Sunday, 16 July 2017

A Weighty Issue

I have never been on the skinny end of the body shape spectrum. In my twenties my weight was no problem, I was full of energy and constantly busy, the way you are in your twenties. As I have grown older it has become easier to put on weight and harder to lose it. Eighteen months ago I broke my ankle in three places (1), since then it has been much harder to lose weight.

Working as a nurse has never made it easy to manage my weight. Working shifts played havoc with my metabolic system, going from late to early shifts, working nights and being tired and hungry after a shift. The hospitals I worked in never had the best canteens, most times the only decent things to eat were the chips, that is when I got time to have a meal break. I have forgotten many how times I was too busy to even get a meal break. Moving to work in the community I thought would be better for my weight, but it was still as busy, I often didn’t get the chance to have a lunch break and now the only places to get some lunch are supermarkets or fast food outlets, no chance of a hospital canteen.

It’s all very well to tell someone to eat healthy but so often there is much more involved that a simple choice between eating a salad or eating a burger and chips.

There’s now a project to get nurses to lose weight, it’s called Healthy Weight Initiative for Nurses, shortened to WIN, and is being run by C3 Collaborating for Health, London South Bank University, the Royal College of Nursing, the Royal College of Nursing Foundation and the Burdett Trust for Nursing (2), but C3 Collaborating for Health seem to be the organisation leading on it. All the details are on the C3 Collaborating for Health website (2) are that C3 Collaborating for Health seems to be leading on this campaign (3).

In the nursing press WIN has claimed that 25% of nurses are obese, and that 38% of nurses over 55 are obese (4). Yet nowhere on the C3 Collaborating for Health website (5) can I find how they obtained these percentages. They provide no link to the study were this came from, no details of how them obtained these figures, certainly no link to the data they used. The Nursing Standard article (4) references that the figures come from a report Prevalence of obesity among nurses in England compared to other occupational Groups, WIN, 2016, but nowhere can I find this report.

On the C3 Collaborating for Health website there is a blog about the procession of the WIN campaign (3). This blog links to paper about obesity amongst Scottish nurses, Prevalence of Overweight and Obesity Among Nurses in Scotland: A Cross-Sectional Study Using the Scottish Health Survey (6). This study concluded that two-thirds of Scottish nurses are overweight or obese. Shocking. But a closer look at this study and the data does not support this claim.

Firstly this study did not carry out any original research or data collection, what they did was draw their conclusions from a survey carried out by the Scottish government, the Scottish Health Survey. Every year the Scottish government interviews 4,000 Scottish people on a whole range of different aspects of their health, not just their weight, and publishes the results (7). The Scottish government decides what questions are asked, who is interviewed and how the data is analysed. The authors of the study had no input into any of these details, all they did was take the published data and then draw their own interpretations from it, they were using second-hand data. 4,000 people take part in each Scottish Health Survey, the Scottish population is 5.4 million (8). The Scottish Health Survey samples 0.08% of the population.

Prevalence of Overweight and Obesity Among Nurses in Scotland: A Cross-Sectional Study Using the Scottish Health Survey (6) based their conclusion on a sample of 411 nurses. There are Trusts in England who employ more nurses than that. A study from 2011 looked at health lifestyles of 551 nurses from one England Trust (9). They found 11.5% of nurses were obese, and that study collected its own primary data. So who am I to believe?

Where is the evidence that a quarter of British nurses are obese? Nowhere that I can find.  C3 Collaborating for Health certainly does not provide it.

C3 Collaborating for Health claim that they gathered information about weight issues in nursing, they said they did this through a survey, focus groups and workshops (3). They also say they spoke to overweight nurses at the RCN congress in 2016 (3). From all this they say they gathered nurses’ opinions on the factors that cause their poor health and weight gain. From all this information C3 Collaborating for Health said they have “development of three stimulating intervention design sessions” (3), only one of which they discuss on their website is a “My Health” page added to each nurse’s yearly appraisal (3). My reaction was, “Bloody cheek!”

