Targets or trade unions?

Submitted by Matthew on 13 November, 2013 - 12:12

On 5 November, the Care Quality Commission (CQC) reported that at Colchester General Hospital cancer waiting times had been misrecorded so that the hospital avoided financial penalties for not meeting targets. When staff tried to object, they were bullied by management.

Alarm is a sound response to cancer waiting times being too long. Some cancers can metastasise (have the cancer spread from one organ to another) quite fast, and delay can make the difference between the cancer being curable or not.

But if a hospital does not have the resources to meet the targets, what should it do? If it stops providing cancer treatment, it will receive even less money. It is easy to see how managers can come to think that falsifying records is the lesser evil, and that anyone who objects must be made to keep quiet.

The market system that NHS hospitals are currently forced to operate encourages fraud. If NHS organisations were free to admit failings without fear, then it would be easier to make improvements.

It is widely recognised that if nurses are afraid to admit errors, then patients are put at more risk, and neither the nurses nor the system learn from the error.

If a nurse realises that she or he has given a patient the wrong medication, then often no-one would know unless the nurse admits it. If the nurse fears a punishment, then she or he is unlikely to admit the error.

But it is better both for the patient and for the hospital if the error is admitted promptly. Then remedial action can be taken for the patient; the nurse can be retrained or supervised if necessary; and factors such as having two different drugs stored side by side which look the same can be eliminated.

Yet the NHS operates more and more with a “blame” culture, and that culture is fed down from managers to other staff. In Colchester, managers put pressure on staff to falsify the records, and bullied junior staff to prevent an exposure.

Another idea in nursing is the “hierarchy of needs”: it is not possible to provide care and compassion for others when your own basic physical and emotional needs have not been met.

If nurses are unable to take lunchbreaks on 12 hour shifts, then it will be harder for them to care for patients, however strict the “targets”.

The RCN reported on 12 November that there are nearly 20,000 nursing vacancies currently unfilled in England.

The number of nursing student places commissioned has been cut 15% since 2010-11, so the RCN forecasts a shortage of 47,000 registered nurses by 2016.

As a result nurses are doing an estimated one million hours of unpaid overtime per week.

The “four to one” campaign,, demands a mandatory minimum of one nurse for four patients. The NHS medical average in 2009 was 14:1, which means a 20% higher mortality rate.

Identifying and tackling problems depends on resources and culture in a workplace. There are organisations which, in the Colchester case, helped provide support to staff, and allowed them to whistleblow, and expose the problems in the waiting times for cancer patients. Organisations which can help staff trust each other, and feel strong enough to try to change things. Organisations which can fight for better resources.

Those organisations are trade unions.

A union can provide a safe place for members to voice their concerns and discuss how to improve things. Trade unions can be experts in health and safety.

Yet many trade union workplace organisations are too weak to do what they could do. That is a large part of the problem afflicting the NHS at the moment.

The media will use the Colchester scandal to try to paint the NHS as a failing institution, and add weight to calls for “reforms” that mean destruction. But the real answer is to ensure that all NHS services have the resources they need.

And a chief way to do that is to build strong unions in NHS workplaces.

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