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Tell me about 'bonkers' bureaucracy, says DH nurse

  • 21 Comments

The Department of Health’s new deputy nursing director has called on the profession to help him identify examples of over the top bureaucracy that need to be changed.  

Speaking last week at the Florence Nightingale Foundation annual conference, David Foster highlighted how nurses around the country could help with the DH’s “red tape challenge”, which is intended to help cut the amount of bureaucracy nurses are exposed to.

He described how nurses at one trust had told him about the form they had to complete in order to secure a package of palliative care for patients that chose to die at home.

“The form was 80 pages long,” he said. “That’s clearly bonkers.”

“That’s the sort of thing we really need to expose and do something about. We have to balance what is a sensible record with what is unnecessary bureaucracy,” he said.

Mr Foster, who was deputy chief nursing officer for England prior to taking up his new post last week, called on nurses to tell him about any similar examples they knew about.

“You know about those sorts of things in your own patches much more clearly than I do,” he told delegates at the conference in London.

Mr Foster also provided more detail on the work of the Nursing and Care Quality Forum, the creation of which was announced in January by the prime minister to spread nursing best practice. It will be chaired by leading patient advocate and former nurse Sally Brearley.

He insisted the forum would be “independent” and was “not being controlled by the DH”. “It’s really important to recognise that, although I might be having conversations with the forum, it’s not for me or my colleagues to say what the forum does or how it does it,” he said.

As previously reported by Nursing Times, the forum is expected to look at four themes, namely “leadership”, “people first”, “values and culture”, and “time to care”.

Mr Foster said these four areas represented Ms Brearley’s “early thinking” and might change in future. It was “still very early days for the forum”, he said.

The forum’s steering committee was due to have held its first meeting at the end of February but this was put back to mid March, as its membership had not been finalised.  

Mr Foster said: “The membership of the forum’s steering committee is being finalised and Sally will finalise that in the very near future.”

However, he added that membership of the wider forum itself would be “anyone who wants to contribute”. “That’s really important,” he said.

He told delegates the forum would not be holding “listening events” like those run by the NHS Future Forum last year when it was drawing up amendments to the health bill.

Instead, Mr Foster said the forum’s steering committee visit organisations around the country “to see what is really happening in the real world”.

“The forum will expose us to the best practice around,” he said, but noted that it would not write a report and would only exist for a limited period.

“It is not a committee in a dark room that will write a report,” he said. “It’s not a group that will go on forever.”

  • 21 Comments

Readers' comments (21)

  • I started my training in 1990, it was completely about nursing no mention of being a social worker as well. Now I feel I have to be more social worker than a nurse. A nurse should be on the ward caring, but he/she can't because of all the ridiculous form filling, and then we get bashed for not caring we can't win.

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  • well, it seems that there are far too many people criticising nurses who have absolutely no notion of the job they actually do in addition to what they are actually supposed to be doing but have very little time for!

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  • Sin to Heal Me ?

    I think my title picture, implies that I am with Mr Foster, here.

    '“The form was 80 pages long,” he said. “That’s clearly bonkers.”'

    Exactly - clearly too long, and 'bonkers' ! Like many bits of guidance, which seem to expand enormously without introducing any real understanding !

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  • Are you kidding?

    Start with the elephant in the room. The health secretary is getting confused: he seems to think he is the peddler of political ideology rather than being responsible for the health of the nation (yes I know he tried to ditch that responsibility, too!). Result: hugely damaging and lasting top-down unnecessary bonkers bureaucracy which will hamper nurses from nursing for years to come. We will all be going blind on paperwork trying to navigate patients via any qualified provider when they need to make choices about their health....

    When you have prevented the idiot Lansley from forcing through a bill with massive bonkers bureaucracy that he has no mandate to do, come back and ask for advice about a few pieces of paper that need changing. Please tell me there is more to the most senior nurses in the country than changing a few forms.

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  • Tiger Girl

    Anonymous | 13-Mar-2012 1:18 pm

    I don't think the point is to change the forms - I think the DH would honestly like to get more 'sense' into the system, so that people concentrate on doing the right thing, rather than just ticking boxes.

