It was inevitable that the travails of Barclays would dominate yesterday's media, a state of affairs that looks likely to continue as the revelations and resignations continue to pile up. But there were some other troubling headlines yesterday, in particular two news items about the state of patient care in the NHS, which should present a greater threat to our peace of mind than the misbehaviour of bankers.
An inquest this week into the death of 22-year-old Kane Gorny heard that a young man who had recovered from a brain tumour died of thirst in hospital despite begging nursing staff for a drink. Kane telephoned his mother from hospital in great distress, having been so desperate for help that he had dialled 999 and summoned the police, who were turned away by nursing staff. Staff had failed to give him the medication necessary to enable him to retain fluid after an operation; instead he was restrained by security guards and sedated. His mother told the inquest that she could not persuade the nurses that Kane's condition was serious, and it was only when she managed to get the attention of a senior doctor that they realised he was dying. Shortly after his death, as his family cradled his body, a nurse apparently asked if staff could now “bag him up.”
By a fluke of timing, yesterday also saw the release of a damning report on the failings of the statutory body charged with maintaining standards of nursing in the UK. The Nursing and Midwifery Council (NMC) is the regulatory body responsible for the training, registration and conduct standards of 670,000 registered nurses and midwives. The accomplishment of this task is clearly vital in maintaining patient confidence. Nurses and midwives are on the front line of healthcare; their training, attitudes and behaviour have more impact on patients than any other aspect of the service. If they are perceived as sloppy, ill-trained or ill-disciplined, not only are lives at risk but also our trust is undermined.
Yet the NMC seems to be in an almost permanent state of disorder, infighting and confusion as to its purpose. In January this year health minister (and former nurse) Anne Milton ordered an inquiry into the state of this troubled organisation; this has just produced its final report and recommendations.
Almost all aspects of the Council's performance fail to measure up. The infelicitously titled Council for Healthcare Regulatory Excellence (CHRE), being the quango charged with conducting the inquiry, found problems “at every level and in every system” and described a culture at the NMC of “resigned resilience”, with low expectations, high staff turnover (31% in the last year alone), poor budgeting and inadequate management.
Instead of concentrating on its most important function – that of upholding standards in order to ensure patient safety – the NMC has been distracted by tasks outside its remit, such as setting up a helpline, or advising on curriculum development. Its failure to monitor and grade standards among nursing training providers is singled out for particular criticism. Worst of all, the inquiry found that the NMC's biggest area of failure was in monitoring and enforcing “fitness to practice.” In other words, it is failing to accomplish the most important task with which it is charged. A huge backlog of disciplinary cases has been allowed to build up, with 4,000 nurses under investigation and a further 1,000 cases waiting to be heard. All this despite the fact that in 2008 a previous investigation into NMC failings had led to the appointment of a new Council, Chair and Chief Executive, tasked with shaking up the organisation and speeding up disciplinary hearings.
Administrative failings have meant that even where a nurse has been disciplined or sanctioned, records are sometimes not updated, so that her new employer will not know of her history. Nurses found guilty of physical or verbal abuse of patients, or of stealing from patients, have been allowed to continue to practice, with nothing more than a caution.
It is a rich irony that one of the relatively few nurses struck off by the NMC was the whistleblower Margaret Haywood, whose frustrations with the appalling standards of nursing and ward management led her to collaborate with the BBC's Panorama programme and provide secret film of patient neglect. Ms Haywood has since been re-admitted to the register. But the practices of which she complained remain widespread, according to reports from not only the CHRE but the Care Quality Commission. In fact the reports of nursing malpractice and patient abuse across hospitals and care homes in the UK are so frequent that we are in danger of becoming hardened to them. We must not lose the capacity to be shocked by such news items.
In its conclusion to yesterday's report, the CHRE admits that it has limited its recommendations for reform to those areas which it sees as most crucial, fearful that it might otherwise overwhelm the NMC's new management. Nevertheless, it comes up with 15 recommendations for change, to focus the organisation on its main purpose and to attempt to improve its governance, data handling, budgeting, caseload management and overall efficiency. A new Chair and Chief Executive have yet to be recruited and appointed; clearly much will rest on the calibre of the individuals chosen to fill these roles.
The full glare of the media spotlight will be on the search for new leadership at Barclays. But the management qualities, courage and determination of the new head of the NMC will, I suspect, have rather more impact on our daily lives and the care of those we love than anything that takes place in the banking world over the next few months.