The health Ombudsman has released a report saying that not enough is being done for elderly people in the NHS. The report has been published widely in the UK press, with many opinion pieces resulting from it.

It’s a report in that it consists of ten narratives based on ten complaints. To that end, I’m not sure it could be said to be representative of the NHS as a whole, and certainly I know of several nurses who are distressed at their good professional name being tarnished with headlines resulting from the report. I am also intrigued by the authors’ use of descriptions of patients which rests on illustrative stories from their lives, pre-hospital, as ‘proof ‘ of their worth. In fact anyone should have good care whether or not they have been interesting and/or intelligent or whether they are unpleasant or dull. I suspect that they have been included as an attempt to ‘humanise’ the stories: but there is not an equivelent narrative explaining or understanding why things went wrong from the NHS’ side.

In any large organisation such as the NHS there are going to be problems. Certainly you need to try and prevent and minimise them. What the Ombudsman does not realise it the extent to which external interference has distrupted the interaction with doctors, nurses and patients. When nurses have a new patient they have reams of risk scoring exercises to perform (DVT risk scores, fall risk scores etc) taking up time, paper and mental space. Many of these have been introduced after similar external outcries. Patients are devolved to tick box paper based exercises. The very art and practice of nursing has been reduced down so that nurses can only be promoted or progress through their career through management positions or doing routine tasks previously done by doctors. There is little official recognition of the enormous and essential value of high quality ‘shop floor’ nursing. Many ‘routine’ tasks of nurses – washing, cleaning, feeding – have been delegated to nursing assistants. Many are excellent: but the shift in what is deemed ‘valuable’ work, worth paying well for, harms patients if these tasks are seen as low skill rather than high value.