So the report into Mid-Staffordshire NHS Trust is public, and it makes for grim reading for the public and a valediction for many coal-face, NHS workers. For anyone about to become an inpatient it must make them feel extremely nervous. When in hospital you are basically reliant on the care provided for you by the staff, so to read that patient deaths were caused by neglecting the basic standards and that patients were left unfed, unwashed and unmedicated, must be horrifying. At this point is it easy to dump all the blame on those who physically failed to provide care, in this case nurses, but hallelulah, the report then goes on to get to the crux of the matter by finding fault with the Trust Board and the Local Health Authority and then recognising that the Department of Health is ‘remote from the reality of the service at the front line’.
Here is the author of the report speaking at a press conference, he graphically enumerates the failings at Mid-Staffordshire, neglect that makes me shudder, failures in compassion and caring, a culture where patient care was obviously not the top priority. Some of this may well be down to a few front-line workers, to a culture within that institution that has been allowed to continue without investigation, and yes, there should have been investigation, many patients and their relatives had made complaints. Why would this situation been allowed to continue? Lack of leadership, I’m going to qualify that, lack of effective leadership but, being a clinical NHS worker, the words which leap out are ‘Insufficient staff to deliver effective patient care’, ‘a focus on reaching targets, achieving financial balance…. at a cost of delivering acceptable standards of care’.
For years I have been writing about staff shortages and paperwork but in The Safety of Services blog entry I highlighted the government and DoH as being culpable for many failings within the NHS. In fact, reading it now, 5 years after I wrote it as a response to a report from the King’s Fund, I am truly depressed to see how nothing has changed. Substitute NHS for Maternity Services and you have the skeleton of today’s report.
There is a tiny piece of self-satisfaction, knowing that I can sit at home, tapping away in my spare time and come up with an immature version of an official report but there is also huge sadness. It just goes to show that those who are a position to influence and drive positive change in the NHS never listen to front-line workers as what I write thousands voice.
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I’m in a sulk. I received an ‘invitation’ to register for a conference today, HSJ Maternity Services Conference 2010 , I clicked on the link and was really interested in the agenda, especially as there was much in there which pertained to community midwifery, both the practice and the funding. I checked the date, yes, I would be fit to attend, Tuesday, not ideal as it’s a clinic day but there is enough time for me to rearrange that clinic, so I clicked on the delegate rates. Now, much as I love conferences and know that I would get a great deal from this one, £399 ( £430 with travel etc) is way out of my price range and, for me, a mega amount of money to spend on a ONE day conference so I shall not be attending and I doubt that any other ‘grass roots’ midwives will either. I would hazard a guess that if I cared to attempt a chat with any midwifery managers that day they would be thin on the ground. They will all be there, in London, chummy, chummy, huddling together and nodding wisely as other managers powerpoint away telling them how to impose more paperwork on clinicians whilst reducing patient contact. Sorry, there is the ‘token’ speaker from a users group, the NCT, she will explain how women are unhappy with the care they receive and what the maternity services need to do to improve the situation. The women are unhappy, well I am as well but it ain’t going to get any better, ever. With reduced budgets, increased workloads and increased paperwork there is no way the service can do anything other than reduce and reduce. If you look at the programme it just about says it all, ‘collecting data; analyzing; compliance monitoring; monitoring improvements; engaging the workforce to gather and report timely information; measuring quality’ of yes, there’s a lot of information gathering going on here and who will do it? The midwives. First though there will have to be lots of nice meetings, brain-stormings and oodles of consultations, I should think a few management companies are rubbing their hands at this point anticipating the studies which will be initiated and the revenue these will generate.
I want to be there, I want to be able to hear rationales, I want to debate and comment on change and, more importantly, is it cost-effective and will it improve outcomes? Personally I’m fed-up with having initiatives thrust upon us from some faceless echelon which magics up ideas and then expects the workforce to implement, audit and document ad nauseum. In a previous post I recorded a days work and compared the time spent on patient contact with other tasks, and now I find that The Nursing Times has discovered that community midwives spend 40% of their time on paperwork and travelling. and they had to conduct research (wonder how much that cost) to come up with that revelation. Well, now its official will someone please take notice and reduce the repetition and the gathering and recording we have to do. Yes, talk about it at the conference but not as to how midwives can record data but as to how systems can be introduced which will cut down on the repetition and free up midiwives to do the job they were trained for.
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