Dave

Happy New Year to all.

Well, as we kick of 2012, it is good to see that political leaders still have the NHS as a spinning plate.  All hail the recent visit by Dave to Salford Royal NHS Foundation Trust where valuable light was shed on the innovative leadership being demonstrated across the hospital as part of the NHS Institute Time to Care and Productive Ward initiative - good old fashioned ground-up change with common sense at its heart. 

Dave really knows a good thing when he sees it.  The introduction of walking the floor style of leadership inspired by Salford Royal's Chief Executive David Dalton  appears to have made some dramatic effects on important patient safety statistics as well as the patient experience. It's not rocket science but “drop in visits” or lurking around long corridors (even the lovely PFI funded ones at Salford Royal) could be perceived as having sinister or punitive connotations but spare a thought, it might just be persuasion.

Allow me to just straighten my rose tinted spectacles, but I remember with great pride as a student nurse (adult) being shown how to straighten bed wheels and align curtains: this wasn’t to make Stirling Royal Infirmary just look nice, it was to allow the ward domestic a free passage or route to properly clean below and behind beds. As a post-registration student nurse (paediatrics) at the Sick Childrens Hospital in Edinburgh you needed to stand when a Nursing officer entered the room or ward, not on ceremony but as a matter of respect – you were about to whisk them round without a pen or scribbled note to explain who was in your ward and report their status.

Ministers have introduced great plans to ‘reset’ Britain’s approach to caring for patients. This reform will include as “common practice” a Matron, Sister or Team Leader on every ward. Come on Dave, we have all of them already – everywhere. What is lacking is not the titles, but the numbers…on the ground. As part of the discussion forum in a recent Guardian article discussing the pending “radical shake up", blogger "schrodingerscat85" has issues with Dave’s ideas and, well, just makes great sense:

"I am a qualified nurse working on an oncology and palliative care ward, and I think this is ridiculous. What do they think we do if we are not making sure our patients are comfortable? Every time I see one of my patients, whether it is whilst administering medication, assisting with a wash, helping them to the toilet, or just going in to a bay to get something, I am talking to them. We do not need prescribed hourly 'rounds' to do this.

In any case, I do not know how this would work. It takes at least 90 minutes to complete a morning medication 'round', then making up intravenous medications. After this, I will catch up with my HCA to make sure all our patients are washed and comfortable. By this time, patients may be being discharged (paperwork, phonecalls, chasing up other services- 'discharge facilitators' who sorted all this out for us were recently made redundant) and family arrive on the ward, often wanting to discuss their relatives progress. Whilst this is going on, people are requesting pain relief (generally controlled drugs, two qualified nurses to administer), become acutely unwell, die, need tracheostomy care, need dressings changed, need the toilet etc etc. If we stop every hour to do a 'round' then patient care will be affected negatively- how will people get medication, pain relief, blood transfusions etc in a timely manner if we are spending our time on this guff? This will only be another piece of paper to sign and file, and then be audited.

In addition to this, all wards have a senior sister / ward manager / team leader who manages the team and oversees standards and care on the ward. This has been the case for as long as I can remember, so I don't know what Dave is talking about. "

We better be careful what we wish for. We need a balance, some synergy if you will. Former Matron Hazel Halter offers us an insight into an era we will never have again in terms of hard graft and respect. However Modern Matron Hilary Loftus  [He is real isn't he?] offers us an insight into the perils of taking the training manual to bed.

Have a good shift “schrodingerscat85”