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Throwing out the baby with the bathwater: just how much more negative publicity can nursing take?

November 6, 2013

So: another week, another damning verdict on NHS nursing. This time the focus was on the way the NHS handles complaints, but that didn’t mean there weren’t plenty of distressing real-life examples of poor, unempathic care and defensive, self-serving attitudes. Co-chair of the review was the Right Honourable Ann Clwyd MP, appointed by the Prime Minister after her husband, Owen Roberts, died in appalling circumstances in a hospital in Wales. No one who heard Ms Clwyd break down in tears on the World at One last year as she described how her husband was treated ‘like a battery hen’ in his final hours can fail to have felt her pain.
Nursing’s reaction to the recent avalanche of adverse publicity about the NHS has ranged from public apology and vows to learn the lessons, to private rumblings (often heard in canteen conversations) about how the emergence of ‘patient power’ has ‘swung the pendulum too far in the opposite direction’ by depriving nurses of their authority and eroding respect. For this reason, reports like Ms Clwyd’s are something of a double-edged sword: while they undoubtedly perform an invaluable and necessary service in uncovering shortcomings and refocussing attention, they may also, as an unintended consequence, serve to deepen the very suspicion and distrust they seek to overcome.
Because the truth is that with every passing report – and its attendant gleeful media hype – we come another step closer to throwing out the baby with the bathwater. Along with the ‘uncompassionate health care worker’, the ‘person with issues with the NHS’ has practically become a new social type – with each of them sullenly projecting their own negative preconceptions onto the other. I doubt if any nurse reading this will not at some time have sat though a handover where they were warned that someone’s relatives ‘are a total nightmare…sit there watching you like hawks…question every little detail…use their watches to time how long it takes you to answer a call bell…’
In this context, the new report’s recommendation that ‘Trusts should provide patients with a way of feeding back comments and concerns about their care on the ward including simple steps such as putting pen and paper by the bedside’ (p33) is bound to be seen by nursing’s rank-and-file as just fanning the flames – officially sanctioning the idea that nurses are essentially feckless people whose input will only reach the required standard if an army of patient-vigilantes is drafted in to police them. (And let’s not forget that patients, by and large, are not qualified health care professionals; and how much fuss are the Gentlemen of the Press currently kicking up over the idea that their activities should be regulated by politicians?).
So in the midst of all this heightened tension, the obvious question raised by the ‘pen and paper’ proposal is: just how far are managers prepared to alienate staff in order to obtain data about hospital care? Or – it might be the obvious question were it not for the fact that along with quaint old pen and paper, it’s already out-of-date. The advent of social media means that from their hospital beds, patients can now tell the entire world what is happening to them – in real time. Technology has overtaken us. What we should now be asking is: how do we react to what is already out there?
On 29th August this year, a doctor called Kate Granger was admitted to hospital. Over the next few days she sent, from her hospital bed, a stream of jaw-droppingly honest tweets about her experiences – good and bad – as they happened, culminating in the almost indescribably poignant two-word message: ‘I’m frightened…’. As I read it I, like many others I’m sure, felt an answering lurch in my arms as they instinctively told me to get myself over to wherever she was and give her a hug. But I also wondered: while Dr Granger was tweeting, what else was going on – perhaps just a few feet away from her? What were the staff doing? And not just doing – what were they thinking? What were they saying and writing? Was it a case of ‘parallel universes’? And if so, what could that tell us?
Particularly following the publication of the Francis Report, many Trusts have adopted the practice of hearing so-called ‘patient stories’ at board meetings. The idea of this is that through hearing or seeing on video real accounts of patient experience at their hospital or in their community, board members can develop a more sympathetic relationship with the public they serve and can pinpoint areas where services require improvement. People who have been in attendance when these stories were presented have commented on how useful and interesting they found them.
So – great idea. But my question is – could we take it further? Firstly, why are we limiting ourselves to patient experience? Why can’t frontline staff also be invited into the Boardroom to tell their story about the frustrations, abuse and disappointments (as well as the triumphs and satisfactions) they endure/enjoy every day at work? And secondly, (and although it might be very difficult to bring about), could we find a way of placing next to each other a patient story and a staff story about the same day on the same ward? Or maybe a representation of a patient written by the patient him or herself compared with a representation of the same patient taken from the medical or nursing notes? Instead of writing yet another report, could we turn it into some form of installation or performance art? How powerful would that be as a tool for identifying the barriers – from both sides – to communication and empathy?
Through the notes and in handover, nurses have always made representations of patients. With the arrival of social media, patients are now not just enabled, but also (it would seem) fully empowered to start making and distributing representations of us. It’s already happening. We can’t stop it. We might not like it, but we have no choice but to accept that nursing in the future is going to be a much more collaborative skill than it sometimes has been up to now. Years have been wasted in talking about this – but now the time has now well-and-truly come to embrace it and look for ways of adjusting. In return, we have the right to expect that patients and the media will give us their respect and understanding. The alternative is for all of us to just hunker down even further into our respective silos. And how does that help anyone?

For Ann Clwyd and Professor Trisha Hart’s review of the NHS Complaints Procedure, see:
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253320/complaints_review_report.pdf
For the Daily Mail’s excited rendering of the above, see:
http://www.dailymail.co.uk/news/article-2478637/Labour-MP-Ann-Clwyds-report-standards-care-Nurse-refused-clean-sick–went-university.html
For a Twitter storyboard of Dr Kate Granger’s experiences in hospital, see:
http://storify.com/katemgranger/the-other-side-live
For a superlative fictional account of the differences in staff and patient perspectives, see:
http://illusionsofautonomy.wordpress.com/2013/10/03/a-night-in-the-system/
(A favourite blog of mine. Amongst many wonderful posts Dr Berry has written on a similar theme, this one is a personal stand-out. Everyone should read and reflect).

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