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Dean Royles: 'This constant infighting makes it easy to pick off nurses'


Nurses have taken the brunt of the criticism surrounding Mid Staffs, says Dean Royles

Recent weeks have been tough for the NHS and for all of us who work in it. The Francis report, the public inquiry into the sad events at Mid Staffordshire Foundation Trust, found failings from the top to bottom of the NHS. Organisations, individuals, clinicians and medics, managers and administrators have all been found wanting.

Like many in the NHS, I spent the last few weeks with a knot in the pit of my stomach. What would the report say? Would the recommendations make sense? Where would the finger be pointed?

As it happens Francis came out saying that we shouldn’t be looking for scapegoats. It seemed a smart move. It means we can all own the report. We don’t need to be defensive. We can look at the recommendations and consider if they make sense both intuitively and practically and then move on with pace and purpose and start making changes.

A nurse on twitter said she had been “emboldened” by Francis. It’s a great reaction. The approach to blame avoidance almost worked. There was some rational commentary but pretty soon we saw the need in the media to identify a simpler solution than the 290 recommendations, and it seems to me nurses and nursing has taken the brunt of the criticism.

“As it happens Francis came out saying that we shouldn’t be looking for scapegoats. It seemed a smart move. It means we can all own the report”

The NHS has had a number of inquiries into patient care issues, such as Bristol and Alder Hey, but I don’t recall nurses being held so central and so vilified by some of the commentary. Take this example from the Telegraph on Friday 7 February:

“So now we know. Britain’s nurses and doctors are as bad as Britain’s bankers. Our angels in white are just as selfish, just as arrogant and manipulative and secretive, as the barrow-boys in pinstripes. In fact, in many ways they’re worse. The bankers bled the country dry, but to my knowledge they didn’t kill anybody. The death toll at Mid Staffs is placed at 1,200 victims. And that may be a conservative estimate.”

It’s shocking isn’t it, but is it surprising that someone wrote it? And that it was published in a national newspaper? No, it isn’t because for too long the NHS has tolerated and exacerbated professional factions. Doctors blame nurses, nurses blame doctors, clinicians blame administrators and managers blame staff. The only time we agree is when everyone is blaming politicians. It has to stop.

It is hardly surprising when we have this constant infighting that it becomes easy for others to pick off a particular group and the rest of us find it easier to join in. It’s not fair, not professional and certainly does the NHS and patients as a whole a disservice. None of us, neither managers nor clinicians, looks big by making another group look small. It just adds to a picture of disfunctionality.

As a human resources professional working in the NHS, you get to see the very best in people, the very best in our staff. Day in and day out in our hospitals, in our community services, in our GP practices and our mental health services. For those not working in the NHS you only have to watch reality TV programmes set in accident and emergency departments or maternity wards to see examples of unfailing compassion, bravery and the exercise of incredible skill, knowledge and expertise. Saving lives and bringing hope to people where care and compassion are what matter most. It makes me incredibly proud of the NHS and of its staff and the environment that makes this commonplace.

These innumerable acts of kindness, empathy and healing don’t make the news headlines or generate inquiries. But it is right that, even in the midst of making sense about Stafford Hospital, we acknowledge and recognise this element of our NHS and the staff (and managers) that make it happen.

In HR you are also exposed to the situations where it goes wrong, whether through staff conduct, capability issues or sometimes though having insufficient resources at the right time. In the NHS this is always traumatic, always painful and can sometimes affect your belief in the generosity of the human condition. But the fact that I know about these and I know most nurses do too, reassures me that we have been addressing poor performance. We can of course do this better and more consistently. Francis will see organisations fundamentally examine all their people management practices from recruitment through appraisal and development to performance management.

There has also been a lot of speculation that increased educational requirements is responsible for a lack of compassion. How bizarre. If this were true, wouldn’t the same apply to doctors, speech therapists, dietitians and pharmacists? We have to move on from this debate.

One of the problems we now face is the perception that poor care is the result of wilful neglect but that great care happens by accident. It doesn’t. It takes time, effort and commitment and good leadership on the board and on the ward. It is this that gives the NHS some enviable patient satisfaction results. And the backbone of this great care are nurses.

I work in the NHS because over the years I’ve been inspired by nursing staff. From the healthcare assistant that lived on my street when I was a child, who all the neighbours looked to for guidance and information, to the nurses I met as a human resources manager sharing the copious amount of chocolates they received in thanks from grateful patients, and proudly showing me the noticeboard full of thank-you letters.

From the midwives that skilfully delivered my four children to the directors of nurses I now work with, who are determined to use Francis to drive the world-class staff engagement we will need if we are to turn Francis into a byword for improvement rather than failure.

Dean Royles is director of the NHS Employers organisation


Readers' comments (31)

  • Pirate and Parrot

    Would the recommendations make sense?

    Yes, they make sense to me !


    'Doctors blame nurses, nurses blame doctors, clinicians blame administrators and managers blame staff. The only time we agree is when everyone is blaming politicians. It has to stop.'

    Indeed - patient care, can get lost on that particular battlefield !

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  • ...and patients and the public can blame the lot. it sure does waste a lot of time, energy and costs which could be more 'profitably', and more importantly beneficially, spent on patient care!

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  • michael stone

    The achieving of 'coherent behaviour' inside the NHS, is hugely challenging - it definitely tends to be absent at present.

    My own issue (home end-of-life care) requires joined-up behaviour all of the way from GP to (potentially) police officers: if the staff inside a single hospital can't get it right, I'm not surprised that I'm having so many problems improving that area !

    And Francis did not place most of the blame on nurses - how come so many nurses, seem to think he did ? Or do nurses just think that the media are blaming them in relative isolation ? The media I read (not the tabloids) and listen to (Radio 4) are not isolating nurses for blame, so far as I can tell.

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  • Hello Mike. Nurses are getting a lot of stick because managers aren't regulated, they were responsible for most of what went wrong, NONE of them have had any sanctions, many have actually been promoted (I met one in my local health economy had was literally speechless at the brass neck of the man) and the whole thing is skewed at the professions not the culture. You can only change that if you start by changing the people at the top and my biggest disappointment in the whole report is how he bottled it/ had political pressure not to call for some key resignations.

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  • The Nobody | 16-Feb-2013 8:12 pm

    are there no clinical managers in any of these posts?

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  • There are two newspapers that seem to want to turn the nation against nurses, that is what has to stop. I don't know how their editors allow them to publish some of their stories.

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  • Anonymous | 17-Feb-2013 10:06 am

    if the reports are true they need to be brought to public attention. those which are not need to be suppressed.

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  • Journalism is like nursing. Much is of a very high which is invaluable to society, some is of very poor quality which should be eliminated, and then there is all of the practice in between which is passable but requires discernment on the part of its consumers.

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  • not all british nurses and doctors are bad, that is what is so disheartening.

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  • 10 staff at team brief 3 go home from nightshift ,sister goes to office or meeting takes deputy with her, 2 registered nurses giving medication to 24 patients leaves 3 hca to assist patients wash dress eat breakfast go to toilet. 1 goes on escort . Staff ratio is a joke the ratio is what the managers say it is. The patients don't matter and neither do the staff so suck it up and get on with it. Or say your piece and then do your best.

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