Post Ash Court – what is good care?

By Sarah Kean-Price

Panorama’s recent care home expose showed us a withering and despicable side of care.  When Care Goes Bad.  When it’s no longer ‘caring’ and just…I don’t know.  It’s not care.  A robotic carrying out of technicalities and bullying behaviour towards helpless people.

I was asked to write this article and flinched when I read the request.  The thought of witnessing weeping, confused old people lying in bleak rooms was not something I wanted to do. But it turned out that the program was troubling to watch for more than just it’s upsetting subject matter.

It got me to thinking back to my own career and I faced up to the memories of when my practice stopped being good and instead was not good enough.

Started thinking about the times when my patience was fraying and I was short-tempered.  When I too longed to slap my service user because they just wouldn’t co-operate, even when everything I was doing was for their own good.

Because they didn’t understand or didn’t want to or were fed up of their desires being overridden and I was too tired or distracted to resolve this.

Sometimes I was just plain wrong about thinking I knew better than them what they needed.

Late nights after long shifts and being dog-tired.

Knowing that, even if I called my senior, the likelihood of getting help was low because it was midnight, everyone was asleep and I was on the other side of town to the office.

Pride and not wanting to admit I was having trouble and that my training hadn’t been enough.

Barriers caused by environment – for instance, repeated struggles to get a demented woman scared of walking upstairs to her bed late at night.

Understanding ourselves and others

On Panorama, a sergeant wondered why Jonathon Aquino had treated his service user badly despite seeming to be an affable person. The daughter of the service user was horrified at the way that the other four carers talked over her mother and watched TV as they cleaned her and fed her.

Both fundamentally misunderstood how people work.

This frustration, laziness, fear and anger is inside all of us.  Carers are not angelic robots, bestowing our heavenly tenderness with perfection.  We’re just people; late at night, handling scary medication, wrist-deep in shit, doing our damndest to help and sometimes it goes wrong.

Good care stems from good management.  Half the time, people don’t abuse because the CRB wasn’t rigorous enough or because they are ‘monsters’.  They grow complacent because they aren’t supported and they feel alone and confused.  Indeed, Panorama’s dementia expert noted how difficult care staff find their job, how little they are paid and the problems that occur when care cultures are poor and are left to fester.

Good care happens when the staff are properly supported.  More than ever, the care industry need committed management staff with a contemporary understanding of how people work and  think about things.  Management staff with the refusal to settle for cost-cutting, rota squeezing and profit placed over the people’s needs.

Good care happens when staff care is our focus; regularly and meaningfully carried out.  To pull care workers back from the murk of exhaustion and the grind of shift work and to remind them that this is a formal care situation with real people.  To stop our businesses making our employees think care is a box-ticking exercise because we treat them like boxes to be ticked.

What now?

This is my call-out to you;  the experienced, the thoughtful and the devoted.

Care homes do not have to be like Ash Court, nor do they need to become sullen, grey places where minimum effort is overlooked and rewarded.

Take your experiences, your understanding, your training and your whole-hearted love for this sector and keep places like Ash Court from ever allowing to flourish.  We all have this force of love and compassion in us, just like we have the monsters of exhaustion, pride and inadequacy in us too.

Let’s take our overwhelming majority of good practice, make it our banner and  staff and extend it to our colleagues with the same focus and commitment we show our service users.

Tell us about YOUR healthcare manager

I’ve got one. You’ve got one. We’ve all got ‘em….

Stories of the terrible managers we used to work for. We don’t know where they come from or why they do what they do but, sometimes, it feels like they exist purely to make our life misery!

Equally, everyone remembers their great managers. You know, the ones that always got you smiling no matter how tired you were, the ones that always remembered your birthday and treated you with respect…

We at nurses.co.uk want to hear your stories. What makes a manager a bad manager? What makes a manager a good manager? How did you cope with the baddies and how do the good ones inspire you?

Pull up your chair and tell us your stories – from the most demonic and devilish of the employee-botherers to the shining stars of management that make your day whenever you see them.

The truth about nursing job levels

In what appeared to be an example of rather perverted euphemism, Doublespeak, delusion, inadequate staff briefing or just plain lying, Health Secretary Andrew Lansley claimed at the Royal College of Nursing’s recent annual congress that NHS clinical staffing levels have risen since the incumbent government took control in May 2010.

He was met with overt and clear frustration from the nurses present with jeers, laughs and cries.  The Royal College of Nursing has been tracking NHS posts since April 2010 and have noted 61,113 posts as either being removed or marked as being for removal.

Lansley claimed that whilst nursing numbers have decreased by 3000, doctors have increased by 4000.  Meanwhile, the junior Health minister, Simon Burns, claimed only 450 nursing jobs had been cut.

