PREVENTING ‘WHERE NEXT?’: POLITICAL PARTIES URGED TO COMMIT TO MINIMUM STAFFING TO PREVENT SERIOUS FAILINGS IN NHS CARE
“We would not expect passengers to accept a higher risk of their flight crashing in the evenings or at weekends due to reduced staffing or inexperience, so why should patients accept this for their NHS?”
Writing in an editorial published today (Friday 6 February 2015), the President of the Royal College of Physicians of Edinburgh (RCPE), Prof Derek Bell, and the Chair of the RCPE Lay Advisory Group (and former Chief Nursing Officer for Scotland), Anne Jarvie, have urged all political parties in the UK to urgently commit to developing and implementing minimum staffing levels in the NHS as an important foundation to prevent further serious failings in care [1].
The editorial reviews the reports of 10 major Inquiries and Reviews into serious failings in care in the UK since 2000, including Mid Staffordshire, Bristol, Lanarkshire and the Vale of Leven. The authors believe that patients, NHS staff and the wider public may be forgiven for asking “where next?” and that recent improvements in inspection alone will not be sufficient to prevent a recurrence of such incidents. They advocate the need for the NHS at all levels to actively value staff and to support them in their day to day roles in delivering health care. The editorial further explores why the NHS has not learned lessons from the past, the loss of compassion, the erosion of professionalism, the increasing industrialisation and politicisation of the NHS and evidence that where NHS staff are engaged, a range of patient outcomes (including death rates) are improved. The editorial is published in The Journal of the Royal College of Physicians of Edinburgh.
Different aspects of the authors’ proposals have been welcomed by leading patient, health and legal figures including Dr Jean Turner (former Executive Director, Scotland’s Patients’ Association), Nigel Edwards (Chief Executive, the Nuffield Trust), the Rt Hon Lord MacLean (Chair of the Vale of Leven Hospital Inquiry) and Mr Peter Lees (Chief Executive & Medical Director, Faculty of Medical Leadership & Management) (see later).
Key extracts from the editorial are included at the foot of this press release [2]
RECOMMENDATIONS
The authors of the editorial make 6 recommendations (one each aimed at policymakers, patients, professionals, managers, NHS Boards and Trusts, and the RCPE itself) –
Commenting on their editorial, Prof Derek Bell, President of the Royal College of Physicians of Edinburgh (RCPE), said,
“Doctors, patients and the wider public care passionately about the NHS throughout the UK. While there are no guarantees, and further failings in care may emerge, the potential for “where next?” will only reduce if we work collectively and collaboratively to strengthen the NHS which we all value greatly. This will not be easy and will require incremental change and recognition of what can be improved through regulation and what will require staff engagement and cultural change. As a starting point, we wish to work with the leaders of all political parties in the UK and will be asking them to publicly commit, before the General Election, to implementing minimum staffing levels within the NHS. In parallel, we will engage with other stakeholders including patients, the medical and nursing professions, NHS managers, NHS Boards and Trusts to work collectively to address the issues raised”.
Anne Jarvie, Chair, RCPE Lay Advisory Group, and former Chief Nursing Officer for Scotland, said,
“In recent years, the NHS has made much progress in developing patient and public involvement. Patients are much more involved in their care and have a right to expect safe, high quality care from the NHS. NHS staff are highly committed individuals who want to do the best that they can for their patients at all times. However, the experience gained from recent inquiries into serious failings in care would suggest where failings have occurred, staff had not been engaged and something had happened to reduce their levels of compassion. Conversely, there is published evidence to show that where NHS staff are engaged, a range of outcomes for patients were improved. No-one wants a ‘where next?’ and in addition to focussing on patients, we also now need to adopt a holistic approach to the NHS and to focus on the staff delivering patient care.”
SUPPORT FOR DIFFERENT ASPECTS OF THE AUTHORS’ PROPOSALS
Dr Jean Turner, former Executive Director, Scotland’s Patients’ Association said,
“Patients will be so pleased to see the RCPE raising the urgency to answer the question ‘where next?’
