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NHS staff still unwilling to speak up about poor care, nurse tells MPs

Nursing staff are still reluctant to raise concerns about the quality of care a year after the publication of the Francis report into Mid Staffordshire Foundation Trust, a nurse told MPs last week.

The Commons’ health select committee heard that “very little” had changed for frontline staff, despite the seminal report calling for a new culture where staff were encouraged and supported to speak out.

“There is a shift beginning. But when it really filters down to the frontline staff, then there is very little change,” said Helene Donnelly, one of the nurses who blew the whistle on poor care at Mid Staffordshire.

Ms Donnelly, now a nurse practitioner at Staffordshire and Stoke Partnership Trust, has pioneered the role of ambassador for cultural change at her new organisation.

“There is greater awareness now in terms of raising concerns and perhaps staff understanding their responsibility to do so. But understanding that and actually doing it are two very different things, and that’s the bridge we need to make,” she told the committee during a hearing on raising concerns in the NHS.

She maintained that her ambassador role, which has sparked interest across the NHS, was one of the few measures currently making a difference to frontline staff.

“We nip things in the bid rather than waiting for things to escalate”

Helene Donnelly

“I am visible and tangible, and I actually go out and seek issues and concerns. I don’t just wait for people to come to me,” said Ms Donnelly. “We nip things in the bud rather than waiting for things to escalate and become a massive problem.”

Since she was appointed nearly a year ago, at least 87 staff had approached her to “raise concerns of varying degrees”, compared to the two or three calls received by the trust’s whistleblowing helpline previous 12 months.

Ms Donnelly also said she was being contacted by NHS staff from around the UK, because “there is no role like mine in their organisation and they don’t know who to go to”.

“It’s one role that could be implemented in all trusts with a relatively standardised format,” she told the committee. A network of cultural ambassadors could then report back to the Care Quality Commission on common issues and trends, she suggested.

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Readers' comments (25)

  • michael stone

    You need to separate the evaluation and progression of 'the concern' from the nurse/docotor/HCA/whomever raises it in the first place, so that staff don't feel 'worried about raising issues'.

    This network of cultural ambassadors reporting to the CQC, sounds quite similar to my suggestion for layers of what I think I termed cultural champions within hospitals, who would look at reported concerns and perhaps [if unresolved] take the issues to Trust Boards.

    This 'we (the trust, ext) are dealing with the speaking out issue' is one area, where 'guarding against mere lip-service' is hugely important !

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  • michael stone | 24-Mar-2014 1:53 pm

    You clearly lack even the most basic understanding of this problem: your solution adds but £ to the government payroll and bums on seats at endless meetings. If the problem is staff not speaking out, how on earth could the solution be to flood hospitals with 'busybody' types which nursing staff will avoid like the plague? You haven't got a clue!

    Believe me, there are enough of us actually in the profession who are more than happy to open our mouths, raise concerns and protect our patients.

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  • tinkerbell

    Ms Donnelly also said she was being contacted by NHS staff from around the UK, because “there is no role like mine in their organisation and they don’t know who to go to”.

    There should be one of these in every hospital and training for staff to raise complaints and mandatory training for managers to attend if we really want to see any change. Not putting much effort into changing the culture. Pathetic.

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  • I like the fact that Ms Donnelly said that she nip things in the bud and she go out and seek concerns. That is very pratical and positive. All the good sisters/managers I have ever worked under and they were few sad to say, always dealt with problems as soon as possible. I have seen too many managers/sisters lacking in leadership skills.
    Most are just happy to delegate and following instructions from their bosses.
    Leaders should care for their patients and their staff to ensure a happy caring environment.

    I was called by my ward sister on my day off, she wanted to know what I told the CQC staff the day before when he spoke to me in private.
    I felt intimidated by her call, I never expected that this sister could be so bullish to do a thing like that.
    However, I was not too suprised as she was the type to follow without any challenge whatever her boss wants her to do.

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  • tinkerbell

    you shouldn't be phoned up on your day off, it is your day off.

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  • michael stone

    Anonymous | 24-Mar-2014 4:25 pm

    My 'busybody' types, are actually the staff: ward nurses would as a group have a 'ward nurse representative' who they selected; junior doctors a representative for junior doctors; ward managers ditto; etc.

    Other staff would raise non-personal concerns with 'their representative', who would then 'look at the concern' and discuss it with whoever was relevant (including others of these 'representatives of groups). If the issue couldn't be resolved, these people could eventually raise ti at board level.

    No cost involved, as I'm NOT suggesting that these people would be paid - I'm suggesting that you use normal staff-to-staff discussions, more sensibly as part of looking at concerns. And not lots of arranged meetings, either: these peopel would just talk to and phone or e-mail each other, at least while working out if 'something really is an issue'.

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  • michael stone | 25-Mar-2014 11:34 am

    So what you're advocating is a union, what a novel thought! Just to remind you that the RCN (a union) was up to its neck in attempting to cover-up what happened at Mid Staffs.

    Nurses went to their union representatives with grave concerns expecting that something would be done; but, as most senior people in the RCN are also in managerial positions, ranks were closed and a cover-up attempted.

    As usual, you lack even the most basic understanding of nurses and the NHS.

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  • Anonymous | 25-Mar-2014 12:54 pm

    I second that this troll should be removed!

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  • michael stone

    Anonymous | 25-Mar-2014 12:54 pm

    No, not a union - a network of people, concerned with improving behaviour and service, who discuss and try to resolve issues without getting tangled up in 'absurdly formal and auditable process'.

