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#FRANCIS LIVE

'Francis will encourage nursing to put patients before paperwork'

Florence Nightingale said in 1859 “hospitals should do the sick no harm” and yet Mid Staffs showed that principle is not always being upheld in today’s NHS.

Concerns about the culture, organisational management and drive to meet targets were raised in the first independent inquiry behind closed doors. The failings of that trust to protect its patients were so manifold and so appalling that a public inquiry was called for – and took place.

The results of that public inquiry were published this morning and they go beyond just the failings at Mid Staffs to tell us much about the present culture of the NHS – and how it must change if it wants to stop a Mid Staffs from ever happening again.

To pretend that Mid Staffs is the only organisation in the NHS where such harrowing ordeals could occur is a falsehood. In our survey on understaffing published this week, over 80% of the 595 nurses who responded felt there were likely to be “a few” or “many” trusts that could be failing their patients as Mid Staffs did.

So everyone in nursing – and indeed healthcare - must take note of what Francis says if today is to give us a consistently safe NHS, that everyone can be proud to work in.

Nursing care is a major part of those 290 recommendations published this morning.

Mr Francis calls for healthcare assistants to be registered and suggests the Nursing and Midwifery Council should be in charge of their regulation.

He wants a national code of conduct for HCAs and wants them to be clearly identifiable from registered nurses – something many nurses have long called for.

He also mentions the importance of nurse training, and recruiting students with the right values – as well as helping to maintain those values.

What the Francis inquiries have proved to us is that there is no one quick fix.

So little wonder that he has so many recommendations. Everything needs to change for the better, is his message. So he advises making sure patients are allocated a key nurse, keeping ward sisters on the wards so they understand patient care pathways and are more familiar with their patient than their paperwork.

But what happened at Mid Staffs wasn’t just about what happened on the wards. The pursuit of foundation trust status made the trust’s board and senior management obsessed with targets, so much so that they neglected what should have been their unequivocal priority – patient care.

To the families, those people who change their loved ones’ bed sheets matter more than the people looking over the spreadsheets. Those people whose hands are entrusted to steer the NHS must create a culture where patient care is the top priority, no ifs, no buts.

This is the core “business” of the NHS, and anything else is a distraction.

Readers' comments (18)

  • tinkerbell

    Good.

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  • If them up there stop shoving all the paperwork on us, we could concentrate on caring for our patients. We have to do 10 sets of notes per week for documentation audit, safety thermometer survey, catheter acquired UTI audit, hand hygiene, MCA assessments, umpteen risk assessments daily etc, etc, etc. Where will it all end? I just want to give my patients the dignified, compassionate care they need and l can deliver (given half a chance)

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  • If it's not written down - it's not done! That's what a court of law would say. The problem with this current scandal is that all the solutions are coming from people up on high, such as Francis and Cameron. God knows why they think they have the solutions. The only real solutions to this "crisis" is from the nursing fraternity itself. The whole problem is just so misconceived.

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  • As a care home nurse, I'll be interested to know what the care Inspectorate in Scotland (and the equivalent in England and Wales) have to say on this one. The order of the day is more and more and more paperwork, and certainly in excess of what I've ever seen in hospital nursing notes. We are held over a barrel on quality gradings, and the ridiculous thing is now that care homes whose paperwork is good, get good gradings, regardless of the standard of actual care delivered.

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  • Chapter 23 of Volume 3 of the report reviews Nursing and this section covers nearly 40 pages and gives some very pragmatic views about the role.

    The review discusses the impact of the changes to nurse training since the traditional apprentiship schemes were replaced with 'academic' qualifications. The report states that 'the Inquiry was told of
    concerns that today’s nursing training contains an inadequate quantity of practical experience at an early stage.' (section 23.56).

    It identifies that no assumptions can be made about the qualities that nurses exhibit in their role as may have been made when the training was 'hands on' . For example student nurses would have given care to patients themselves as part of their training and not just observed the role as they do now. 'In the past, it may have been taken for granted that anyone wishing to enter nursing wanted to do so because they were motivated to provide hands-on care for patients.' (section 23.60)


    The incredible value of providing basic patient care was finally formally recognised currently this seems to be viewed as an unskilled task that HCAs undertake. 'Washing a patient requires compassion and patience. Providing any form of personal care requires a very high degree of attention paid to the patient, as meticulous observation helps protect against pressure ulcers and detects early signs of deterioration in a patient’s condition. It is important that a nurse undertaking this vital work promotes the patient’s self-respect, dignity and well-being. None of this is likely to be achieved by a reluctant or ill-trained nurse.' (section 23.61).

    The bottom line is that the nurses in these units must have known that they were giving bad care - it takes no training at all to recognise that patients lying in dried-on faeces have been neglected.

    Each section of the health service must accept their responsibilities. Nurses themselves must accept that to be considered as a professional you must exhibit basic professional competencies. These include the essential skills which are at the heart of the role of a nurse (physical care of the patient, assessment and compassion).

