Practice team blog
All posts from: January 2012
The royal colleges - representing health professionals (whether these are medics, nurses or midwives) - are not natural rebels.
Possibly mindful of their charitable status, if they disagree with government plans they prefer to do so behind closed doors, and to use the carrot of co-operation rather than the stick of confrontation.
Despite this, last week the Academy of Medical Royal Colleges were preparing to announce that, with the exception of the Royal College of Surgeons, all were opposed to the Health and Social Care Bill. The academy later pulled back from releasing the statement - apparently after college presidents received ministerial phone calls - and agreed to continue discussions with the government. Many will be disappointed at this apparent loss of nerve, but at least Mr Lansley cannot claim to have the academy’s support (can he?) That cat is out of the bag.
Until last week the government could dismiss opposition as coming primarily from the “usual suspects” - unions, hostile media and pressure groups. It could claim the avalanche of opposition from individual health professionals was rooted purely in self-interest or aversion to change. And it could tell us that the clamour from alarmed members of the public had occurred because the poor dears simply didn’t understand such a complex piece of legislation.
So now, only the surgeons are truly on-side. A profession that cynics might say stands to benefit most if the Bill becomes law without significant changes. Why? Because it’s difficult to see the aftermath not leading to longer waiting lists - and when people wait longer for surgery, if they have the money, they are more likely to go private.
Despite the plethora of clearly argued cases against the Bill that have been presented over the past 18 months - many of which have come from highly respected organisations not given to overtly political pronouncements, the government has pressed on. With virtually no credible support, how will it now justify forcing through this radical, unmandated and unpopular legislation?
An Ode to Mr Lansley (with apologies to Martin Neimöller)
First the unions opposed my Bill, but they oppose for the sake of it so I ignored them
Then the media opposed my Bill, but they make bad news out of anything so I ignored them
Then the pressure groups opposed my Bill, but they are professional agitators so I ignored them
Then health professionals opposed my Bill, but they were just worried about their pensions so I ignored them
Then the public opposed my Bill, but they weren’t intelligent enough to understand it, so I ignored them
Then the royal colleges opposed my Bill (except for the surgeons, who I heart), but it’s more important to be strong than right, so I damn well ignored them too
The principles underlying the approach are sound. Any system that guides the organisation of care to build a therapeutic relationship between nurses and patients has to be welcomed. An article by Gregory Dix published in this week’s Nursing Times outlines how IR has had a positive effect on care on a medical admission unit in his trust. It enabled nurses to be proactive rather than reactive, anticipate patients’ needs and find out what works for them. I don’t think there is much to disagree with.
The problem comes when intentional rounding is championed by policymakers who believe blanket adoption is a catch-all answer to the challenges facing nurses.
We only have to look back to the “named nurse” policy to see the pitfalls of this approach. In the 1990s, policymakers hijacked some of the organisational elements of primary nursing - that each patient would have their own nurses - and set a time frame for implementation. The philosophical principles of primary nursing were ignored and “Not my patient” became the slogan that epitomised the failure of this initiative in many hospitals. And we live with the legacy of this failed policy today.
The transcripts of the Mid Staffordshire inquiry has demonstrated that nurses need to reassess the principles that guide how care is delivered to patients. Intentional rounding is only part of the solution. The problems facing nursing are complex and sound bites suggesting there is one answer are foolish and - more worryingly - misleading to the public.
So, ignore the politics and take a good look at intentional rounding; it is a really useful tool. If it is not for your team - fine, but you need to be prepared to explain why.
Politicians are not qualified to tell you how to nurse but they do it anyway. We need to find a way to ensure the nursing forum is about nurses and their patients rather than politicians, otherwise I fear a repeat of the “named nurse”. Cosmetic change with no substance is time wasted.
Now that a second nurse from Stepping Hill Hospital, Victorino Chua, l has been arrested for allegedly tampering with medication, I wonder whether those who attacked Rebecca Leighton so viciously will reflect on their actions.
Ms Leighton was arrested last year shortly after the police inquiry began into a number of suspicious deaths at the hospital. Her arrest led to a media feeding frenzy as newspapers scrambled to unearth ‘dirt’ on her and portray her as a rather sleazy party girl. Meanwhile, Facebook pages sprang up containing shocking threats and incitements to violence against her and calling for punishments last seen in medieval Britain.
While Facebook eventually took down the offending pages I am yet to hear of any individuals being arrested for posting such malicious content. It seems that, while teenage boys indulging in riot fantasies from their bedrooms must be given long prison sentences, it’s OK to threaten to kill a nurse - so long as she’s suspected of wrongdoing.
Even when Ms Leighton was released without any charges related to tampering with medication, social media saw plenty of comments about her having ‘got away with it’. If she had the means to do so, I suspect she could have successfully sued hundreds if not thousands of people who libelled her in their rush to judgement.
Nurses are entrusted with caring for people at their most vulnerable, so it is not surprising that there is an outcry when they abuse this position - regardless of whether this abuse is serious enough to be deemed criminal. However, they are entitled to the same treatment as anyone else when suspected of abusing their position - they are innocent until proven guilty. I hope Mr Chua receives better treatment than Ms Leighton.
A friend told me on New Year’s Eve that she was going to quit smoking.
After 30 years of smoking it was time to flush the fags down the loo and breathe easy.
The decision was inspired by the dentist telling her that her planned tooth implant would stand a better chance of success if she gave up smoking 6 weeks beforehand .
Her partner was less than supportive saying she spent more time talking more about giving up smoking than actually doing it and was sceptical about her chances.
Great news, I said – how are you planning to do it? Well, she said, she was just going to stop. That was the extent of the plan.
As we know, giving up smoking is hard but sustaining the change is even harder.
I was surprised to discover that my friend had no knowledge of any of the support available – for example, smoking cessation groups or the Quit Kit that she could get from the chemist.
I gave her as much information as I could but it was not the ideal setting. Anyway, the subject was making her sufficiently twitchy that she was heading outside to have one of her last cigarettes of 2012 and ever, or so she hoped.
So what I am thinking is that health professionals have an important role to play in prompting people to give up smoking in 2012 but they also need to make sure that they know of the support that is available.
All the research shows that supported cessation is much more likely to be successful in the long term than the ‘I am just going to give up’ approach.
Where do you stand?