The NMC and 3 yearly revalidation.

Here we go again.

Poor service? Always blame the staff and put them through their paces.

I may at times, and on sufferance,  frequent a well known national pub chain that seems to take over town centre premises, note a local theme for its development, and then provide cheap beer and wine in addition to ‘food’. Almost, but not quite, the Ryanair of pubs. I say ‘pub’ but that would be to commit a category error because these establishments are nothing like our treasured timber framed, CAMRA endorsed ‘Plumes of Feathers’ or the ‘Red Lions’ of shire and dale. They serve a particular purpose of course and do so very well. However one thing I often note is the long wait at the bar as the one or two members of staff work hard to serve the hordes of thirsty and often impatient public. As I stand and wait, as they also serve, I could grumble at their lack of attention to my needs, I could complain when they get stressed and do not greet me with bonhomie, I could recommend to friends and family that they give this place a wide berth, I could wonder about staff training and suggest that they undergo frequent testing and certification to ensure that they are up to the job, say every three years at least? But I don’t, because I know that like Rynair, budget pubs provide budget service. Employing more staff would mean perhaps an extra penny or two on the price of a pint and we don’t want to pay more for a pint do we? Well, it seems we will do so if the quality of both service and product increases, that is why the ‘Plume of Feathers’ still exist. When I go to my local, instead of one member of staff per 10 customers, I know the ratio is far far less. Not only that, I will be greeted with a suitable amount of bonhomie.

The Nursing and Midwifery Council however have forgotten this. In the media scrum preceding and following Frances, Keogh and Berwick, we have policy making by the Daily Mail, in perhaps a reaction to be seen to be ‘doing something’ we may have nursing  ‘revalidation‘  every three years? The doctors have it as well so what is the problem?

It blames the staff, focusing on their own failings while ignoring failures in organisational cultures, failures in staffing levels, ongoing training and professional development, clinical supervision. it ignores structural shifts such as dependency levels and throughput. It is blaming the bar staff for your wait, not the management for not employing more staff. It is expecting club class travel on Rynair and then complaining when you have to pay for your own peanuts.

Lets face it, the NMC is powerless to do anything about the structural problems facing the NHS, it can’t do anything about the myriad ineffectual inspection regimes, it is silent in the face of both the Nicholson Challenge and the further cuts asked of NHS provision. What is can do is ‘protect the public’ by imposing more bureaucratic, costly and probably ineffectual revalidation processes on 670,000 registrants. Watch this space for an increase in registration fees to cover admin costs.

What is the evidence base for this policy? The quality of service provision depends on many many things, is revalidation really going to make that much of a difference? The precedent set by doctors does not automatically apply to nurses, and it does just not follow that standards will improve by this measure.

What is does achieve is ‘doing something’, but will that result in better quality care? Will it promote greater professionalism? Having attended the annual NET13 conference, I can tell you there are thousands of professional nurses across the globe who wish to professionally  provide the best care they can. I was heartened to hear stories of success which I think occur despite not because of inspection, regulation and revalidation but despite it.  Professionalism already exists, what is required is not some stunt to, falsely, reassure the public that something is being done. To quote, Roy Lilley: “Fund the front line, make it fun to work there”  and reports such as Frances will be history.

Finally, do I really have to make the point that this is not a defence of abusive, lazy,  socio-pathic or burned out staff? Staff failures should be dealt with by proper management. Staff failures are also management failures. Performance management anyone?





1 comment:

  1. carol dimon

    well said. There are multiple factors involved in the delivery of care and poor care does not solely exist in the NHS. There is evidence of poor care throughout history in all countries. Revalidation by the method proposed by the NMC is a means of silencing whistleblowing and supporting the business objectives of the employer.there is no quick fix. Who are these people who propose such things? see hook “The commodity of care”.

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