begins to go wrong.
It can be forgotten that each of us may have others to whom we are important; the story of Mr & Mrs J shows that so well.
Even within areas of care (cancer and Palliative care) where so much has been written about good practice; education offered and expertise is available, that Mrs N and family went through what they did only serves to reinforce negative messages about the way people die - and support the argument for the need to introduce legislation allowing the opportunity to help those who wish to end their lives by assisted suicide, for example.

Such examples play right into the hands of those who will sensationalise all that is worst about health care; and management is no exception. When reading the Case studies http://www.ombudsman.org.uk/care-and-compassion/case-studies it is the poor response to the original complaint that leads to the Ombudsman being involved. Why is the NHS taking so long to get investigation, communication, and restoration through action right? An apology early on can go a long way to making people feel heard. Subsequent action is important too; making sure those involved know how serious the situation is; reinforcing the need to think at work - to work on your thinking too - so that we all remember who to put first as we go about our work.