Voice of Vested Interest

I think the RCN (Royal College of Nursing) is having a real identity crisis.

Because its leaders can't seem to make up their minds whether the RCN is a professional organisation - with a key role in promoting higher standards in the nursing profession - or just another, old-fashioned trade union.

But on the latest evidence - I think it's the latter as the RCN continues to stick its head in the sand over the fall-out from the Francis Report and the 1200 unnecessary, shameful deaths at Mid Staffordshire Hospital - which has now gone into administration of course.

Now the RCN keeps banging on about nurses being singled out for criticism in the wake of the Francis Report - and that the finger of blame should really be pointed at the local health Board.

Which is nonsense, of course, since the nursing profession is not being singled out - all that's happening is that people, myself included, are pointing out that nursing and other staff on these hospital wards failed in their duty to look after fellow human beings - people's mums and dads, brothers and sisters - vulnerable patients in their care.

So this was not a system failure - this was a people failure, professional people in many instances - not just nurses but doctors as well - yet they were all too busy or too wrapped up in other things to notice that patients were being neglected and that some of them died a quite unnecessary and miserable death.

In the circumstances, I think a bit of humility is called for - maybe even a period of quiet reflection on how such a terrible thing could happen in a modern NHS hospital in the UK.

Voice For Service Users (5 March 2013)


Trade unions are experts at lots of things - especially at telling other people what to do and how to do it.

But in my experience trade unions are seldom keen to accept any critical assessment of their own performance or the kind of independent scrutiny - which operates routinely in many other areas of public life.

I wrote a post last month about the lack of leadership from the trade unions during the care scandal at Mid Staffordshire NHS Trust - in particular the largest nurses union, the RCN.

Here's what the independent Francis Report into Mid Staffs had to say about the RCN:

Royal College of Nursing

1.98 At Stafford, the RCN was ineffective both as a professional representative organisation and as a trade union. Little was done to uphild professional standards among nursing staff or to address concerns and problems being faced by its members.

1.99 A prime reason for this was a lack of effective representation from elected officers on site. Further, the support avaialable from RCN officials at a regional and national level was limited.

1.100 The RCN is not, of course, a regulator but a combination of a professional representative body and a trade union. However, it does represent a group of qualified professionals and seeks, as it should, to promote high standards of service and conduct. The evidence reviewed in this report suggest that the RCN has not been heard as might have been expected in pursuing professional concerns about the standard of care.

1.101 It appears there is a concerning potential for conflict of interest between the RCN's professional role of promoting high quality standards in nursing, and its union role of negotiating terms and conditions and defending members' material and other narrow interests.

Ouch! - was probably the intitial reaction of the RCN to such devastating criticism of its role at Mid Staffs - and I suspect that the other NHS trade unions behaved in a similar fashion.

The lesson to learn is that NHS trade unions cannot champion the cause of services users and their families - who need a strong voice of their own to balance the many vested interests which control the NHS.

What's needed in the NHS and elsewhere in the public services is more People Power - and less control by the senior managers and bureaucrats who run the show at the moment - sometimes for their own selfish ends.

Hospital Trip Advisor (4 February 2013)

I am beginning to think that Dr Peter Carter - the chief executive of Royal College of Nursing (RCN) - is losing the plot.

The leader of the country's largest nursing union was in the papers at the weekend - making some rather extraordinary claims about poor standards of care in the NHS - and here's what Dr Carter had to say:

“Will there be another Mid Staffs? Yes, sadly there will be. There are 1.2 million people employed in the NHS and there is a hospital in every town. It would be foolish to say everything in the garden is roses.

Mid Staffs cannot be an isolated incident. The fact is, the service is under huge strain. Trusts are not thinking intelligently about how they deliver care and are simply cutting the numbers of frontline staff. Our members have a personal and professional responsibility to raise concerns.

The vast majority of patients still get good care, but that is no consolation to those who don’t. Mid Staffs has got this massive profile now, but there have been many others like it . . . Bristol Royal Infirmary, Basildon, Alder Hey. The report into Maidstone and Tunbridge Wells [where hundreds of patients died after an outbreak of the superbug C-difficile] is painful to read. On the wards there were beds that were eight inches apart ... what the hell were the managers doing, but also what was going on with the nursing culture? There was a culture of bullying and intimidation.

If the board had spent time walking the wards, talking to patients and staff, just doing their jobs, they may have saved hundreds of lives.

You wouldn’t expect staff at Kwik-Fit to get by with a bit of TLC and a bit of common sense. These are old people ... their bones are like porcelain, their skin is like tissue paper. They need highly skilled specialist care. The idea that four or five unskilled staff can take care of 30 elderly patients is nonsense.”

Now these comments come in advance of the report on Mid Staffordshire NHS Trust - where poor standards of care said to have caused up to 1,200 unnecessary deaths between 2005 and 2008.

So the first point to be made is that the scandal of Mid Staffs happened at a time of plenty for the NHS - which means that, broadly speaking, resources and money were not any part of the problem.

The second point I would make is that the NHS is one of the most highly unionised industries in the UK - and the RCN is one of the largest, most influential trade unions - with lots of RCN members in senior management and leadership positions.

In which case I fail to see how it can sensibly be argued that Trust's board members were somehow responsible for saving hundreds of lives - when there were all these staff around who were paid, some of them very generously as well, to look after patients.

I happen to think it would be a good for NHS board members to interact more with patients and their families - but surely this would be much more practical if the regulatory bodies in the UK made more unannounced inspection visits - and actually asked patients and families for their views on the standard of care received.

My mother died five years ago after and before she passed away my mum was a frequent visitor to her local hospital where - I think it's fair to say - that some of the care she received was very poor.

But no one asked my mum what she thought of her care - nor any of her family - which strikes me as very odd in this day and age - because feedback from patients and families is the obvious way to highlight underlying problems.

To paraphrase Dr Carter's own analogy - I think I receive much better customer care from Kwik-Fit than my dear old mum did at times - from her local NHS hospital.

A former health secretary in the last Labour government - Alan Milburn - came up with an interesting idea recently with his suggestion that the NHS needs an equivalent of Trip Advisor - so that patients and their families can provide useful feedback after a hospital visit.

People power meets patient power - now that really ought to be part of the answer.