How far forward are we from the Francis report?

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The Francis report at the time was an opportunity for journalists to be “shocked” about patients neglected in the care of nurses.  The implication is everyone should be shocked.  For me, what would be truly amazing would be if any actual clinical staff were surprised at all. 

Because I was previously in charge of complaints in a typical hospital group, I stopped being shocked long ago.  I’ve also been in jobs where I regularly had to read reports from the Mental Welfare Commission and various Ombudsmen.  For me “shock” has been replaced by “curious”.

I am curious as to why this sort of thing is still a problem in the NHS.  I remember the cases thirty or more years ago, in the last century when nurses and student nurses blew the whistle and got whole wards or hospitals closed for systematically neglecting older or cognitively impaired patients.  Whistle blowing charters were introduced and laws have been changed, and yet, here in the 21st century, old and frail patients still in hundreds of thousands of cases receive care in our hands that would shock a journalist.

People trot out their perennial complaints that “too much time is spent on paperwork, and not enough on patients.”  Well, that makes me curious as well, bearing in mind the extent to which the care notes often contain little useful information about the individual, and even less about their progress or any care that they have received. If all that time spent gives such poor results, the real problem is maybe that not enough effort and intelligence is employed on paperwork.

Nurses need to be better organized and more conscientious, or care is just going to get worse. 

The abiding image from Francis was not patients caked with vomit, but nurses with their eyes cast down.   We only turn our faces away when we don’t know what to do, and are ashamed.  You didn’t need training to know toilets should be sanitized and patients should be comforted.  We just don’t know how to make it happen.  Clearly we are learning the wrong things.

Nursing education still does not teach us how to organize or change the system to make sure decent care happens for every patient, all of the time.  The only thing that is rationed in nursing is time and we waste that criminally.  And I don’t mean administration.  I mean complaining and being defensive when we should roll up our sleeves and make change happen.

Hospitals can be particularly dangerous for people with dementia.  The role of nurses in supporting families and friends to reduce the risk is vital. But nurses still need to learn how to do that.