Health care lessons from the UK
Sir, – I am obliged to rebut the inappropriate and inaccurate misrepresentations that have been made by Liam Doran, INMO (Letters, October 16th) regarding the reported Irish Hospital Consultant Association meeting last Saturday, which I attended. The use of the term “too posh to wash” was ascribed to me in a disparaging manner failing to understand precisely the content of the discussion.
Had Mr Doran been present, he would have discovered it was Peter Watson Jones who introduced this term. Mr Watson-Jones, as a highly respected solicitor and lead investigator, was invited by the IHCA to speak on the disturbing findings from the Mid Staffordshire inquiry. He detailed the findings of a “culture of mediocrity” in an NHS Trust that were identified as having an excessively high mortality rate. Three core critical findings were outlined. Serious concern was raised in regard to nursing standards and patient care. The chairman of the inquiry, Robert Francis QC in response, coined the term “too posh to wash” when the report was published in February. The British government immediately acted on the grave findings. On March 26th, the secretary of health, Jeremy Hunt, announced in Parliament that nurses were not too posh to wash and that the current nursing degree programme would have to be changed to reflect that. It is his intention that new training nurses will be obliged from now on to work for one year as health care assistants to improve their empathy and understanding of patient needs. This should be placed in the historic context of the decision in 2008 with the 2020 programme initiative that nursing should move from a vocational traditional hands-on profession to a degree level one.
As most medical professionals are aware, the medical and nurse training bodies in Ireland have a very close relationship with their sister colleges in the UK. We have invariably modelled and copied our training programmes and our healthcare systems to reflect the NHS model.
We are about to introduce “networks”. These demographic structures are distributed in a very similar pattern to the original health boards except they will be linked to a tertiary level teaching hospital. They sound remarkably similar to the financially targeted driven NHS trusts that have now come under critical scrutiny. I have simply asked are we about to follow in a similar vein the mistakes that have been now begun to be learned in the UK.
I work on a daily basis side by side with both degree-trained nurses and nurses of the older tradition. I have the highest respect for them. Nurses work extremely hard and frequently under enormous pressures because of patient throughput. As a consequence, they are forced to spend an inordinate time on paper work and computer inputting driven by modern structures and bureaucracy. This is a fundamentally at variance with what they were intended or trained to do.
There is much valid concern regarding recurrent media reporting of adverse hospital events, some of which have led sadly to individual patients’ demise. Too often, there has been an attempt to immediately identify the medical consultant as the chief culprit. “System failures” are frequently now cited in a neutral noncommittal way by the HSE with reassurance that lessons have and will be learned.
In our current blame-driven adversarial culture, it has become far too easy to immediately target the medical consultant and support staff rather than acknowledge the real possibility that the deficits lie elsewhere. I suspect James Reilly and his senior Department of Health officials may well be reflecting on the (Francis) Mid Staffordshire inquiry in that context. I certainly hope he is. – Yours, etc,
Castleknock Road, Dublin 15.