“It has been my perception over the past seven years working with patients and their relatives that common to all concerns and complaints are varying degrees of poor communication. Concerns raised can grow into formal complaints if there is no time or expertise to deal with them and this cannot be cost-effective; lives and early diagnoses depend on expertise and time. Patients are aware of the pressures NHS professionals are working under, but nothing erodes trust more than ignoring concerns. Trust can sometimes be irrevocably lost when many reports over recent years appear not to have produced noticeable improvements to patient care. Despite the fact that 98% of patients are content with care, 2% is a large number of people with concerns.
“I am sure we can improve patient care in hospitals and the community if we listen and act upon information gathered from NHS professionals and patients, but we need to eradicate bullying. Patients desire more health professionals with more time and expertise to cope with the complex issues of the present population. Patients do not feel safe when health professionals with less training are roped in to perform tasks; that is seen as a dilution of a service which will deteriorate if continued. The goodwill of health professionals has and is holding our NHS together, but there has never been a cost for that goodwill included on any balance sheet”.
Nigel Edwards, Chief Executive of the Nuffield Trust, said,
“This important editorial highlights issues about behaviour, culture and leadership that have remained in spite of numerous reviews. It calls attention to the failure of some of the current approaches that are being taken to address these. Many of the changes that we have seen in the NHS have failed to address the key question of how people work together, with patients, to improve services. Relying on governments to provide an answer to this is unwise – the solution is in the hands of the NHS itself. The challenge is how to mobilise this effort in the face of extremely tight finances and a top down culture”.
The Rt. Hon. Lord MacLean, Chair of the Vale of Leven Hospital Inquiry, said,
“I recognise many of the issues raised in this editorial. In my report, I was critical of the failure to learn from earlier reports into Clostridium difficile outbreaks in other parts of the UK. I am, however, heartened by the high level of interest shown in the Vale of Leven Hospital Inquiry Report since we published in November 2014 and in particular, Scottish Government's commitment to implement all 75 of my recommendations."
Mr Peter Lees, Chief Executive and Medical Director, Faculty of Medical Leadership & Management, said,
“We welcome this considered and objective review of the public failures which have bedevilled the NHS over the decades. The title ‘Preventing ‘where next?’’ gives a positive lead and the paper rightly, in our opinion, emphasises the need to replace blame with system introspection and reduce the dependence on whistle-blowing by providing a better climate for all.
“In previous years the prevailing view was that ‘workers’ worked for money and were deterred from not working by punishment. This cynical, transactional approach has long been consigned to the wilderness, where it belongs, and FMLM strongly endorses the paper's frequent reference to enhancing the climate and culture in which staff work.
“The report is timely and extremely helpful in proposing clear-sighted cures to the system malaise. The actions proposed for a range of bodies emphasise the point that the solution is a collective one, with legislation having the least effective role. Ultimately, it is modest in not citing the weight it has through its origins in a prestigious Royal College, while FMLM is humbled and proud by its endorsement of our work and influence.”