    But it is very tricky, to work out how to use this more 'common sense' approach, within something such as a hospital - where all sorts of people want to be sure that if something goes horribly wrong, they personally will not end up getting blamed.

    I think, the DH wants some sort of culture change - but exactly what change, and how to achieve it, are issues which tend to run and run !

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  • Tiger Girl | 13-Mar-2012 2:08 pm

    "where all sorts of people want to be sure that if something goes horribly wrong, they personally will not end up getting blamed."

    That's it!

    That's why we:
    fill in cot side assessments forms for all our patients when we haven't got any cot sides [we have to make sure they all come out as negative];
    why we have to do QDS obs on patients for 3 days, EVEN if they are so well [the rehab patients] that the consultant agrees that it is not necessary;
    why we do VTE on patients already on warfarin and so it goes on....
    why personalised care is a myth!

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  • Little One

    How about the fact that I counted how many stickers were needed to fully admit a patient to the unit which nurses are supposed to fill out within 6 hours of the patient arriving and the entire admissions pack required 56 stickers, and that's only every other page. Just to admit them fully.

    How about, as a 24 year old, fully independent patient, I had a falls and bedrails assessment completed every day because it was ward policy?!

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  • Little One 13- Mar-2012 9:42pm

    The system has gone crazy, do you actually have any time left to actually nurse your patient, what is the priority patient or paperwork. In the event of a complaint coming in it will be the paperwork under investigation, the fact that you were probably doing a 100 things at once will not be appreciated.

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  • apparently it is what is visible that is important and paper work is more visible than a little extra care and a little extra attention offered to a patient which only the patient may notice!

    As a third year student who had won the gold medal for student nurse of the year and had hosted a Christian Union barbecue told me when I was a first year it doesn't matter what you do behind the curtains, what is important is that all the morning's work is finished and the ward impeccably tidy before sister arrives so that she is not displeased or angry!

    First she encouraged me by telling me I was good (praise that didn't often come my way from my seniors) but far too slow. But what followed quickly invalidated her praise.

    I had difficulties in marrying the thorough and methodical way of doing a bed bath with two nurses, one to wash and one to dry whilst keeping the patient covered and warm and preserving their dignity, and the practice on the ward. If my tutor from the school (at the time my boyfriend's flatmate's girlfriend and subsequently his wife which made working relationships rather difficult as we used to meet socially in the flat!) came and saw us using the ward shortcuts we failed our assessments. If we did thoroughly and 'correctly' all we were taught in school on the wards we were too slow. For this reason I was pleased when I qualified and then free to choose the best practice from both as I then learned from experience one cannot please everyone all the time and at the end of the day it was the patients who counted most.

    Anyway I digress from my story. This good lady and gold medalist went on to inform me that nobody could see what was going on behind the curtains and I should only wash the patient's face and hands and intimate parts as people do not get dirty in bed and this was much quicker! and this on a surgical ward!!! Luckily it was in the days before MRSA had been identified.

    This experience has also faith in singling nurses out from each other and giving some awards for their achievements. I believe everybody has their strengths and weakness which need to be exploited or worked on and no one is potentially better than another even though their overall performance may superficially appear to be. I know which kind of nursing care I prefer to deliver or would prefer to receive.

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  • michael stone

    Tiger Girl | 13-Mar-2012 2:08 pm

    Anonymous | 13-Mar-2012 4:51 pm

    Anonymous | 14-Mar-2012 9:38 am

    I agree with that analysis - the NHS is absolutely obsessed with paper-trails, and also with tick-box, as opposed to principles/training based, guidance.

    Anonymous | 14-Mar-2012 10:56 am

    'apparently it is what is visible that is important and paper work is more visible than a little extra care and a little extra attention offered to a patient which only the patient may notice!'

    Yes - what does it matter, what the patient's experience is !!!

    Of course, it isn't possible to neatly record 'the little extra care, or extra attention' which might, however, be very significant to some patients - so, senior managers who are under pressure are not required to have records of that, and therefore it can cease to be a priority !

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