by Dorret Groot Wassink
Special to UK Progressive
When you ask medical students why they want to become a doctor or a nurse the answer is seldom: ‘to take care of older people.’ However, that is the focus of most NHS healthcare work today. Nearly 65% of people taken into hospital are over 65 years of age. So the question becomes how do we deliver care to older people in a way we ourselves would be happy to receive?
The recent Policy Forum for Wales event last week featured speakers who agreed that our current system struggles to deliver quality care to older people. The scandal in the Sussex Orchid View care home, the Francis report (Staffordshire NHS trust inquiry) and the Andrews report (care of older people in Bridgend, Neath and Port Talbot hospitals) all point in the same direction – the organisational culture plays a big role in allowing for unacceptable healthcare practices to happen.
The main contributor to the unacceptable health practices within some NHS Trusts is poor staff morale. This is caused by pressures to achieve financial targets in an unsupportive and negative, fear-based culture. High staff turnover and the challenge to recruit ‘right-skilled’ professionals are also contributing factors.
Peter Watkins-Jones led the Staffordshire inquiry and said, ‘it is a watershed moment in the position of healthcare. The recent Sussex case is an example that poor care can happen anywhere.’
The main recommendation from the Francis report focuses on achieving a culture change where the ‘service user’ vs the ‘system’ is what counts. The five categories of change in the report are:
- A culture of openness, transparency and candour
- Clear fundamental standards
- Accurate, useful and relevant information available to all involved
- Compassionate, caring, committed nursing staff and
- Strong patient-centred healthcare leadership
UK policy makers are working to put measures in place, ensuring everyone working in healthcare is personally responsible and prosecutable for the quality of care delivered. A concern is if nursing and medical staff are forced to work under such a policy or in a threatening environment, staff morale would further decline.
All speakers at the Policy Forum for Wales event agreed that an open and transparent learning culture is essential for delivering good quality healthcare. Such a learning culture is where people dare to speak up, know they are listened to and their voice makes a difference.
In an environment where professionals in healthcare currently have to comply with more than 250 standards, implementing another policy is not going to do the trick. Yet policy makers are doing just that, starting with a new policy of clearer standards and a new ‘duty of candour’ – a duty to speak up when mistakes are made or poor care is delivered. This policy seeks hold all healthcare professionals personally involved and responsible for delivering the right level of care to a patient.
While the intentions of the policy makers are in the right place. It will be interesting to see how they create better morale and engagement and an open, transparent culture.
It is a significant enough achievement of the Francis report that of their 290 recommendations, 283 were accepted by the UK government.
The elephant in the room though, is pressure on budgets that causes too many NHS trusts to focus on achieving financial targets at the expense of quality care. Research recently commissioned by Welsh government found rising costs and tight finances could cause a two-fifths budget shortfall or a £2.5bn funding gap in a decade.
This next decade will see a further increase in demand with an aging population. Shouldn’t the NHS finance directors also be put under stricter governance?
Niall Dickson, Chief Executive and registrar of the Medical Council’s view on the financial pressure is, “actually real quality is cheap; it requires doing things dramatically different. Higher budgets are not going to lead to better quality, reinventing how we deliver healthcare will. Times of austerity are times that can bring real, transformational change.”
The biggest challenge is to work from a patient-centred approach and fix our current fragmented healthcare delivery system. We need to stop looking at the patient as a collection of body-parts, stop thinking in terms of treatments and shift to caring for the whole person.
Another NHS bedrock shift is needed to move delivery of healthcare from the hospital to the community in or near to the patient’s home. The quality of at home care cannot be matched by hospital care… even if we fix the current quality issues. For frail elderly people, hospital-stays should be avoided as much as possible because a couple weeks in hospital often results in a further diminishing of their physical and mental capabilities.
Frail, elderly people with multiple chronic conditions suffer under this current fragmented approach. Instead of being moved from specialist to specialist and, when in hospital, often from ward to ward, bigger changes to the system are needed to put the patient at the centre.
It start with enabling and supporting hospital staff to provide essential care at all times by creating a culture where patient care vs. money comes first.