    The idea is that these people (I think I called them Culture Champions) are 'one of us' because you elect your own; they talk to each other as a 'network' and thus learn to understand 'the other side's perspective'; they try to resolve issues at, for example, the level of a specific ward as a first step, if appropriate; but, if the problem cannot be resolved, they are empowered to take unresolved concerns to Board level. And it would be much harder to bully these people, than to bully the individuals who first raised the concern.

    I notice that the police whistleblower, who told some MPs that police were fiddling their figures, has just resigned from the force and says the police were 'bullying' him.

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  • Anonymous | 25-Mar-2014 12:54 pm

    Anonymous | 25-Mar-2014 1:08 pm

    apologies, there should have been a full stop after 'that'.

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  • michael stone | 25-Mar-2014 2:01 pm

    I think you need to explore the definition of a union.

    So your answer to the problem of nurses and professionals not speaking out is to give the very same people the title of 'culture champion' and this new name badge will immediately embolden them and make them open up and challenge abuses?

    Stone, you are absolutely deluded and demonstrate just how little understanding you have of the problems in the NHS.



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  • tinkerbell

    michael stone | 25-Mar-2014 2:01 pm

    Mike you say to want to understand how nurses think, you will never truly understand until you live and breath and eat nursing. It's never too late to do your nurse training. It might be the faster route for you to take. Just saying.

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  • I thought the above photo was a video. what happened?

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  • tinkerbell

    https://www.youtube.com/watch?v=a0XWijJ5VuM

    try this:)

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  • tinkerbell | 25-Mar-2014 8:29 pm

    from above - the comment, I mean! :-)

    Ta

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  • Tinkerbell

    from

    Anonymous | 26-Mar-2014 9:40 am

    many thanks again. Have just watched the excellent presentation in which Ms Donnelly says it all. She will go a long way and needs considerable support and others working with her to spread her and most nurses' convictions.

    Her presentations will improve further with time and practice as she gains self confidence but I would like to see somebody offer her a course so that she can become more confident, more assertive and thoroughly convincing leaving little room for doubt in the message she is trying to convey.

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  • much is spoken about blowing the whistle against poor care but some must also be guilty for this care.

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  • Doctors working in primary care and and staff working as clinicians in A&E as frontline staff must have received training and worked under supervision for five years to be safe. Unfortunately, this was over ruled by Patricia Hewitt in 2006 and nurses were allowed to prescribe. I was working as a salaried GP in pilot Nurse-led practice in primary care. As a doctor who worked for 25 years and trained junior doctors, I had the experience and knowledge to identify wrong doings. Nurses working as clinicians in the local walk-in clinics and nurse-led practice were making mistakes in diagnosis and offering treatment that were not correct and so I had to deal with complications.

    As doctors, we strive hard to reduce complications and so it was very uncomfortable for me to see my patients suffer. I also felt uncomfortable because it is unethical for doctors to instigate complaints from patients. Not knowing what to do, I contacted GMC and asked them what I should do. They told me that I must inform PCT and NMC, and so I did. What happened after that is one that I will not even my worst enemy to go through.

    Please read articles published in 2007 http://www.theguardian.com/society/2007/aug/23/health.freedomofinformation
    Legal Aspect of Nurse-led clinic
    http://www.bioscilibrary.com/resource/EndocrineNurseCourse/ent04/ent04_wil.htm

    Working is all about Far from having a 'pathetically poor' knowledge of diagnosis, before they can even access a course, nurses have to be able to demonstrate that they have sufficient assessment and diagnostic skills in the specialist area they will prescribe in. I forward names of patients to PCT, GMC and also informed Royal colleges in UK. Not one institution has acted nor implemented changes.

    Care offered by NHS is not only unethical but will not be improved if they continue to offer this substandard care using staff not trained to clinically examine, diagnose and manage. Complications and longterm illness is not only devastating to patients but also increase cost of healthcare.

    The nursing and midwifery council must stop publishing articles about raising concern and accept they must blame themselves and stop harassing doctors and victimising them. Knowing how uncomfortable it can be to work as a doctors to standby and watch people suffer, I have published videos that explain why the care offered in NHS is unethical.

    http://youtu.be/GXTrZ9R9uEk

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  • could this be the video mentioned in the above article.

    NT please provide links to save time wasted searching for them. Thank you.

    HoC Health Committee Tuesday 18 March 2014


    Committee Room 8
    Meeting started on Tuesday 18 March at 2.30pm. Ended at 4.37pm
    Complaints and Raising Concerns
    Witnesses
    Dr Kim Holt, Patients First, Helene Donnelly OBE, Ambassador for Cultural Change, Staffordshire and Stoke on Trent Partnership NHS Trust, and Cathy James, Chief Executive, Public Concern at Work
    Visit the Committee's homepage.

    http://www.parliamentlive.tv/Main/Player.aspx?meetingId=15120

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  • michael stone

    Anonymous | 25-Mar-2014 2:51 pm

    Just to be clear - unions represent people who are not their own members, then ?

    tinkerbell | 25-Mar-2014 7:38 pm

    Well, even if I trained as a nurse, I'm fairly sure I'd be a hopeless nurse, and I'm not sure it would help me much either. But it is interesting that when I asked George K why does he buy NT, he also replied that it 'is to understand how they think'. Neither of us want to change how we think - we just want to work out how to present our 'arguments', in a way that will be easier to 'see' for clinicians, and to understand the 'I see this, but you seem to see that' issues.

    I got an e-mail from my CCG contact today, replying to my e-mail that asked if my lot isn't signed up to NT's SOS campaign, why not - she isn't sure if my CCG is signed up or not, but is going to look into it.

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