Sunday, April 21, 2013

Not Waving But Drowning

Apologies for lack of posts. Denham Senior has been hospitalised with a serious heart condition and blogging has therefore moved to the back seat. But today's report from the Royal College of Nursing just has to be clocked.

According to their latest survey, NHS nurses are still "drowning in a sea of paperwork". Nearly one day in five is spent filling in forms, ticking boxes and ordering supplies. RCN general secretary Peter Carter says:
"These figures prove what a shocking amount of a nurse's time is being wasted on unnecessary paperwork and bureaucracy. Yes, some paperwork is essential and nurses will continue to do this, but patients want their nurses by their bedside, not ticking boxes."
Yes, indeed. And visiting Dad in two NHS hospitals over the last several weeks we've been able to study the process up close and personal.

The first stop was a large acute hospital just beyond the M25. It suffers all the usual problems: decrepit buildings, huge financial deficit, and a chronic - and I do mean chronic - lack of parking for visitors. Admission even for blue light emergencies like Dad is via a 12 hour plus trolley wait in A&E, and once finally admitted, care is in the hands of those overstretched uncontactable doctors. The nurses spend huge amounts of time behind the counter filling in forms rather than being out on the ward with patients, and you virtually have to book an appointment for one to stop by your bed. The whole impression is of an operation struggling barely to keep its head above water.

The second stop was one of Britain's top specialist heart hospitals, and it is much more impressive. What's done there in terms of heart surgery is truly world class, and its clinical staff are the business. The doctors are top notch, and the nurses do real nursing (Dad even attempted to take one home with him). Morale seems high, with junior nurses actually on first name terms with the top consultants. True, it's clear that staffing ratios are higher than in the general hospital, but much more striking is the excellent attitude and commitment of staff members.

Yet even here, the nurses told Dad they have a complaint. It isn't the hours, or the inconvenient shifts, or the stressful sometimes stomach-churning work, or even the pay. Their number one complaint is excessive paperwork. And even though they don't let it interfere with patient care, we watched them filling in great piles of paper in every spare moment.

So what's it all for? Why do we need all this paper?

Back in the dark days of the Commissariat, much of it was to satisfy the central planners that patient pathways were being rigorously followed, that prescribed risk assessments were being fully documented, and that every bedpan could be duly accounted for. Or rather, to provide a full audit trail which could be filed away to protect bureaucratic backsides in the event of a system malfunction.

But surely we're now three years on from all that. Surely we don't need all that now?

It's not that Jezza Hunt isn't aware of the problem. He's told us before of the million nursing hours a week spent on form filling rather than caring for patients. Of the nurse who had to fill in a 22 page form and 10 additional forms to get a desperately ill patient admitted to a trauma ward. And of the Hospital Trusts who have to report to, and comply with, 60 different regulatory, licensing, commissioning and public scrutiny authorities. Why, he's even ordered a review of NHS bureaucracy.

But he's attempting to tame a monster. The NHS is far too big, and the bureaucracy far too entrenched, for one single weedy minister to prevail.

The only way of getting on top is to break it up, give us choice and competition, and allow the hospitals themselves to find ways of managing their own affairs. They must be held accountable for results, not for how many boxes their nurses have ticked.


  1. Anonymous7:06 pm

    And the left will absolutely do their upmost to scream it down.

    Look at how the hospital staff all came out to "protect" Stafford Hospital, and the woman who's husband got such piss poor care he was drinking water from a vase, got hauled off by the coppers...

    It's producer capture, and it's a third rail issue...

  2. Dear Mike

    Good luck to the old man dude, sounds like he's bagging his healthcare on a try it on basis - good lad. I guess blokes are easier patients.

    Anywho - you mentioned 60 different orgs and you chucked in scrutiny right at the end. I've been around the block a few times and what are these scrutiny bodies of which you speak? If you're gateposting to what I think you are then scrutiny is the wrong word.

    All the best


  3. Ah... wondered

    Best wishes from a bunch of avid Wat blog followers down in Wiltshire.

    That paper? is simply, I'd say - for status reinforcement - the penpushers feel challenged and like the Hagfish they have a defence mechanism to deter threats. Not all of 'em - just far too many of them...

  4. Budgie12:20 am

    Statement by hospital manager to a bunch of new junior doctors: "If you work overtime it shows you are incompetent (and we know where you live)". So as one of them said to me, what am I supposed to do when there is a complicated emergency admission 10 minutes before my shift ends, just go home?

    The one to two hours it might take to follow through, then doesn't get booked at all (for fear of the doctor blotting his copy book) and the manager goes home (after her 7½ day) happy that the WTD has been complied with (not).

    The managers have the real power and they are abusing it.

  5. Anonymous7:06 am

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  6. Is that the only prime duty for the nurses?

  7. And the problem with the paperwork is this:-

    If the paperwork says you did something then you did (even if you didn't).

    If the paperwork isn't completed then you didn't do the thing it refers to (even if you did).

    Have a guess which takes priority? The paperwork or the patient?

  8. nice post. yup I too hate too much paperworks.


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  13. I get that a lot of paperwork has come from GP negligence claims and reports but surely if diagnosis's were made correctly in the first place there wouldn't be so many claims and paperwork!

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