    In all of the TV debates that I watched yesterday the nurse representatives seemed unwilling to accept their responsibilities for the issues in Stafford and this was the most disappointing element for me.

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  • There will be so much more paper work after this enquiry, to keep the legal system happy.Francis mentions whistleblowers ,look what happened to Graham Pink so many years ago and to many more after him,and will continue to do so (new buz word in the NHS is conflict,no doubt the whistlebower will be accused of causing conflict). Lets get rid of these high Band 'clip board fannys' and start acting on the results of the patient surveys with a caring, common sence attitude,its not rocket science.The surveys tell us time and time again,NOT ENOUGH NURSES ON THE WARDS.

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  • There is so much unnecessary paperwork these days which stop us being at the bedside; we don't need it all

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  • Give the ward clerk more hours in their working day and let them fill out some of the paper work which does not need a nurse to fill out. Get the sisters back in their uniforms and on the wards in the bays supervising, teaching and helping out.
    Have sufficient staff on the ward while other staff can have allocated time for important documentation.
    Yes I am happy with his recommendation for Health Care Assistants.

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  • Nursing assessment when I first qualified- four sides of A4 paper.
    Nursing assesment form this morning- 52 sides, mostly stuff that is relevant ( in full) to only a small proportion of these patients.
    1200% increase in little over a decade and a half. Still the same number of hours in the day though.

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  • redpaddys12 | 8-Feb-2013 7:23 am

    As a non smoker, I am starting a campaign to advocate that cigarette lighters should become an essential part of a nurses uniform. To be used for the disposal of irrelevant paperwork. Mind you, this could lead to an inordinate amount of time being spent freezing my backside off in the hospital car park, whilst the fire service deal with the fall out of this campaign.
    Perhaps a rethink is required.......probably a shredder at the station would be as effective......or we could make a list of demands and go out on strike to ensure that they are met.

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  • mags | 8-Feb-2013 8:29 am

    don't forget to insist on an industrial sized shredder, a domestic one would never cope. that is if your ideas are listened to!

    would be a safer option than the bonfire.

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  • If its not written, its not done. At the NMC + in the Coroner's court (+ law courts), they place great weight on contemporaneous documentation (weight of paperwork is heavy too) and we'll be ripped to pieces for poor + incomplete documentation. We just have to do it
    "Sorry your honour, I wrote 'Focused on patient's care, patient + relatives seemed very happy I didn't waste time on his paperwork, and had no time left to do other patients' paperwork. Patient appeared well, stable observations and remains alive at end of shift'" just won't work as a defense from litigation.
    To save trees + be green, it will all go electronic, when they've dealt with all the gremlins. But it could cost a few billion to implement, with a couple more consultations.

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  • Andy
    Did they not have Coroners courts in the 90's then? Its about money- these forms need compiling, its worth £1 million to the trust for every extra sheet!

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  • It's easier to fill in a form and not have done the task than do the task and not fill in the paperwork. Whilst the current amount of paperwork exists and the level of staff and skill mix remain below par, guess what will win every time. Until a balance is found, nothing can change.

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  • Paperwork not patients is at the heart of everything we do in the NHS - sadly. Unfortunately you can't concentrate on targets and patients - it's one or the other. It is so true that it would be easier to fill in the form than do the work and it would make managers happy- which is probably why they got away with such poor care at mid staffs.

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  • I worry myself sick if I cant get my paperwork done. As previous comments have rightly stated if its not written down you havent done it. Even patients comment on it. I am off work with the anxiety and stress of it all, plus the fact there are never enough staff, but are still expected to deliver care and fill in all the paperwork, besides mentoring students and filling in their paperwork, besides mandatory training and extra courses we do in our own time. I absolutely love nursing patients and have always been compassionate, but I am almost at the end of my tether at the beauracy and do gooders who know nothing about what we do slating us and piling the guilt on. Disgruntled and embittered 61yr old SRN.

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  • I have just read chapter 23 and so concerned about how I am supposed to manage the recommendations As a ward sister I should be on ward rounds (these last up to 4 hours at a time ) I'm supposed to assist in patient care with the diverse needs of patients which can be very time consuming but necessary and supervise my staff I've to provide role modelling, councelling, mentoring, appraisals for all staff Along with the compulsory attendance at meetings The audit process then the action plans then of course the administration tasks of running a busy ward. also managing the complexities of discharge processes. I have to ensure staff are provided with training opportunities and facilitate their release to such events. all of this within 37.5 hours per week. Other duties include developing fire evacuation processes (I'm a nurse) and the constant scrutiny of ensuring the environment is clean and safe. I welcome some advice on how his is achieved! The Francis report doesn't offer any practical solutions to how this is managed on the front line.

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  • most nurses would welcome the opportunity to be at the bedside caring for their patients All of the expert opinion being given is from academics and politicians start listening to the people trying to provide their recommendations We need more staff to provide proper standards!

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