Francis Report - A Nursing Perspective
Jane Buswell is Chair of the BGS Specialist Nurse and Senior Practitioners Group
On reading the Francis report one might be misled into thinking that the report points to nurses as having sole responsibility for delivering compassionate care and that the only professionals delivering care within the NHS are nurses and doctors. It is unfortunate that the significant role of our Allied Health Professional colleagues within the multi-disciplinary team, and their potential for leadership, has not been recognised in this wide ranging and seminal report.
It would be wrong to look at the individual professional recommendations in isolation. Only 33 of the 209 recommendations are specific to nursing. However, many of these are addressing the same issues of leadership, training, regulation, professional accountability and the roles of our professional bodies, all of which apply equally to doctors, and all other professionals within the NHS.
The implementation of the Compassion in Practice strategy, launched by the Chief Nurse in December will be just one of the actions undertaken by the profession to address the issues around the lack of compassionate care received by many older people. The 6Cs are: Care, Compassion, Competence, Communication Courage, and Commitment. Not new in themselves, the strategy is a new approach to define the core elements and values that underpin care wherever it takes place.
One of the key recommendations is that the special requirements of caring for older people should be recognised by the introduction of a new status of a registered older person’s nurse. This is a golden opportunity for the BGS, as a multidisciplinary association, to play a key role in the development of a post registration, nationally recognised and accredited qualification in the speciality. Although there are standards for Specialist Education and Practice (UKCC, 2001), since the demise of the Nursing Elderly People courses, when the English National Board was subsumed into the NMC, they do not specify educational requirements or qualifications for working with older people. The responses made by the BGS to the Shape of Training (Greenway review ) can equally be applied to nursing and AHPs, particularly in relation to the level of foundation and core training.
The Francis report recommends that the Nursing and Midwifery Council (NMC) should introduce a system of revalidation, similar to that of the GMC, as a means of reinforcing the status and competence of registered nurses, as well as providing additional protection to the public. There have been a number of other reviews of the NMC regarding its effectiveness in both regulating nurses and protecting patients. This now needs to be addressed with some urgency if the additional recommendations made by Frances are to be implemented.
Both the General Medical Council and Nursing and Midwifery Council must develop closer working relationships with the Care Quality Commission – in many cases there should be joint working to minimise the time taken to resolve problems and to maximise the protection afforded to the public.
Francis recognises the conflict and dilemma that has been present in our professional body, and the issues that the Royal College of Nurses faces. He recommends the professional voice needs to be strengthened, and that the RCN should consider how better to separate its trade union and professional representative functions.