Moreover, Lansley stated that these job cuts weren’t the Government’s fault but due to decisions made by trust boards (as if they aren’t remotely guided by the funding decisions of the Government!).

The Royal College of Nursing released a report over the second weekend of May that articulated workers’ worries surrounding the pressures on nurses.  It was based on an online survey of 1246 nurses visiting the RCN website.

Incidents of patients waiting for hours or being treated in corridors and on trolleys as seen by 51% of nurses daily were mentioned in the report.  In emergency settings, nearly a fifth of nurses reported seeing this happen by the hour.

39% of nurses saw patients kept in ambulances or in queues daily because there was no space for them; 5% saw patients waiting over 24 hours; 33% saw patients moved around for purely administrative reasons to meet targets on a daily basis.

Dr. Peter Carter released a statement referring to earlier RCN concerns about funding cuts saying “Two years ago we warned that the need to make £20 billion in efficiency savings in England alone would risk sending the NHS back to the days of treating patients in corridors or areas not designed for care. Sadly, it looks like those days have now returned.”

When questioned about the impending Health and Social Care bill, Lansley said “I don’t want to reopen the debate about the act”.

What do patients really want from the nurses that care for them?

Cancer Research UK have recently released survey findings about patients’ needs for information from their health care support team.  They found that few sought further information to help them make decisions about their illness and subsequent care.   The main need for information stemmed from wanting to feel more secure and settled through better knowledge.

63% of patients surveyed wanted specific questions answered and 46% wanted extra information to help them deal with their issues and understand them better.  The number of patients looking for help on making choices and decisions came to only 11%.

These findings show the need for both available and accessible information services and also the need for a broader understanding of what today’s front-line health care staff can actually provide for their patients.

Nursing, health care assistance, care work and all of these kinds of jobs are not just a case of Insert Syringe A into Limb B or Make Dinner C and feed it to Service User D.  The humanity and community of these roles cannot be underplayed.  Whilst there are all kinds of interesting developments in things like telesurgical procedures and online patient portals that provide health information, the ability to provide nuanced information is still a high priority.

Health sociological work bears out over and over that our ideas and attitudes about heath and wellness greatly impact our ability to feel healthy and well.  Part of how we feel is affected by the quanitiy and quality of our interactions with others.

Combine ill patients with over-worked, tired staff and things aren’t going to go so.  People are so vulnerable when ill and the ability to rise above it and rationalise away rushed conversations and treatment surely is difficult. Good patient care happens, in part, when staff are able to take the time, sit with people and talk to them and their families about how they feel, their worries, concerns and questions.

We can and should explore the options provided by online patient portals, leaflets and websites but for the moment, the evidence suggests that we still need plenty of compassionate, communicative and well-trained nurses.

University of Salford launches 1 year grad diploma for international nurses

The University of Salford has recently launched a new one-year graduate diploma designed to benefit international nursing graduates with a view to undertaking post-graduate study.

From 2013, students from other countries will be able to take the one-year Graduate Diploma in Health.  It is aimed at health care professionals and runs from January to August.

The entry requirements are somewhat relaxed; differing experiences and forms of accredited previous learning are considered to assess your suitability.  For instance, with the right background, you may be considered even without having the traditional credit requirement for studying at Master’s level.

The Graduate Diploma in Health is designed to improve language and cultural understanding within the health sector.  It is also aimed at preparing the student for the format of post-graduate study.

During the first semester, students focus on health-related English language, a introduction to study skills, UK learning culture and individual personal and professional development.

The second semester introduces global sociological concepts of health, communication and relationship theory and takes time to prepare you for further Masters study.

Upon completing this one-year diploma, students can go on to take an MSc in International Nursing or an MSc in International Hospital and Health Service Leadership and Management.

The former increases research skills, provides time within a simulation laboratory and requires an observational placement in a clinical setting.

The latter combines a study of management skills, project leadership and economics with NHS managers partnerships to inform best practice at this level.

The senior lecturer for this course suggests that it will benefit other countries too (should international students choose to work elsewhere) and I must say that I agree.

Whether students choose to work in the UK or use this learning somewhere else, everyone’s going to benefit.  A focus on implementing health service whilst staying aware of cultural differences and a stronger use of English will help in a lot of places.

Not only that but a bit of extra post-grad training can never go amiss.  Perhaps something similar for UK students dealing with international patients would be just as beneficial to the global health community.

How do you think reforms will affect NHS provision?

Opinions surrounding the implications and concerns about government proposals for our NHS from the current Conservative/Lib Dem government swing from support to abhorrence.

We are looking at a real culture shift from socialised and public health care to one partially removed from government control that allows for more privatised elements (this means that more private companies will be able to provide parts of NHS services, rather than the amount allowed now.)

They also propose to change the way the NHS is administrated.  Instead of today’s PCT’s, they propose we move to clinical commissioning groups (CCGs).

