Nurses have the power to “transform” care in failing healthcare organisations but the nursing profession itself lacks a “unified voice” to challenge the government, according to Sir Robert Francis.
In a warmly received speech to the Royal College of Nursing’s annual conference, Sir Robert thanked nurses for all the work they did and described nursing as both a “vocation and a profession”.
“At its heart and soul nursing is a profession and a vocation, which is devoted to the care of patients”
The former chair of the Mid Staffordshire Foundation Trust public inquiry said: “We forget at our peril just how important good nursing is to the wellbeing of patients and the effective running of the health service.”
“I fear that over the years all of us have been taking nursing and our nurses too much for granted,” he said. “Nurses have begun to be seen as a means to make the hospital production line run more smoothly and efficiently, as instruments to achieve various targets.
“At its heart and soul nursing is a profession and a vocation, which is devoted to the care of patients,” he said. “If we the public – and those who run the healthcare system – do not value and cherish that central fact, nursing becomes just another job.”
Sir Robert called on nurses “first and foremost” to value themselves and their work, and “above all” their patients.
“I believe nurses have it in their power as professionals… to transform places of poor care into places of excellence,” he told delegates.
But he added: “Too often we see reports of nurses raising concerns, often time and time again, and then they don’t’ hear any more. That is absolutely inexcusable.”
He noted, however, that an individual nurse would “always be weaker” when trying to act by themselves and called for more at senior levels. “The individual nurse who raises honestly held concerns about matters affecting patients should never be left to fight for them alone,” he said.
He called on trusts to appoint more nurses into non-executive director roles and to encourage groups of nurses within organisations “to voice their shared concerns”.
Sir Robert also warned managers not to “slide back to a reliance on the excuse of finance to fail to deliver proper standards”. “Paring staff to the bone without proper provision for patients needs to remain unacceptable,” he said, in reference to the chronic short staffing in parts of Stafford Hospital.
“What seems to me to be missing is a unified approach… that provides a view which neither government nor the health secretary can afford to ignore”
But Sir Robert also reiterated doubts about how effectively nurses were represented at a national level.
He was “unsure” about the government’s decision to relocate the chief nursing officer for England’s post from the Department of Health to the new commissioning body NHS England, he said.
“Is she in the best place to give public prominence and recognition to the importance of the voice that you all collectively have?” he asked, repeating a point made in his report last year.
Similarly, he said the RCN’s dual role as both a trade union and a professional body weakened it as a “collective professional voice of nursing”.
“Politicians, employers and patients are too easily persuaded that a trade union voice is driven by self- interest,” he said. “What seems to me to be missing is a unified approach… that provides a view which neither government nor the health secretary can afford to ignore.
“There is a need for some more identifiable, authoritative body, which is recognised and has the authority to speak for the profession on issues of patient safety and quality of service,” he added.
Speaking to a packed conference hall, Sir Robert identified areas he thought had improved since the publication in February 2013 of his seminal report into care failings at Mid Staffordshire.
“I believe there is actually much to be encouraged by,” he told delegates, highlighting in particular improvements around “openness” in the NHS.
“We no longer have constant denials that anything is wrong,” he said. “Accurate and fair observations regarding poor standards are good for patients and actually good for staff as well.”
He welcomed the introduction of a statutory duty of candour for healthcare organisations and the Care Quality Commission’s new inspection regime.
“The duty of candour should make it easier for nurses to speak up when they are worried something has gone wrong, and the inspections… should expose leaderships which do not welcome the raising of concerns,” he said.
Sir Robert finished by calling for the lessons of Mid Staffordshire to be applied beyond acute hospitals into community, mental health and primary care settings.
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