Nurses’ yearly appraisals are for our professional development, not for fat shaming. Professional development is very important for nurses, we need to be up to date with current healthcare practice. Who wants to be looked after by an out of date nurse? It is hard enough to get the time and space to have a beneficial appraisal, without them being high-jacked. We need good professional development for good and safe patient care. In the current NHS climate it is hard enough to get training and professional development and appraisals are the gateway to these. Often appraisals are squeezed into free half hours on busy wards, there is already enough pressure on nurses’ time and appraisals are being squeezed and reduced. Now C3 Collaborating for Health want to add another element to an appraisal, an element that will take more time away from planning a nurse’s professional development. And what if the person carrying out the appraisal does not have the tact and skill to sensitively discuss the issues of a nurse’s health? A nurse’s self-esteem and confidence could be shattered.

If this is C3 Collaborating for Health’s best idea for improving nurses’ health (I refuse to use their management-speak buzz words) then they have zero idea of what is involved in working as a nurse, the pressures nurses face daily at work. C3 Collaborating for Health say they did all this research, all these nurses that they spoke with, the results of their survey, (The results of all this they haven’t made available on their website, or I simply cannot find them) and the only way they can think of to tackle nurses’ health is a fat shaming page on a nurse’s yearly appraisal. All this shows is the farcically low knowledge they seem to process of nursing.

Nursing is now a very stressful job and the poor conditions many nurses work under are only adding to their poor health, conditions such as:
  • Nurses working 12 hour shifts without being able to take a break because the ward is so busy (10)
  • Nurses being so busy at work that they don’t have time to keep adequately hydrated (10)
  • Nurses not being able to take their breaks away from the wards they work on (10)
  • The high workloads many nurses now face, and with no national safe staffing levels
  • The high number of empty nursing posts, in December 2016 10% of nursing posts in the NHS were vacant (11), which pushes a lot more responsibility onto a unit’s permanent members of staff
  • The poor quality of food available in hospital canteens. In my Trust’s canteen, fried chicken and chips are subsidised but you pay the full price for healthy salads
  • 12 hour shifts run from 08.00 to 20.00, night shifts running from 20.00 to 08.00. Hospital canteens are closed when nurses finish at 20.30 or later, the only option to eat then being local fast food outlets. Staff working night shifts usually have even less choice, bringing food in from home, what’s available in the hospital’s vending machines or ordering a delivery of fast food
  • The poor quality of food available in hospital vending machines.
As a Community Nurse I have forgotten the last time I took a lunch break. I get back to our office, after seeing my morning patients; eat my supermarket bought lunch at my desk as I do patient follow-up; we have handover and then I have afternoon patients to see, while trying to cram in report and care plan writing before seeing them.

We are legally required to have a twenty minute, uninterrupted break if we work more than 6 hours a day (12). C3 Collaborating for Health doesn’t even call for Trusts be forced to ensure all nurses receive their legally required breaks.

In 2014, Simon Stevens, the NHS England chief executive, called for NHS staff to lose weight to set an example to patients (13). He called for NHS canteens to replace burgers and chips with healthy salads, NHS Trusts to build more gyms, for hospitals to become more cycle-friendly and for Trusts to aware prizes to staff who lost the most weight. Strangely, in the last three none of these have been implemented.

The NHS’s greatest resource is its staff and yet still it under-values them. If a large under of nurses are overweight, and I haven’t seen any reliable evidence that they are, then shouldn’t the NHS be looking at why this is occurring? What elements of nurses’ working conditions are so unhealthy? Instead the NHS just seems to be ignoring the problem, working conditions and staff’s health seem to be at the bottom of their agenda.

I am sure that the C3 Collaborating for Health’s idea will be taken up, fat shaming as part of our appraisals. It is easy and very cheap to blame overweight nurses for being overweight, and yet looking at the unhealthy conditions that nurses are forced to work under would take too much time and too many resources. Unhealthy nurses are not good for the NHS but blaming them for their poor health is no answer.

C3 Collaborating for Health has shown me something though, you don’t have to be a nurse to patronise nurses.

