Good care doesn't have to be complicated.

The tragic case of Kane Gorny is a dramatic example of what can and does, go wrong in a hospital ward. Kane was just 22 when he of dehydration in a London hospital. He was so desperate for fluids and so upset that the hospital staff ignored his pleas that he dialled 999 and called the police who took his call seriously enough to come to the hospital ward to find out what was going on. They were sent away by the staff and Kane later died, for lack of water.

The case isn’t as straightforward as it would first seem, that patients were dying in the NHS simply for the want of a drink of water. This unfortunate young man was suffering from a medical condition which meant that he needed regular medication and constant top up of fluids to ensure that his organs received the hydration they needed. Add into the mix that Kane had suffered a brain tumour a year earlier which meant he could be prone to bouts of aggression. None of this was unmanageable and his post-surgery care after a hip operation should have been routine as long as the staff responsible for his care understood his medical history and specific needs.

The coroner investigating Kane’s death ruled that he was ‘undoubtedly let down by incompetence of staff, poor communication, lack of leadership, both medical and nursing, …a culture of assumption’

It is truly shocking that the many clinical and support staff who came into contact with Kane failed to ascertain the exact needs of their patient. Why was this? Because they didn’t care? I hope not. Because they were too busy? Maybe. Or because there was insufficient ownership and unclear responsibilities? More likely.  They all made assumptions regarding his condition and behaviour. Not one person ‘owned’ the wellbeing of this vulnerable young man. The highly desirable side effect of ownership and responsibility is communication, and good communication between clinical staff would have probably have saved his life.

I have just read a synopsis of the 37 page mandate for commissioning laid down as a result of the
Health and Social Care Bill. It talks about ‘improving recovery of illness’ and that the commissioning board will have a role in ‘maintaining or improving performance’. The government is ‘committed to extending the range of choices at every stage of patient care’. Would any one sentence in the 37 page mandate change the outcome for Kane Gorny? I doubt it. I suspect that he wasn’t so much worried about choice. His needs, and the needs of most patients, are pretty basic. Give me the right treatment at the right time with as much kindness and compassion as is humanly possible.

How can we ensure that quality of treatment and care in our hospitals? Through strong management at ward level. Through clearly defined responsibilities. If one person in that ward had personal responsibility for Kane, then hopefully they would have read his notes and made sure that they understood what was needed. And if they didn’t understand any element of his care there would have been other clinicians on hand to answer their questions.

When I worked in hospitals three decades ago there was a system where at the beginning of each shift the ward sister would allocate a number of patients to each nurse. Those patients would be their responsibility for the duration of the shift and the handover to the next shift was also their responsibility. They ‘owned’ those patients. I hope I’m not being naïve in believing that this simple method could still work today as long as you have enough qualified nurses on duty at any one time.

Why change basic principles. Good care is cost-effective care. Strong leadership, performance management and sufficient hands-on qualified staff create good care.  It doesn’t need 37 pages to explain that simple fact.

Name and shame or name and praise – badges must be worn by hospital staff.

The UK Newspapers seem to be concentrating on Nursing standards this week. Camilla Cavendish in the Times bravely states that she ‘lay on a ward where most of the nurses regarded it as an imposition to ask them for help’ and she goes on to say ‘dedicated nurses look exasperated at having to work alongside ones whose ability to care extends only to caring about when their shift ends.’

Minette Marrin is equally blunt in the Sunday Times today reporting ‘there have been enough scandals to prove the point that disgracefully bad nursing is widespread’

Both articles agree that varying standards of care are a major concern and lay the blame at two doors. One – the type of training for nurses, introduced nearly two decades ago, ‘intellectualising’ the content and focus. And two – the increasing use of healthcare assistants who are usually unqualified, poorly trained and unregulated.

I wouldn’t argue with either of these points and refer to my blog of 15^th February entitled ‘Can you teach someone to care?’ I have sympathy with the dilemma currently facing the nursing profession. Increasing sophistication of technology and treatment regimes mean that nurses need a wide range of specialist knowledge. But this is no excuse not to care.

Peter Carter, General Secretary of the Royal College of Nursing has said that patients’ relatives should take more responsibility for patient’s care. Patients tend to be split into two camps. Those with healthy, compos mentis relatives who do take responsibility for their care, often in spite of, rather than in association with, the nurses. The other group of patients are the elderly and vulnerable who may have no relatives nearby.

I do agree with the sentiments behind Peter Carter’s comments – joint personal care plans between relatives and nursing staff is a good idea but it’s not always going to be possible or appropriate.

When I was an inpatient recently I was in a four bedded unit with one 90 year old lady who had broken her hip, another elderly lady who had broken both arms and one who was completely away with the fairies. None of these ladies had relatives who lived nearby. Luckily as I was the walking wounded I happily took responsibility to ensure that their day to day needs were catered for – fetching things – holding cups and finding a nurse when needed.

And this brings me to my plea. ‘Finding a nurse’ was tricky – not because there weren’t any around but because I couldn’t tell who was a nurse, who was a ward clerk, who was a healthcare assistant, porter, cleaner or whatever. There was no standard uniform and NO BADGES.

In my role as a change leader, I know that it is so often the smallest changes that can make a huge difference.

Yes we need to get back to basics and look at nurses’ and healthcare assistants’ training, caring attitude, roles and responsibilities. Yes we must support the great nurses who do a fantastic job and censure the lazy or mean (as in any profession) In the meantime, every person employed in a hospital should wear a badge stating simply their name and their job title. And this must include doctors.

There are so many good reasons for this. I have no doubt that it is far easier to do a sloppy job if you are anonymous, but the flip side is that good work can be recognised in named individuals. I wonder how much time is wasted every day in hospitals as patients and visitors struggle to find the right person to ask for advice, guidance or help?

The NHS is a service industry. It’s success or failure rests with the individuals who are tasked with providing technical, medical, practical, personal or emotional care.

If anyone is dealing with mine or my loved ones’ needs in the healthcare environment – I want to know who the hell they are.