editorial
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Deputy Editor Aysha Mendes da Mata [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Commercial Manager Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Lindsey Butlin Publisher Anthony Kerr Chief Executive Officer Ben Allen UK Personal subscription rates
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£42 £164 £173 £294 £415
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com © MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2014, Vol 23, No 4
Stuff and nonsense: ‘whole-stay doctors’
T
he ‘whole-stay doctor’ initiative is being introduced by the government to prevent patients from feeling like they are being passed from pillar to post. Having one named consultant in charge across a hospital stay is supposed to be able to bring about an important cultural change and reassure patients that they are not lost in the system. Can you recall the ‘named nurse’ initiative? Circa 1995, the concept was closely related to the development of ‘primary nursing’ and was mostly concerned with providing the patient, their family, friends and others with a single named person whom they could go to about issues associated with care. It was part of the Patient’s Charter, which set out the rights that patients could enjoy and service they should expect from the NHS. On the surface, the idea was laudable. However, as with most things, the devil was in the detail: how to implement it and above all sustain it while still providing a service. Comment was made back then (Wright, 1995) about the value of such an initiative. Unsurprisingly, the ‘named nurse’ was often someone whom the patient had never seen and was never on duty between the patient’s admission and discharge, thus defeating the purpose of the initiative. The only reason the patient knew who was his or her ‘named nurse’, was because it was written on the white board above the bed. In a number of areas it was often the ward sister or charge nurse who was allocated or assumed the ‘named nurse’ for every patient in a care area, thus rendering the whole exercise pointless. Patients had little interest in the concept and implementation was meaningless, mostly due to staffing levels (Allen, 2001). So what is the real issue that the Secretary of State is trying to address? Accountability seems to be the crux of this. A single doctor to take charge of each patient from the minute they are admitted to the second they are discharged. Accountability, Mr Hunt, is far more complex than this and may I remind you that each nurse, midwife and health visitor is accountable for his or her own actions or omissions (Nursing and Midwifery Council, 2008). Mr Hunt is asserting that every patient is a person. What a novel concept. People are complex and they often present with complex stories, so to nominate a ‘whole-stay doctor’ is destined to fail. Referrals to other specialists are usually inevitable given the nature of the person’s needs. In reality, there is already provision in place whereby it is usual for every patient to come under the care of one consultant when they are admitted. It is envisaged that the ‘whole-stay doctor’ will take charge of a patient’s entire period in hospital, as opposed to
passing them on. Beware, medical colleagues, your nursing colleagues have been there and it caused mayhem: off-duty rosters needed to be redesigned (you must not forget the European Working Time Directive) in order to attempt to ensure that the ‘named nurse’ was on duty with the ‘named patient’. In most areas, it eventually became a paper exercise for quality assurance purposes. Another aim of the ‘whole-stay doctor’ proposal is to prevent fewer admissions. In order to do this, the Department of Health must commit to funding and resourcing of community services in order to cope with the deluge of referrals that are being made dayin, day-out to a service that cannot currently cope. This ‘new’ initiative, seems to me a distraction from the more important, more serious ills that are afflicting the NHS. Yes, there is an absolute need to ensure that we prevent the ‘brief encounter’ scenario. We must organise care where the patient is, not organise patients where the care is. There is an absolute need to stop the ‘ping-pong’ experience patients tell us about, and a seamless discharge event is essential. There are other ways of doing all this without resorting to what seems to me to be a fad. There is a need to digitise the system with haste so patients do not have to tell their story over and over again, there is a need to enhance communication and there is an absolute need for overt accountability from all parties. There needs to be a change to the current situation where GPs are unavailable to refer patients in the community if it happens to be at the weekend. Finally, what needs to be addressed are the real issues that the NHS is facing: funding for the service, respect and reward for those who are doing an excellent job despite having to work in the face of adversity. The most important thing I think is the need to ensure that staffing levels are safe and effective allowing clinicians to do the work they are really good at, not having to think of ways of ensuring the whole-stay doctor’ initiative is carried out in order for governance to tick a box. BJN
Ian Peate
Editor in Chief British Journal of Nursing
Allen D (2001) The Changing Shape of Nursing Practice.The Role of Nurse in the Hospital Division of Labour. Routledge. London Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives” http:// tinyurl.com/737we4y Wright S (1995) The named-nurse initiative: what is the point? Nurs Times 91(47): 32-33
