Why NHS leaders who blow the whistle on poor care should be applauded

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Scotland’s most senior nurse, Fiona McQueen, has publicly apologised after an outcry following her publishing a blog which called for greater professionalism in nursing and midwifery. She shouldn’t have felt she had to do so.

Much of the furore concerned four hard-hitting examples from personal experience that the chief nursing officer singled out: “If you wet the bed we’ll call you pishy pants,” a registered nurse said to a patient, for example. McQueen wrote about how her own niece’s midwife made her feel unwelcome, then took the premature newborn away from the new mother with no explanation. She referred to a mental health nurse who couldn’t articulate exactly how they contributed to their patients’ care, and another nurse who could say nothing more positive than they had been in their job “too long and it beats no job”.

She wrote:

At all times I want nurses and midwives to put their patients first. No skipping off for a break when relatives need to speak to you, or worse when patients should be having their meals served. But also, nurses in leadership roles need to ensure nurses are working within an environment where there are enough nurses to deliver care safely and effectively.

If McQueen’s intention was to be challenging and attention-grabbing, she succeeded. An official complaint from Unison resulted in a storm of Twitter protest, including calls for her resignation, as well as national media publicity. It was sufficiently contentious to become the subject of a national BBC radio phone-in.

Not everyone was against what she said. There was notable support from distinguished nursing leaders such as my colleague June Andrews at the University of Stirling, who described the blog as “visionary”; and from The Royal College of Nursing, which highlighted the importance of being able to raise concerns about poor practice. She also had her fair share of supporters on Twitter.

But faced with a considerable outcry, the chief nursing officer apologised on radio for any distress that she had caused hardworking nurses, midwives and other healthcare professionals. Inevitably, her partial climb-down has diminished the force of her original point.

Telling it like it is: Scotland’s chief nursing officer.

The hard facts

So was such an outcry justified? First, it is important to read the whole blog to understand these criticisms in context. It was a call for improvement in nursing and midwifery care, and by implication across the whole NHS. McQueen made various positive comments, including:

I have met some outstanding undergraduate nurses and midwives who give me real hope that our future is safe in their hands.

And

I have met some outstanding nurses and midwives and hear of examples of care being delivered that is so good it’s breathtaking.

As for the state of the NHS, patient complaints are on the increase. In 2014-2015, NHS Scotland received more than 22,400 official complaints, a rise of 9% on the preceding year. This equates to about 61 each day. Around 57% were upheld, with treatment and staff among the most common causes of complaint.

It is hard to compare with elsewhere in the UK, since systems differ and statistics are not compiled at national level. But locally, the picture appears similar. A recent external review of hospitals in Wales found clear examples of poor quality care. And national surveys of maternity care in Scotland and England have found that around a third of women report not always being treated with kindness and understanding in hospital after giving birth.

Up to scratch? ariadna de raadt

Complaint statistics and external reviews should be approached with caution, however. Each of these instances might represent a failure of care, but they must be viewed along with the wealth of other healthcare experiences. In fact, in 2014-2015 only 0.05% of NHS patient contacts in Scotland resulted in an official complaint being raised, and a recent patient experience survey showed that satisfaction with inpatient nursing care was very high, with significant improvements across all areas.

Notwithstanding this, McQueen’s blunt but effective examples of poor clinical care are clearly not unique – and may be on the rise. This makes patients’ dealings with the NHS feel like a lottery, leaving them wondering whether they will have a good or bad experience. No one who is sick or vulnerable should bear this additional burden of uncertainty. And not only is poor nursing care unpleasant – it can also be dangerous. This was clearly demonstrated in a report about Vale of Leven hospital in the west of Scotland, which found that systemic nursing failures contributed to patient deaths from Clostridium difficile infection.

It is therefore right to call out poor practice to raise awareness. We need healthcare leaders who continually strive for excellence, who support professionals working tirelessly to provide the best care in difficult circumstances, but who are not afraid to be honest when they see failures. We are fortunate to have McQueen. We should expect no less from those who lead our National Health Service.