21st Century Care and Compassion

In response to the Francis report this week, the Health Secretary is expected to say that the cause of the high mortality rates at Mid-Staffs’ was a management culture that permitted poor lines of accountability and traded operational targets for compassionate care on the front-line (Calkin 2013).

However, while the Francis report lists the evidence of failure, I believe it fails to tell the narrative that we all know: that while there remains no official guidance on staff/patient ratios (RCN 2010) cost cutting will continue to be achieved through a reduction in qualified staff and an increase in untrained staff; resulting in less able staff, delivering more complex care, to sicker patients, in shorter delivery times.

Any nurse will tell you that this sort of strategy is lethal (UNISON 2009): the increased levels of stress quickly turn into higher rates of sickness absence, leading to more pressure on less staff, more agency workers, higher staffing costs, less continuity of care, poorer record keeping, less resources for training, less knowledge and experience, less organisation, lower morale, more fatigue, less compassion and more patient safety incidents.

The medicine for this malady is not rocket science: health and safety legislation already requires all UK organisations to monitor their sickness absence records and regularly review their action plans (Health and Safety at Work Act 1974). Hunt should recommend that NHS boards must lead the way on reducing sickness absence as a major public health initiative (NICE 2009); this would unite the NHS’ strategic and operational objectives; not divide clinicians and administrators into politically antagonistic factions within an organisation, as witnessed and abhorred by Francis.

If we are really going to learn from these mistakes then Hunt should also take the opportunity of revitalising health surveillance systems, to create a 21^st century hospital environment. New technology is available that feeds clinical data directly into clinical governance systems (e.g. University of Leicester 2011, University of Oxford 2012, Oregon State University 2012); if this technology were reproduced in the areas of deficit noted by Francis: nutrition, fluid balance, digestive processes, pressure sores and excretions, it could lead to the automatic recording of early warning systems, making the investigation of critical incidents easier, and freeing up nursing staff to do what they are good at – good old bedside care and compassion!