Nurses not only ones 'at fault' over patient experience
Nurses should not be held solely responsible for patient experience, one of the country’s most senior nursing figures has warned as ministers press ahead with new plans to rank hospital care.
Poor results from the new “friends and family test” should not be seen as entirely the “fault” of nurses, according to Sally Brearley, chair of the Nursing and Care Quality Forum – set up in 2011 to advise the prime minister.
New health secretary Jeremy Hunt has championed the national roll out of the friends and family test as a way of driving up standards in quality of care, with organisations competing to perform well against it.
Under the test, inpatients who stay overnight in an acute hospital and patients treated in accident and emergency will be asked whether they would recommend the care they have received to their friends and family.
Scores on the test are calculated by deducting the number of respondents who would not recommend a service from those that would, and range from 100 to -100. Results will be published in a hospital league table.
The test, due to come into effect from April, is also likely to form part of the Ofsted style ratings system that Mr Hunt also wants to introduce for healthcare providers.
But Ms Brearley, a former nurse, told Nursing Times the way the test was being discussed by the government implied that the results were all down to nurses.
For example, she highlighted a previous announcement that trusts performing well against the test could be let off repaying government loans to buy new technology designed to free up nursing time.
Ms Brearley said: “It implies the results are all down to the nurses, which is not the case, and if we do poorly on the friends and family test, it’s the fault of nurses.”
A version of the test is already in use for hospitals across the NHS Midlands and East region where it was first developed.
Nottingham University Hospitals Trust scored 61 against a regional average of 68 in the latest round of results in October.
Anne Crompton, the trust’s corporate clinical lead for patient experience, told Nursing Times the question on friends and family was useful as an indicator of where to look deeper. But the most value for nurses on the wards came from asking patients about why they had responded in the way they had, she said.
Unsurprisingly, she added that initial data showed that positive staff attitude and kind caring treatment were the biggest drivers of good performance in the test. However, she noted that issues such as waiting times – for drugs or transport to go home, for example – were another significant element affecting scores. Such factors are largely beyond the control of nursing.
Mid Staffordshire Foundation Trust scored 51. Its director of nursing Colin Ovington told Nursing Times that, despite initially seeing it as something imposed on them, his nursing staff were now enthusiastic about the test and using the information to drive improvements.
Professor Peter Griffiths, chair of health services research at Southampton University, told Nursing Times it was “very important” that the test was used to get results about specific teams, rather than just at trust level.
“[The test] has been put forward in the context of concerns about nurses and, while nurses are not the only group who shape a patient’s experiences, there is lots of evidence that they are pretty important,” he said.
Ms Brearley’s comments come in a week in which the profession continued to face high profile criticism from the new health secretary.
In a speech interpreted by unions as an attack on staff, Mr Hunt described a “crisis in standards of care” as one of the biggest problems facing the NHS. He said: “In places that should be devoted to the patient, where care and compassion should be uppermost, we find its very opposite; coldness, resentment, indifference to human feelings.”
Separately Mr Hunt also told the Commons he had “some sympathy” with views expressed by a backbench MP that caring nursing had been lost in the move to an all graduate profession.