Drew Payne

Friday, 30 June 2017

Data Protection: Another Jeremy Hunt Failure

"Completely unacceptable", Jeremy Hunt described the data leek (1). He said patients needed to feel confident the NHS would look after their personal data. "If we are going to win that trust we need to strengthen the independent oversight of data security within the NHS to a level that we don't have at the moment." (1)

Hunt wasn’t speaking about the patient data leak that came to light this week (2), he was talking about a patient data leak that happened in 2015 (1). 56 Dean Street, a sexual health clinic in Central London, ran a regular email newsletter sent out to its patients, many of whom are HIV positive. At the beginning September 2015 they sent out an email to 780 patients but the person sending out the email newsletter forgot to hide the recipients email addresses. Everyone who received the email could see all the email addresses of everyone else it was sent to (3). Jeremy Hunt was very quick to condemn it and in very harsh language.

Having your health status outed to 779 other people is certainly traumatic and I won’t want it to happen to anyone, but ultimately no one’s health was damaged by it. I cannot say the same for data leak that was revealed on Tuesday.

On 27th June the National Audit Office published a damming report into the NHS Shared Business Services (SBS) disgustingly poor handling of confidential patient documents (4). Jeremy Hunt was forced to answer questions in parliament about this sorry affair (5). It has all made a mockery of his claims, back in 2015 (1), for patients to be able to trust data protection in the NHS.

In 2008 NHS Shared Business Services (SBS), a private company, was created as a joint venture between the Department of Health and Sopra Steria (4). Though a private company NHS SBS is 49.99% owned by the NHS and the Department of Health had three places on the company’s board, though them only took up one of them, Jeremy Hunt himself took that place (5). NHS SBS’s website boasts that the company will save the NHS £1 billion by 2020 (6).

NHS SBS was contracted to deliver medical paperwork from hospitals to patients’ GPs in many areas across the country. First they had contracts with PCTs and then, after PCTs were abolished in 2010, with NHS England (4).

In 2011 NHS SBS’s own internal audit found that they had 8,146 items of undelivered correspondence (4), yet they seemed to do little or nothing about it. In June and July 2015 an NHS SBS administer raised concerns internally about a large back log in undelivered correspondence (4). They raised concerns, in August 2015, that the backlog was now being destroyed (4). As far back as January 2014 Senior Managers at NHS SBS knew about the clinical risk this backlog of correspondence posed but they didn’t have any plans to deal with it (4). In November 2015 the backlog of correspondence was escalated to NHS SBS’s Chief Executive (4).

NHS SBS told NHS England, their employer, about the backlog on 16 March 2016 and the Department of Health (49.99% owner of the company) the next day (4). NHS SBS’s
Chief Executive told the company’s board about the problem on 24 March 2016 (4), a board Jeremy Hunt himself sits on. In April 2016 the Department of Health decided not to tell Parliament or the public about NHS SBS’s failure to deliver patient correspondence (4). They argued that they didn’t want to “worry” patients and the public, and publicising this would have lead to questions they could not answer (4). The subtext being that the Department of Health didn’t want to be embarrassed by this, they were one of the majority owners of NHS SBS.

The DoH did inform parliament on 21 July 2016 about NHS SBS’s failure but only as a written statement (4), if Hunt had done so in person it would surely have generated a lot more publicity. In the written statement Hunt called it “an issue with a mail redirection service” (4). It not mention the potential harm to patients, which NHS England was concerned about, that this backlog of correspondence could cause.

As of 31 May 2017, NHS England has found 709,000 items of unprocessed correspondence and 1,788 cases of potential harm to patients have been identified, so far (4). They have still not finished checking all the undelivered patient correspondence, and do not expect to do so until December 2017, so far they have only checked a third of the documents (7). The undelivered correspondence included cancer test results, child protection details, patients’ medical records, treatment plans which included changes to patients’ medication and forms registering patients with GP practices (4). NHS England estimates that it will all cost at least £6.6 million in administration alone to resolve (4), they haven’t said how much the clinical follow up of the patients involved will cost, and so NHS SBS has borne £2.26 million of these costs (4). Will this be counted against the £1 billion NHS SBS claims to be able to “save” the NHS? (6)

The National Audit Office’s report into all this was very scathing (4). They criticised NHS SBS for its poor response to the backlog, poor management and low prioritising of the backlog and for being “obstructive and unhelpful” to the NHS England investigation (4). They also criticised Jeremy Hunt for a conflict of interest, he was both Secretary of State for Health and had a seat on NHS SBS’s board, he was in charge of the Department of Health who are responsible for NHS England who were the organisation who employed NHS SBS and he was on the board of NHS SBS.

