Home > Gender Politics, General Politics > Nursing’s existential crisis (part 1)

Nursing’s existential crisis (part 1)

At PMQs on Wednesday, Cameron was confronted with Ann Clywd’s personal testimony on standards within the NHS.  He concluded his reply with:

I set up a nursing care quality forum that I have attended myself to discuss these issues with nurses and nurse leaders. There is no silver bullet and no magic wand, but some simple steps, such as asking every hospital to carry out a friends and family test, asking the patients and the staff whether they would be happy for their family or friends to be treated in that hospital, can make a real difference. So can hourly rounding, which is not something to do with statistics but the idea that the nurse should be there by the bedside of elderly patients once an hour checking that they have had water and something to eat, that they do not have bedsores and that they are properly looked after.

This is utter shit.

I have written before about Cameron’s arrogant, ignorant and patronising insistence that hourly “intentional” rounding promises to embed within nursing a managerialism which will, in, short order, actually reduced standards of care, not improve them. It is difficult to see how a process which requires up to 150 boxes per patient per day to be initialed by nurses will do anything else.

When I wrote to Cameron’s Nursing & Care Quality Forum about this, setting out the kind of implementation research they should study before going down such a path, my letter was at first ignored and then, when I demanded a reply, was dismissed with the assurance that they had seen “some research” from the US with promising results.

It is with a certain grim satisfaction, therefore, that I note that the Hospital Trust where Ann Clwyd’s husband suffered such a sad and lonely death introduced “intentional rounding” some three years ago.  A Cardiff & Value University Health Board document reads:

Many improvements are thanks to a new process called ‘intentional rounding’ which guides nurses to deliver more structured care.  It includes hourly checks on patients to look at any potential risks such as the position they are lying in and the condition of their skin.  In the wards, nurses have made a real difference to patients’ mealtimes.  By implementing simple measures such as colour coding food trays and patient food charts, patients’ dietary needs are being more easily recognised and met.  The colour coding systems enables nurses to understand what a patient needs, in terms of assistance at meal times, which is important if a patient has difficulty communicating.  There is ample evidence, from research and from hospital visitors and family members, that nutrition has direct implications for patient recovery and length of stay.  Importantly, it also ensures mealtimes are as enjoyable and comfortable as possible.
Of course, one of Ann Clwyd’s area of complaints is that, as her husband died, a cheery shout about mealtimes resounded in the ward.
There is an existential crisis in nursing.  The crisis is exacerbated by tbe cuts. but it wasn’t started by them.  To suggest otherwise, as this piece does is denial of the type we saw from some on the left in the Winterbourne abuse case.  Nor is it because the “wrong people” go into nursing (as Ann Clwyd has suggested on the Marr show this morning).
The crisis has complex roots, including the changing class relations between doctors and nurses and the physical architecture of hospitals which have not taken nursing into account, as well as the long decline is staffing levels, but perhaps the biggest issue has been the abject failure of the profession’s main union, the Royal College of Nursing, to take responsibility for what really goes on on wards.  Rather, just as Cameron has done, it has sought to put the problem in the management in-tray, and blame “poor leadership” when it goes wrong.
More in part 2.
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  1. December 9, 2012 at 3:00 pm

    In the end, healthcare in the NHS is sold as a commodity by a State Capitalist enterprise. Unlike, even a private capitalist enterprise, where the profit motive tends (setting aside the obvious contra examples) to ensure that managers seek to ensure quality control – because your job and income depend on the company making profits, and earning income) State capitalist enterprises are always charactersied by rent seeking actiivty.

    The normal conditioning of workers under Capitalism to seek to get paid as much as possible for as little real work as possible, continues to apply to workers in a State Capitalist enterprise such as the NHS as it does to any other enterprise. The attendant “Alienation of Labour” that leads to the “Friday Afternoon car”, applies equally in the NHS. If you feel you are in relatively low paid job – or indeed even if you are not – with no real personal relationship to the consumer of your product, then udner condiitons where you continue to have a job, and continue to get paid, whether your output is good quality or bad, why would you be bothered one way or another. That is exactly what happened in the USSR, and other such societies that had state run industries and services.

    Only if the workers producing the products, and providing the services have a direct interest in the quality of the product or service they are producing will they have an incentive to maximise quality and efficiency. Only under such conditions will the alienation of labour begin to break down so that workers do not see the act of labour as “work”, but as a natural means of manifesting their own humanity and fulfillment. The fact that you stop being employed by a private employer, and become employed by a state employer cannot change that. In fact, it can make it worse.

    Only if workers directly own the means of production themselves will they have an icnentive in both improving quality and efficiency, because only on that basis will they be able to secure their own jobs, and rising incomes. The more they do that on a Co-operative basis with other workers, who are their consumers, will they begin to build a real personal, human relation between production and consumption, which replaces the commercial foundation of production under Capitalism.

  2. Edgar
    December 10, 2012 at 6:38 pm

    The first effect of privatisation will be to see ridiculous increases in managers and doctors pay, but especially managers. Managers will ensure that the minimum number of stock is available at any one time, this is already a feature of private health care systems. Imagine how bad this would be if they were selling those services to the entire population.

    Managers would also seek to override costly control mechanisms.

    Decisions will be made based on budgets and not clinical considerations (see Michael Moore’s Sicko).

    Finally, as every manager does, they would look to blame others when things go wrong and deny knowing anything (eg Rebecca brooks).

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