The blaze of publicity in the Daily Mail about the Patients’ Association helpline appeal is beginning to die down. So now let’s look at their longer term strategy for improving elderly care, which is to appoint independent matrons to hospitals all around the country.
Intuitively, I am uncomfortable with this approach, but I don’t have a better alternative so until I do, I will go along with trying any new idea, in what is a desperate situation. My reservations are that as “independent” people, they maybe able to be critical friends but they won’t have the teeth to change things. There are lots of good nurses and ward managers working inside in the NHS who are well aware of its deficiencies but seem powerless to change the system, so how will someone from outside reminding them of their shortcomings help. It could work if it is done co-operatively and with the full support of a senior management team who genuinely want to improve their service to older people. So perhaps it would be best to pilot the approach first with a few Health Authorities who are given the freedom by the Department of Health to step outside of the current systems and procedures.
The Health Secretary, Andrew Lansley, was quick – almost too quick – to support the Patients’ Association. Cynically you might think he was just trying to jump on board the Daily Mail publicity band wagon or at least trying to contain an issue which might otherwise get out of control. The problem is Mr Lansley, health care of older people is already out of control, and needs more than sticking plaster solutions. What a happy coincidence that Mr Lansley was able to announce his intention to set up “health watch organisations all around the country to act as a voice for patients”. In my own cynical way I would say they are very aptly named – designed to make small ticking noises but not be loud enough to disturb anyone. It sounds like a remake of Community Health Councils which were abolished by the last Government.
Mr Lansley goes on to say that he also intends to send senior matrons and nurses around hospitals to do spot checks on standards. Forgive me but shouldn’t they already be doing that, it is a fundamental part of any manager’s job. The Minister goes on to say he wants to see unannounced inspections and a national report to shed light on standards of care in hospitals. Isn’t that what the Care Quality Commission is supposed to do? Mr Lansley increasingly sounds like a guilty suspect who under the pressure of difficult questions will say anything, but one who has no intention of changing when he gets out of the spotlight.
It’s not long ago that the Labour Government introduced the concept of “modern matrons”. These were to be the superwomen of a new millennium nurse-led health service supported by a degree qualified infantry of project 2000 nurses. Sadly they seem to have crashed and burned in the headlong rush to achieve Government targets for discharging patients as quickly as possible; a sort of McDonalds fast health service. It’s quick but not very satisfying or healthy in the longer term.
Perhaps we should look further back for an answer. To the 1950’s and 60’s of ITV’s “The Royal”, where matron Wendy Craig ruled over her empire of cleanliness, starched -uniformed nurses and all knowing doctors. Wendy would shred today’s nurses of paperwork and risk assessments and just walk the floor setting standard in her every word. She would answer the information demands of management with their targets and e-mails by telling them to get off her ward and mind their own business. In The Royal there were more nurses and carers and far less Administrators and Managers. At what point did we conclude that more bureaucracy would improve health care?
Harking back to the past, while offering some interesting insights, is unlikely to lead to a solution. Nostalgia is only tinged with truth. So I doubt that “independent matrons” on their own will be able to change very much.
Fundamentally the problem is that the health service is being overwhelmed by the rapidly increasing numbers of older people. Particularly the older elderly with multiple health needs. Advances in health care, whilst a blessing, compound the problem further by making new and often expensive treatments possible. We can’t, nor should we want, to turn the clock back. But we must recognise that our vastly improved health service capacity to keep people alive longer will only be a success story if we also extend the quality of life.
To do this we need a much more radical reform of the health care system for older people. It needs a new vision, new resources and thinking way outside the box. That’s what I will write about next.