Join the discussion about preventing serious failings in care #preventingwherenext
ENDS
Contact: Graeme McAlister on 0131-247-3693 or 07733-263453
Notes to Editors
[1] ‘Preventing ‘where next?’: patients, professionals and learning from serious failings in care’, The Journal of the Royal College of Physicians of Edinburgh, advance online publication, 6 February 2015. Key extracts from the editorial are reproduced below and an advance copy of the full editorial can be obtained from Graeme McAlister on 0131-247-3693 or 07733-263453; g.mcalister@rcpe.ac.uk
[2] KEY EXTRACTS FROM THE EDITORIAL
“Bristol, Oxford, Tunbridge Wells, Mid Staffordshire, Gosport, Lanarkshire, the Vale of Leven and Aberdeen are just some examples of places where NHS services have, in recent years, been the subject of inquiries or reviews regarding poor standards of medical and/or nursing care. Patients, NHS staff and the wider public may be forgiven for asking “where next?”, particularly as six of these inquiries have reported within the last two years. To both the casual observer and many working within the NHS, we have witnessed a trail of inquiries and reviews which have produced hundreds of detailed recommendations, which at face value appear to have had limited effect”;
“It is clear when reviewing the publicly reported failings in care over the last 15 years that the recommendations most embraced by policymakers have been at a statutory level and regard regulation and inspection. While regulation and inspection provide a valuable means of independent assessment, they will not prevent recurrences alone. It is necessary not only to better understand why at times NHS services appear less patient-focussed and compassionate, but to develop systems that support healthcare professionals to deliver high quality care”;
“The experience of these inquiries suggested that staff had become immune to the problems experienced and for some their moral compass was off course. We need to consider why this can happen and engender a culture in which patients and staff wellbeing is our primary focus at all times”;
“Concerns about care are not new; Inquiries into serious failing in care in the NHS started in the late 1960s. In 2003, the Nuffield Trust published a review of 10 inquiries between 1969 and 2001 and concluded that while ‘inquiries or investigations - can undoubtedly contribute to future improvement - it is far from clear that the NHS is learning all it can from failures or making the most of opportunities for improvement that they offer’; a statement which appears true today”;
“The increasing pressures experienced by doctors, nurses and other health professionals are well-documented. There is emerging evidence to suggest that the increased industrialisation of the NHS, through which NHS services are becoming increasingly viewed as commercial products and with a relentless focus on ‘efficiency’ rather than quality, is leading to a decrease in morale and an erosion of professionalism. Combine this with perpetual structural change within the NHS and the increased politicisation of health, and we have the making of a perfect storm”;
“it is clear that we must move beyond the cycle of blame which often emerges following reports of serious failings in care and recognise the limitations of regulatory responses. This approach negatively impacts on staff morale, stifles innovation and contributes to the four common themes which have been identified and must be addressed - poor leadership, insufficient staffing, poor communication and poor professional engagement. Of those, only one (insufficient staffing) would benefit directly from a regulatory response, by building on the recommendation regarding minimum staffing made in the Francis Report, and the innovative work of the National Institute of Healthcare and Clinical Excellence in developing safe nursing levels for adult in-patient wards and A&E”;
“We need to develop minimum staffing levels for doctors in the medical specialties and other professions in hospitals and this is urgently required for medical staff for out of hours including weekends and Hospital at Night rotas. There is strong evidence to show the increased risk of death and poorer outcomes in patients when treated out of hours when staff capacity is reduced, and a solid case for developing 7-day working. Returning to the experience of the aviation industry, we would not expect passengers to accept a higher risk of their flight crashing in the evenings or at weekends due to reduced staffing or inexperience, so why should patients accept this for their NHS?”; and
“Major cultural change is required within the NHS … indeed, a recent review found that where NHS staff were more engaged and empowered, the quality of care and a range of patient outcomes (including mortality rates) were improved. The NHS has made much progress in developing Patient and Public Involvement. This can take many forms, from recognising patients as experts in their own health (particularly in chronic disease management) and learning from them, to involving patients in decisions about how hospital services are delivered and can be improved. It is now necessary to build on this success and give similar priority to addressing and supporting the needs of NHS staff and recognising the ‘people’ element within the NHS, without which care could not be provided. Only by adopting a holistic approach and looking at the whole of the NHS, how it functions and it’s people (patients and staff), will we be able to progress”.
ABOUT THE RCPE
The RCPE is an independent standard-setting body and professional membership organisation.
Our aim is to improve and maintain the quality of patient care. We help qualified doctors to pursue their careers in specialist (internal) medicine through medical examinations, education and training. We also provide resources and information to support and facilitate professional development for physicians throughout their careers.
The RCPE helps to develop standards of medical care and training and to influence health policy. We ensure that the views and practical clinical experiences of our membership are taken into account by health policymakers throughout the UK. We have a strong UK and international presence with over 12,000 Fellows and Members in 91 countries, covering 56 medical specialties and interests. www.rcpe.ac.uk
The Journal of the Royal College of Physicians of Edinburgh
The Journal of the Royal College of Physicians of Edinburgh is an open-access, peer-reviewed journal published online and quarterly in print. It is indexed in Medline, Embase and other online databases.
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