195
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Deputy Editor Aysha Mendes da Mata [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Commercial Manager Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Lindsey Butlin Publisher Anthony Kerr Chief Executive Officer Ben Allen UK Personal subscription rates
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£42 £164 £173 £294 £415
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com © MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2014, Vol 23, No 4
Stuff and nonsense: ‘whole-stay doctors’
T
he ‘whole-stay doctor’ initiative is being introduced by the government to prevent patients from feeling like they are being passed from pillar to post. Having one named consultant in charge across a hospital stay is supposed to be able to bring about an important cultural change and reassure patients that they are not lost in the system. Can you recall the ‘named nurse’ initiative? Circa 1995, the concept was closely related to the development of ‘primary nursing’ and was mostly concerned with providing the patient, their family, friends and others with a single named person whom they could go to about issues associated with care. It was part of the Patient’s Charter, which set out the rights that patients could enjoy and service they should expect from the NHS. On the surface, the idea was laudable. However, as with most things, the devil was in the detail: how to implement it and above all sustain it while still providing a service. Comment was made back then (Wright, 1995) about the value of such an initiative. Unsurprisingly, the ‘named nurse’ was often someone whom the patient had never seen and was never on duty between the patient’s admission and discharge, thus defeating the purpose of the initiative. The only reason the patient knew who was his or her ‘named nurse’, was because it was written on the white board above the bed. In a number of areas it was often the ward sister or charge nurse who was allocated or assumed the ‘named nurse’ for every patient in a care area, thus rendering the whole exercise pointless. Patients had little interest in the concept and implementation was meaningless, mostly due to staffing levels (Allen, 2001). So what is the real issue that the Secretary of State is trying to address? Accountability seems to be the crux of this. A single doctor to take charge of each patient from the minute they are admitted to the second they are discharged. Accountability, Mr Hunt, is far more complex than this and may I remind you that each nurse, midwife and health visitor is accountable for his or her own actions or omissions (Nursing and Midwifery Council, 2008). Mr Hunt is asserting that every patient is a person. What a novel concept. People are complex and they often present with complex stories, so to nominate a ‘whole-stay doctor’ is destined to fail. Referrals to other specialists are usually inevitable given the nature of the person’s needs. In reality, there is already provision in place whereby it is usual for every patient to come under the care of one consultant when they are admitted. It is envisaged that the ‘whole-stay doctor’ will take charge of a patient’s entire period in hospital, as opposed to
passing them on. Beware, medical colleagues, your nursing colleagues have been there and it caused mayhem: off-duty rosters needed to be redesigned (you must not forget the European Working Time Directive) in order to attempt to ensure that the ‘named nurse’ was on duty with the ‘named patient’. In most areas, it eventually became a paper exercise for quality assurance purposes. Another aim of the ‘whole-stay doctor’ proposal is to prevent fewer admissions. In order to do this, the Department of Health must commit to funding and resourcing of community services in order to cope with the deluge of referrals that are being made dayin, day-out to a service that cannot currently cope. This ‘new’ initiative, seems to me a distraction from the more important, more serious ills that are afflicting the NHS. Yes, there is an absolute need to ensure that we prevent the ‘brief encounter’ scenario. We must organise care where the patient is, not organise patients where the care is. There is an absolute need to stop the ‘ping-pong’ experience patients tell us about, and a seamless discharge event is essential. There are other ways of doing all this without resorting to what seems to me to be a fad. There is a need to digitise the system with haste so patients do not have to tell their story over and over again, there is a need to enhance communication and there is an absolute need for overt accountability from all parties. There needs to be a change to the current situation where GPs are unavailable to refer patients in the community if it happens to be at the weekend. Finally, what needs to be addressed are the real issues that the NHS is facing: funding for the service, respect and reward for those who are doing an excellent job despite having to work in the face of adversity. The most important thing I think is the need to ensure that staffing levels are safe and effective allowing clinicians to do the work they are really good at, not having to think of ways of ensuring the whole-stay doctor’ initiative is carried out in order for governance to tick a box. BJN
Ian Peate
Editor in Chief British Journal of Nursing
Allen D (2001) The Changing Shape of Nursing Practice.The Role of Nurse in the Hospital Division of Labour. Routledge. London Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives” http:// tinyurl.com/737we4y Wright S (1995) The named-nurse initiative: what is the point? Nurs Times 91(47): 32-33
195
