For anyone with some experience of poor care on an NHS ward, or who has read the numerous stories of patients badly treated by over-worked or harassed nursing and care teams, yesteday’s revelation in the Sunday Times that people are now employing private nurses to look after them on NHS wards will seem understandable.
Although the practice of employing private nurses, often at around £200 per day, is not that widespread yet, the article suggested that the Patients Association believed that many NHS nurses welcomed these privately-funded nurses onto the wards as it helped ease their workload. That may be true, and there certainly can be no doubt that the intensive supervision that those with private nurses receive will certainly help to identify and ameliorate any post or pre-operative complications. The mantra of choice and patient-centered care has been at the heart of government health policy for the last 10 years, but why does the idea of people employing their own nurses on NHS wards seem so strange?
The first reason is a practical one. How can care effectively be organised so that the dividing lines between what the NHS nurses and private nurses do is clear to all? Would the private nurse step in if he or she saw another patient suffering on a ward and there was no immediate NHS nursing assistance available? There is also the insurance ramifications and certainly the experience of Prestige Nursing and Care with some NHS Trusts in Bristol is that they simply do not countenance this type of arrangement for that very reason.
Then one has to consider the morale of both the NHS nurses and patients on wards where these private nurses go into work. With an Orwellian twist it now seems that all patients are equal, except that some are more equal than others. This has always been true when you consider private hospitals and clinics and even private wards within NHS Trusts, but such encroachment into your common or garden NHS ward sends dangerous signals to both patients and nurses alike. On a larger scale it also calls into question how holistic the care the NHS gives can be. If patients are effectively voting with their wallets by saying they are happy to have the more acute clinical procedures undertaken with the NHS but do not trust it to provide effective after-care, you are faced with the very real danger of fragmentation of many services which themselves rely on an holistic approach.
So how has it come to this? Those with means have always had the opportunity to choose additional care if they so wanted, but the NHS has largely remained sacrosanct. The debate must now move on to address two key questions, both of which have been asked many times throughout this year. The first concerns the role of acute hospitals in a modern 21st century healthcare system and whether there are other options best suited to treating the elderly or those with long term ocnditions. The other question relates to nurse training, and whether the current system is producing those with the right skills and attitude to flourish in the role. We can never be sure whether instances of poor care are because nurses are either unwilling or unable to provide the level of care they should all aspire to, but public perception seems to be favouring the former explanation at present.
The late Steve Jobs of Apple famously favoured closed systems over the open ones of Windows, because be wanted to control every aspect of the user experience without outside software or hardware developers becoming involved. He felt that this control delivered much higher levels of user satisfaction and reliability than his rival Windows, which was put onto any PC that wanted it. The analogy is certainly true here, the traditionally closed system of the NHS ward is in danger of opening up to outside parties and in doing so becoming merely a platform where disparate parties co-ordinate to deliver care. Although agencies like Prestige Nursing and Care do benefit from the demand from private nurses going into hospital wards, I still favour the good old-fashioned closed system of the NHS. What Apple did to ensure this type of system remained popular was to relentlessly innovate, what the NHS must do now to stop this becoming the thin end of the wedge is to follow suit, starting with how it organises and delivers nursing care.