For some reason, CCGs are going to be allowed to choose where their patients come from.  Instead of geographical allocation (for example, Gloucestershire’s PCT administrates health care for Gloucestershire), CCGs will be able to build a patient list out of people who are potentially geographically separate.  They also will choose who provides which services to their area’s public health care providers.

These changes have sparked two concerns.

First, Professor Allyson Pollock of Queen Mary, University of London, thinks that changing the way patient lists are made will make it harder to tell who’s being helped and what help they need.

She is worried that the change in patient list organisation is badly-defined and  going to harm data collection and understanding.

She also predicts that it will be harder to ensure proper coverage and fair provision and that figures for long-term bed management and resource provision will also be impeded.

Secondly, a TUC-funded research group has noted that nearly half of the CCG groups they studied have many doctors that could make more money if their companies are chosen to provide health care services for the CCGs that they work for.  Currently, 22 out of the 50 studied had substantial external financial interests in private health-care provision.

This sparks concerns that NHS provision may start to be affected by personal interest for making money, rather than what’s best for the patients and the NHS itself.

What do you think?  Do you worry these things will change your NHS for the worse?  Maybe you think it’s only natural that doctors would work with other health companies and this isn’t an issue? If you want to read more and have a subscription, you can access the studies at www.bmj.com

Learning disability nursing – make a positive choice…..

I met Graham at the Learning Disability event, Positive Choices, last year. He’s full of enthusiasm and, having spent a large part of his working career in a commercial environment before switching careers, he’s a great spokesperson for how working in LD can really change your life.

Here, in a video he’s put together, he’s demonstrating how, in turn, we can make a difference to someone’s life – by making a positive choice

Learning disability nursing - make a positive choice

Graham Burrell's video about learning disability nursing

A care home for all seasons

Guy Hands, who runs the equity firm Terra Firma, has just spent something around £800m for the care homes group, Four Seasons. By the sounds of it, and I’m no acquisitions expert, Guy Hands is keen to use this big story to restore his reputation.

Hopefully, he’ll also be keen to ensure the ongoing care for his 24,000 residents. It would seem he’s been able to purchase it for a snip (it was worth £1.4bn six years ago). And that would give hope that we’re not going to see assets sold. Indeed, Terra Firma has said that they’ll invest and grow Four Seasons and deliver “high-quality care and peace of mind for residents”.

In February, Guy Hands announced that he’s in investment through his love of “transforming businesses, not just making making”.

But you could forgive the industry for a little anxiety. Where heavy investment is made, typically, cuts sometimes follow. And recent history makes everyone think of how poorly steered Southern Cross was by its previous owners.

Notwithstanding all of that, Terra Firma will be working hard to make sure it transforms more profit from this venture than it did in it’s foray into the music industry where it lost over £3m and a good slice of its reputation. And profit and good care are not the easiest bed-fellows.

Home Managers – be aware of the guidelines regarding qualifications

We had a call last week. It was from a very annoyed and despairing home manager. She’s extremely well qualified, but is being told that because she doesn’t have the correct paperwork she won’t be able to get a home manager’s job.

We published a long article about this on our sister site, socialcare.co.uk, so browse there for the full story (it’s here).

We’d love to hear from other people who have found themselves in the same situation. The issue is, it turns out, that you ARE employable, even without a Level 5 Diploma. You are even employable without the qualifications it has superceded: the RMA (Registered Managers Award) and the NVQ 4 ‘Leadership and Management for Care Services’.

So long as your potential employer has evidence from you of competence and experience, and so long as they then enrol you on a Diploma course within 3 months, and you complete it within 2 years, you’re all working within the guidelines set by the CQC and Skills For Care.

What is concerning is if there are any recruiting employers out there who are unaware of this. It seems that there might be – the candidate who called us last week is evidence of this.

So we’d love to hear from jobseeking care and home managers, as well as recruiters about this issue. We’re happy to report our findings back to the CQC and Skills For Care.

Study shows home births are more ‘cost effective’

A study published in the British Medical Journal yesterday found that planned births at home as opposed to in hospital can be more cost effective for women at low risk of complication, in particular women who have given birth before.

Over a two year period the study looked at just over 64,000 low-risk women in four planned birth locations – at home, in a freestanding midwifery unit, in a midwifery unit attached to a hospital (alongside midwifery unit) and in an obstetric unit. Unit overheads and staffing costs were key components of the final mean cost figure per planned birth, which are £1066, £1435, £1461, and £1631 for births planned at home, in freestanding midwifery units, in alongside midwifery units, and in obstetric units, respectively.

The study also showed that while women who had given birth previously could give birth at home with no increased level of risk, women giving birth to their first baby had an increased risk factor by planning a home birth. However, home births in both cases still represented the lowest mean cost.

Follow the link to BMJ.com to read the study in full.