Francis Report into NHS care

This is a wide ranging report into the failings at Mid Staffordshire NHS Trust. The above link takes you to the home page. I cannot do justice at this stage but this affects everyone working in the NHS.

This is not a new issue. I ‘trained’ in the 1980’s and saw nurses struggle to give care to the standard they wanted to. I knew students who gave up because of the gap between the ideal and reality. In 2001 the department of health published ‘essence of care for patient focused benchmarking, which are the sort of standards discussed in the report. This did not prevent Mid Staffs. A ‘patient centred NHS’ is not a new conceopt either. Nightingale once said “It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm”. [1859]. Francis kept mentioning culture today and I agree. In our book ‘Psychology and Sociology for Nurses’ the power of culture and socialisation was discussed as mechanisms which allow poor care to flourish. in the leadership literature, there are warnings that leadership development could be just another fad if the organisation of the NHS does not change. Quality and Leadership have been core aspects of nurse education for well over a decade as exemplified in the Dept of Health document ‘Making a Difference’. There is a plethora of models, education, literature, quality improvement provisions, leadership development programmes, for nurses but all to no avail it seems in some NHS hospitals. Kath Melia described the difficulties students faced when in practice back in the 80’s, not being able to put into action what they might have been taught. The concept of the Theory-Practice gap has been known for decades. This refers to theoretical knowledge (such as ‘holistic care’) not being applied in clinical practice, or clinical practice rendering theory irrelevant. The NHS has been badly managed and resourced. Care work is invisible and not measured and so does not show up in Trust accounting and priorities. Being able to drink a cup of tea is a priority for patients in many wards but this may not help the Trust acheive its targets, save money on its budget or acheive its Foundation status. Nurses and patients know ‘its the little thngs that count’ – count that is for patients and nurses but not it seems to organisations. Society must also shoulder some responsibility for our structures for care of older people – dehumanised, isolated, institutionalised and underfunded.


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