A View From the Board

Contribution to 2020health report ‘Too posh to wash? Reflections on the future of nursing.’

By Tony Caplin, Chairman, The North West London Hospitals NHS Trust

A Trust Chairman has many responsibilities, none more important than assuring good patient care. Whatever else fails, nothing can be worse than a failure to look after our patients.

An NHS Hospital Chairman should see responsibility to patients as his or her first duty. It needs to be seen to be so by others and demonstrated over and over again. The chair needs to make sure this responsibility is in the actual bloodstream of the organisation.

The Trust I have the privilege of Chairing is by any standards very busy. Every single day, seven days a week we need to discharge 25% of our total bed capacity simply in order to stand still.  The Trust works too close to 100% of capacity, a challenge by any standards.

Like most Chairs I am neither a clinician nor an expert in hospital administration. Worse, I am very part time and depend heavily on the excellent professional executive team. Key in the team is the Chief Nurse, because key to good patient care is leadership; the role of the Chief Nurse can and should make a big difference. This post is critical to any organisation which delivers care to patients. The Chief Nurse cannot take on this role alone. I have habitually made a nuisance of myself by walking into a ward or A&E at different times of the day without notice. I make a point of saying hello to all the staff, I deliberately look at cleanliness and how tidy the ward is. I also make the clearly visible point of asking a patient if they are being treated well. I encourage my non executives to do the same in an orderly professional manner.

As a non professional it took a while to figure out what I was looking for in the ‘very best’. I think dignity stands out as the key word. A good nurse affords dignity to the patient, showing real interest, empathy and compassion. Dignity should reduce suffering, enable the patient to recover quicker where possible, and feel safe.

A busy hospital will have its share of complaints, a busy inner city hospital more so. It is vital complaints are dealt with quickly and in accordance with procedure and practice. There are numerous reasons why a patient or loved one will write a complaint. The truth is, too many are genuine, and demonstrate shortcomings in the system. The truth is, our hospitals are too busy; the desire to meet targets and budgets constantly a threat. The danger that this could get worse is threatening high standards of patient care.

We have tried hard to encourage a no blame culture throughout our hospital. Better we learn from mistakes than knee jerk into blame. Although I believe this has much improved the environment, I have been too often saddened by examples where we have let ourselves and our patients down. I have learnt to realise the enormous good done by the body of the nursing staff and I have also learned how difficult the nursing job is. It is a human system, and human beings are not perfect. Mistakes happen, we all get tired, overworked and do work in high stress situations.

To further improve our care we commission professional neutral advisors to interview and video patients once they have left us to share their experiences as a patient – good, bad and indifferent. We continually learn from this process as these independent professionals tease out the truth. We then play back the video to the nursing staff in select groups to enable them to learn. This activity has had a material beneficial impact on individuals as well as the body of the Trust. We also play selected videos to the board.

Our Board takes a real interest in the work of our nurses. Every Board meeting we invite three Matrons to share with us their anxieties, plans for the future and real life examples of recent improvements. In addition every quarter we invite a patient to come and address us on their experience, good or bad, and what they think we should be doing.

Our Trust pioneered the ‘we care’ programme, now adopted by many other Trusts in the UK. I am proud of the nurses in our Trust; they have continually made improvements in a difficult environment. We recognise that good nursing is essential to good outcomes, but nurses need to be supported in their work. Looking back, Boards could be faulted for not spending enough time understanding the role of the nurse, and importantly their wellbeing. Boards need to find more ways to demonstrate the value they place on nurses and the contribution they make.

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