If you want to see just how badly wrong things can go in a nationalised system of health—the so called “jewel in the crown” of U.K. public services—read this report. Beware; it is 1,781 pages long, excluding the executive summary. Few will need to read every word, and fewer still will do so. Nevertheless, for a rapid assessment of the systemic, professional and personal failures that conspired to create the biggest scandal in the history of the U.K. National Health Service, the executive summary will suffice.
As a U.K. citizen and nurse, I am well aware of the problems in Mid Staffordshire. The U.K. media have had little difficulty in deciding what to headline in the past week, and there have been the inevitable swipes at nurses with degrees, another subject of past entries in this blog. While the public are provided with further depths to the scandal and shock and informed that no ‘heads have rolled’… yet (disciplinary proceedings may now begin), the professions are more concerned about the recommendations made by Lord Francis QC, who chaired the enquiry.
The recommendations are copious, and those related to nursing cover several pages. The range of recommendations covers the “whole nine yards,” from sublime common sense to the ridiculous type of ignorant knee-jerking that is so common when non-nurses comment on nursing. At the ridiculous end is the recommendation that the U.K. regulatory body for nursing, the Nursing and Midwifery Council (NMC), together with universities, should work over the course of several months to produce a system for testing the aptitude of nursing candidates, paying special attention to caring attitude and compassion. This ought to tie the NMC and university schools of nursing up for months deciding what to measure and how to measure it.
Surely, the three-year programme of undergraduate nursing education is at least partly supposed to weed out those unsuitable for nursing and also to mould those with promise into good nurses. I can see where Lord Francis’s idea stems from: 1) the ubiquitous driving force of the well-meaning public servant that “something must be done (about it)” and 2) that “there is something that can be done (about it).” There were manifest failures of medical and surgical care, yet there is not a similar recommendation that aspiring doctors be pretested for aptitude.
Giving credit where it is due, Lord Francis did make two excellent recommendations that would be easy to implement. The first of these, which seems uncontroversial but has eluded nursing in the United Kingdom since the mid-1980s, is a national standard for testing the competence of nurses to practice. While not wishing to use the tragic circumstances surrounding Mid Staffordshire to illuminate my own good sense and that of some close colleagues, it is interesting to reflect on some recommendations made by a few of us in 2002: “A clear finding (from this study) is that no single method is appropriate for assessing clinical competence. A multimethod UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.” I doubt we can take the credit now, but at least we can demonstrate that some nursing academics were making common-sense recommendations over a decade before Lord Francis.
The other excellent recommendation is that: “The Nursing and Midwifery Council and other professional and academic bodies should work towards a common qualification assessment/examination.” The United Kingdom long ago abandoned a national state examination for nurses but, again, along with a colleague, I have published the view that we should return to a national curriculum and a state examination for nursing. Surely, this is a recommendation worth pursuing.
This entry has been very U.K.-, not to mention self-, centred. March finds me in Hong Kong, Saudi Arabia and Canada, and also in front of my colleagues speaking about international strategy. I will also be delivering a paper on nursing leadership at a local event of the Honor Society of Nursing, Sigma Theta Tau International. I expect that next time I post, Mid Staffordshire will no longer be in the headlines and that I can report something that illuminates the best in U.K. and international nursing. Meantime, I contemplate approximately 25,000 miles of flying, jetlag and hotel rooms; actually, not the worst prospect.