Monday, 10 October 2011

Will NHS reform really get an old lady the help she needs to eat her hospital meal?

Two stories in the Sunday papers yesterday demonstrated very clearly the state of play on NHS Reform.

A front page story in The Observer reported ‘Ministers fear the Lords will kill off controversial reforms’. If the bill is ‘so badly stalled it would fail to get Royal assent by next Spring – meaning it would fall’. It doesn’t take a rocket scientist to work out that if the bill founders, the NHS will continue to sail in unchartered waters without maps or GPS.  Sir David Nicholson has gone on record as saying that more delays would be ‘hugely damaging’ I agree with his view that the ‘NHS needs clarity and consistency, particularly about the timetable for modernisation’. But did he mean hugely damaging for savings initiatives or hugely damaging for patients? Or both?

The Sunday Times focussed on the scandal of inconsistent nursing care with ’20 hospitals break the law with unsafe care’ The article makes for very distressing reading, with reports of patients’ calls for help being ignored as nurses get on with their paperwork, and meals and drinks being left out of reach of the elderly. Spot checks by the CQC (Care Quality Commission) have resulted in a painful and embarrassing catalogue of bad care, and lack of caring (two different things). It is truly shocking that patients should be left wanting for the most basics of care.

So what should be the priority here?

The passage of the Bill through the House of Lords makes for interesting political commentary. This may be an opportunity for the Lords to really demonstrate the value of their institution and halt some badly thought out reforms. But will this really help? What about the frail old lady who can’t eat her meal because the nurse or care assistant simply can’t be bothered to remove the cling film. Does she need to understand who commissions her care? Is she really interested in outcomes? Probably not. She just wants to get better and receive some gentle help and care along the way.

And please, ward staff, don’t give me you are ‘too busy’. It’s basic human kindness and good sense to notice if a patient needs help with their meal. Another example was of two nurses having a conversation between themselves while assisting patients to eat their meals. That’s just plain bad manners – and how mean, considering that may have been one of the few opportunities during the day for some interaction by that patient with another human being.

To bang my old drum again. While the argy-bargy of political bartering continues, patients are not receiving the care they deserve. Leadership, training, a caring culture and performance management do not need a Bill of Parliament. Good, strong management in all NHS facilities is a must. And it’s needed NOW.

Many commentators, me included, have quoted ‘shuffling deck chairs on the Titanic’ and ‘fiddling while Rome burns’. But sadly – these metaphors still apply.

I am put to mind of one of my favourite, silliest of films – Airplane. There is a very poorly passenger, with a naso-gastric tube and IV drip and a well meaning person starts to play the guitar and sing to try and raise her spirits. A jolly sing song ensues, with everyone on the plane ‘engaged’ (although that buzz word didn’t exist in the 70’s when this film was made). What the group fail to notice is that, in her enthusiasm, the songstress has disconnected the patient’s drip. The patient goes into convulsions, unnoticed as everyone else on the plane sings and claps, believing they are doing a good job.

Luckily – another passenger notices just in time and reconnects the IV before the patient expires. Perhaps the most appropriate and uncomfortable metaphor for the NHS so far…


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