IHSCM: Your Friday Weekly News, Editorials and Events
AMBER
Red, amber, green – the traffic light approach that guides so much of our day-to-day personal lives, organisational dynamics and societal behaviour. At the most basic level we know that green means ‘go’ and red means ‘stop’. Amber has always been the more challenging element. What does amber really mean? The Highway Code describes it thus: Amber means ‘Stop’ at the stop line. You may go on only if the amber light appears after you have crossed the stop line or are so close to it that to pull up might cause an accident’. To my mind this means that we should prepare to stop.
You will know perfectly well by now why I am writing about amber. Right across the UK, health and social care providers continue to be challenged by staff shortages and in all the recent workshops at NHS premises that I have undertaken, nurse leaders consistently talk to me about those shortages and the ‘amber’ status that they provoke. When the Chancellor of the Exchequer, Secretary of State for Health and Social Care and Prime Minister all talk about financial black holes, the need for NHS reform and a requirement for spending to be reined in, the amber lights multiply very rapidly. I wonder whether any of them have had the opportunity to talk to people like you on an open basis about your experience of what happens when amber staffing levels are identified. I doubt that there is a single nurse working in the NHS now who hasn’t been obliged to complete a shift in the last month in the knowledge that there were insufficient staff available to deliver prescribed safe care.
Yes, the RCN and others provide guidance and letters on what to do if a nurse feels that safe staffing is absent and your trust will have incident procedures, but it is now so universal and frequent that there seems little point beyond personal audit trail protection. To be fair, what are you as a manager supposed to do anyway? Three times in the last couple of months I have been obliged to offer comfort to visibly distressed nurse and operational managers as they tell me of the strain and anxiety that the situation of, at best, amber staffing provokes. They feel that, even of they raise the matter with their line manager, nothing can or will change. Recruitment freezes are in place. Agency hire is very restricted. The implication to them is ‘get on with it as best you can – highlighting it isn’t going to help you or your staff’.
NHSE have impossibly dense / impenetrable guidance and policies on staffing – have a look HERE and HERE to see what I mean. And even the RCN acknowledge that ‘there is no simple tool or method’ for assessing safe staffing.
I’m afraid that the effects of this are dreadful. Walk around your place of health and social care work and see how many health professionals are now not routinely wearing name badges. Dr Kate Granger’s heart would be breaking over the damage being wrought to her inspirational ‘hello my name is’ campaign. Name badges are being consigned to the drawer because patients and families increasingly use them to single out individual care professionals in complaints provoked by insufficient care. I have seen evidence of name badges being used to track down health professionals on social media to direct online abuse at them for perceived poor care – most of it as a result of insufficient staff. Some of it is malicious.
There is little wonder that the staffing crisis shows no signs of being resolved whilst our staff are being subjected to this sort of stuff. I am starting to marvel at the fact that we have any frontline staff at all.
What to do? Well, sooner or later a chief executive of a hospital trust is going to have to be courageous enough to call ‘stop’ and illuminate the red light. That will be provoked, in my opinion, only when enough people like you raise and document your concerns and make it clear that your staff simply can’t deliver safe care on a consistent basis. You’ll get the most horrible pressure and, no doubt, assertions that you are being melodramatic from the hierarchy and, if you in a very senior role, the mandarins of the DH&SC, but your staff need someone to stand up and say ‘enough’. The patients and communities that you serve do as well.
I take no pleasure in being obliged to write this editorial. But I must speak up for those who feel silenced and have confided in me. Write to me with your views. What should be done? jwilks@ihm.org.uk.
Stay safe, stay strong, and thank you for the brilliant work you are all doing.
Jon Wilks, CEO