NHS SBS has now lost the contract to deliver medical correspondence (5).

Jeremy Hunt was forced to answer questions in parliament on Tuesday about this scandal (5). He didn’t go willing to parliament, instead he had to be forced to answer questions by the Shadow Health Secretary, Jonathan Ashworth, had petitioned the Speaker of the Commons to hold urgent questions on this (5). Hunt was accused, during these questions, of being “asleep at the wheel” by Labour MP Clive Efford (5).

Answering questions Hunt justified not originally telling parliament and the public about this scandal because he said if he did GP practices would have been “overwhelmed” by calls from worried patients (5). This is the opposite of what he called for after the 56 Dean Street email breech (1). Hunt did admit that the Department of Health’s oversight of NHS SBS was not good enough (5), but this should fall directly on his shoulders because he was the only Department of Health person sitting on NHS SBS’s board. Will he be held directly responsible for this complete failure? Who will he answer to for this?

Hunt also told MPs the investigation had not found any patient harmed by this paperwork backlog (5), but how could he claim this? NHS England’s investigation into this disgusting scandal will not be completed until the end of the end, and correspondence not sent to GPs included cancer test results and treatment plans that included changes to patients’ medication. Again Hunt has made claims that the evidence does not support.

When I first heard about this scandal I can’t say I was surprised, but I was deeply sickened. Again this was a scandal were a private company, contracted to work for the NHS, was putting profit before patient care, and exercising the most disgustingly low clinical governance. What sickened me most was how deeply Jeremy Hunt was involved in this and how he tried to cover it up. Yet again Hunt has shown poor judgement and even poorer leadership.

This isn’t the first time Hunt has failed and failed to such a high degree. I have worked for the NHS for nearly 30 years (I worked in the NHS several years before I started my nurse training) and I have watched a large number of extremely poor Secretaries of State for Health bungle their way through the NHS but Hunt seems to be the worst in my living memory. Whenever there’s a problem or scandal in the NHS Hunt’s leadership repeatedly fails whatever is needed. His reactions show that he just doesn’t understand the problem (8), or he ignores the problem (9), or his actions make the situation worse (10), or he is very quick to pass the blame (11), or worst of all he spills forth untruths (12).

Why is this completely incompetent man still in such an important job?

The answer is simple, the NHS is such a low priority to Theresa May. Her actions since becoming Prime Minister attest to this, starting by not sacking Hunt from his post.

Our Secretary of State for Health is incompetent and one of the worst in living memory, but his repeated failure in the role only bares testament to the poor quality of the leadership of the Prime Minister who keeps him in this post.

Drew Payne

P.S. NHS SBS’s twitter address is @NHS_SBS, why not tweet them with your feelings on how they managed this scandal? I did.

Wednesday, 21 June 2017

Silent Prayers

Bert (not his real name) was a patient on my District Nurse team’s caseload, he needed daily visits to help him take his medication, and he was one of my favourite patients, even though we’re not supposed to have favourites. He and I could talk for far longer than the time I was allocated to his care. Bert was a great believer in capital punishment, not just for murder but for a whole range of different crimes. Every fibre of my being is opposed to capital punishment; no matter how severe the crime the state does not have the right to enact vengeance to such a degree, because capital punishment is no more than vengeance. Yet Bert and I never argued about it. Every time he started talking about capital punishment I’d just quietly change the subject.

My job there was to provide Bert’s nursing care needs, not to argue with his options or to try and change them. I have many patients with whose views I do not agree, I am a very opinionated person (Just read some of my previous blogs to see that) but when I am working as a nurse it is not my place to be forcing my opinions onto my patients; I am there to be their nurse not someone to challenge their views and to even call their views wrong. I would like to do that, so many times I would like to do that, but I just cannot.

This isn’t just my opinion, it is also part of my professional code of conduct (1). Section 1.5 says I must “respect and uphold people’s human rights” (1). The Human Rights Act 1998 lists 18 articles that make up our human rights (2), Article 9 is Freedom of Thought, Conscience and Religion and Article 10 is Freedom of Expression. How can you say you respect someone’s human rights and in the next breath tell a person that their views and beliefs are wrong?

