Monday, 11 February 2013

Mid Staffordshire NHS Trust: Performance Related Pay is not the Answer!

The serious systemic failures in care at Mid Staffordshire NHS Trust described in the Francis Report and the recommendations from them have sent shock waves through the NHS. The experiences of staff, patients and relatives who gave evidence paint a grim picture of a system at breaking point; of overworked, under qualified staff, unable to maintain basic standards of care and safety 

Becky Johnson, student nurse

No-one ever became a nurse for the money- we do it because we genuinely care! Undoubtedly, there are some individuals who are currently not safe to take care of patients. However, the knee-jerk response to scapegoat the entire profession not only does us a disservice, it fails to address the real problems in the NHS, leaving patients at risk. My friend and colleague hit the nail on the head when she said: “It makes me sad and very angry that something so disgusting and tragic was allowed to happen... This is why NHS hospitals should not be run as business organizations by people who are managers but nothing else. Patients are not just numbers!” 

Mid Staffs were so obsessed with being one of New Labour’s Foundation Trusts, a step towards privatisation, that they ran it like a business Footfall, turnover and productivity became paramount. It can be no co-incidence that wards, already ran on a shoestring, went into melt down when staff numbers were cut. The problem was compounded by a reconfiguration of wards in order to squeeze more money out of the service. A culture of bullying started at the top and permeated down to the wards. 

Far from alleviating the underlying factors that led to poor care at Mid Staffs 2005-2009, today’s era of austerity cuts and privatisation only serve to compound systemic problems, making further crises of care likely to inevitable.

Robert Francis has listened to the testimonies of patients, relatives and staff He knows what happens if you run a service like a business. Yet in his opening remarks to the Health Minister Jeremy Hunt he says that the required changes to improve the service can now be implemented within the system created by the Health and Social Care Act. You can’t fight fire with fire. The drive to privatise has created the conditions for the systemic failures at Mid Staffs. 

Francis recommends the implementation of Performance Related Pay for nurses. Nurses will be paid on the basis of how “compassionate” they are, judged by individual patient feedback forms of individual nurses. Aside from the obvious practicalities of implementing and utilising such a system, especially when nursing patients with dementia, who are unconscious, experiencing confusion, under anaesthesia, compassion is subjective. It can’t be measured by tick-list. What about those patient’s who just don’t like you? 

In the NHS, we treat everyone, which means treating people who have prejudices. I stopped counting how many times patients have said to me “I’m so glad I don’t have a black nurse”. You don’t know where to look! Sometimes, patients are reluctant to follow medical advice. The nurse that encourages a patient with breathing difficulties get out of bed is not always popular, but she is compassionate! Fear of being marked down by patients could see many nurses feeling they have no choice but to compromise their professional integrity. Of course the patient is at the centre of the care we provide, but applying the business principal, “the customer is always right” to something as complex as healthcare will create more problems than it solves. 

The Francis report also advocates registration for unqualified healthcare assistants. HCAs provide the majority of hands on personal care, under the supervision of a registered nurse. They are incredibly underpaid for the work they do and are often unsupported in their jobs. Because they are cheaper, the government want a move towards more HCA, managed by fewer qualified nurses. This takes nurses further away from the caring side of nursing, with qualified staff focusing on more technical, high status tasks. 

This division of labour has come about in order to reduce costs. However, nursing requires a holistic approach. Registration of HCAs does not address this contradiction. In many ways, it entrenches it further. In any case, the over-reliance on HCAs was clearly a factor in the breakdown of care at Mid Staffs. There will always be a need for auxiliary staff, however, in order to provide the quality of care we want to, we need more nurses and fewer HCAs. This does not mean sacking HCAs and recruiting nurses, Funding needs to be made available to up-skill HCA’s into registered nurses. Wards should grant secondment to HCAs who want to do their nurses training and guarantee them a job at the end of it. 

Universities need to provide support to ensure HCAs have the academic requirements for the course. There has been much criticism of university based nurse education. Some have suggested it is responsible for creating uncaring nurses. This is fundamentally untrue. What a university education does is equips nurses for the reality of the job It is physically, emotionally and intellectually taxing. It requires a critical approach. Intelligence and compassion are not mutually exclusive qualities, we just work under a system that restricts our ability to show either.

  • Stop the destruction of the NHS. Repeal the Health and Social Care Act
  • No cuts, closures or job losses in the NHS
  • End the postcode lottery. We call for a fully funded, high quality service in every area
  • Kick big business out of the NHS. Scrap the dodgy PFI deals and cancel the debts
  • For a national trade union-led weekend demonstration against attacks on our health service
  • For mass action to defend the NHS with trade union strike action at its heart
  • For a new mass workers' party to provide a fighting, political alternative to the pro-cuts parties