Last year Sarah Kuteh, a nurse at Dartford and Gravesham NHS Trust, was dismissed for what appeared to be expressing her Christian believes (3). She quickly took to You Tube to defend herself (4), saying that she had “discussions” with patients when she asked them what their religious beliefs were. The tabloids were quick to pick up her story. The Daily Mail called it a “persecution of Christians” (5), the Telegraph claimed she was sacked for “offering prayers” (6), “How could telling anyone about Jesus be harmful?” the Mirror asked (7), and the Daily Express claimed she was sacked for offering to pray with fellow Christians before surgery (8). She even appeared on This Morning television program defending herself (9).

Not unsurprisingly Sarah Kuteh took her case to an Industrial Tribunal (10), backed by the organisation Christian Concern (11). Her tribunal was earlier this year and out of it came some very uncomfortable truths.

Sarah Kuteh was open about the fact she’d been working in a pre-admission clinic, and part of her role was to fill out a pre-admission questionnaire with patients. What she wasn’t honest about was when the patient said they had no religious beliefs, in answer to only one question in the questionnaire, then she would preach at them about her own beliefs (12). She told one patient his chance of surviving cancer was better if he prayed (13). She questioned another patient so intently that he was left feeling shaken (14), she had constantly questioned him about his beliefs, offered him a bible and wanted him to join her in singing a psalm. He felt patients shouldn’t have had to face such religious preaching when they were in such a vulnerable position. Another patient felt very awkward after she quizzed him about what he thought Christianity was (14). She implied to another patient that they would be cured if they believed in God (15). Yet another patient complained that she spent more time talking about Christianity than she did on the pre-admission questionnaire (13). None of these patients had said that they asked her about religion, all of them complained that she had preached at them, forcing her beliefs onto them.

Dartford and Gravesham NHS Trust had received eight complaints about Sarah Kuteh, all complaining that she’d preached her beliefs at them (14). After the first five complains Sarah Kuteh was disciplined for her behaviour, this was chaired by the Trust’s General Manager of Medicine and Sarah Kuteh received a Formal Warning (14). This was not the story she implied in her You Tube video (4). She didn’t heed this warning because there were three more complaints about her behaviour after she received it. This behaviour lead to her dismissal, after a formal disciplinary hearing chaired by the Trust’s Executive Director of Nursing and Quality (14). The seniority of the people chairing her hearings is testament to how serious the Trust took her behaviour. Anyone who works in healthcare knows that patients are reluctant to complain, for these eight complaints about her how many other patients did Sarah Kuteh leave upset or distressed by her behaviour?

The Industrial Tribunal did not find in her favour, they found for her employer and that she had been fairly dismissed (15). With the weight of evidence against her how could they have found in her favour?

If Sarah Kuteh had been preaching a far right or far left wing message at patients, if she’d been preaching hard line atheistic views would there have been the media circus around her dismissal as there was? A very well oiled Christian propaganda machine kicked in with her case, getting out her message that she had been dismissed solely for standing up for her beliefs, the media coverage of this case is the evidence of this. But this case isn’t about Christianity or religion or even beliefs.

This case was never about religion. It related to professional nursing responsibilities, behaviour and conduct in a public facing role and position of trust.  Dartford and Gravesham NHS Trust Spokesperson (15).

This case was always about someone forcing their views on other people, people at very vulnerable times in their lives. This case is about someone forcing their views on other people and ignoring those people’s own views and wishes, discrimination of the worse type. This is about a nurse ignoring her responsibility to nurse her patients so that she could preach her views at them. People facing surgery can be very vulnerable, add to that all the worries and concerns that come with a cancer diagnosis and you have extremely vulnerable patients.  Sarah Kuteh seemed more interested in promoting her own views than meeting her patients’ needs. At times her behaviour seemed to border on bullying.

As nurses we are required to deliver non-judgemental care for our patients (1), how can we do that when we tell our patients their beliefs are wrong and our beliefs are the right ones? This is the opposite of non-judgemental.

Drew Payne

 This was the Dartford and Gravesham NHS Trust full response to Sarah Kuteh's dismissal