Managers should work out of hours, says dignity report

18 June, 2012 | By Sarah Calkin

NHS managers need to be more available outside normal office hours in order to improve the care of older patients, a new report has recommended.

Delivering Dignity, the report from the Commission on Improving Dignity in Care for Older People, also recommends senior NHS managers invest time in getting an impression of how care is delivered in their organisations.

It claims staff seeing non-executive directors and managers talking to patients and their families will “understand that the organisation sees dignified care as a priority”.

The report, which was compiled after receiving submissions from around 230 organisations and individuals, found evidence staff on duty outside regular hours did not always have the skills, experience or support to make urgent decisions. It calls on managers to ensure that “appropriately senior and suitably qualified staff are available on all shifts”.

It recommends sisters and charge nurses are given “significant responsibility” for staffing and budgets and all staff involved in caring be given time to reflect on their role.

The commission was set up by the NHS Confederation, Age UK and the Local Government Association to complement the public inquiry into the system failings surrounding Mid Staffordshire Foundation Trust by looking into the provision of care to older people in hospitals, the community and care homes.

Commission joint chair Keith Pearson said there was a need for a “major cultural shift” in the way the NHS thinks about dignity to ensure “care is person-centred and not task-focused”.

He added: “This will require empowered leadership on the ward and in the care home, as well as a lead from boards and senior managers. It will also mean changing the way we recruit and develop staff working with older people.”

The report also recommended hospitals and care homes collect “extensive” feedback from older people, their families and carers and the Department of Health work on producing a patient record, which is owned by the individual and give’s details about their life story, family and likes and dislikes.

It suggests commissioners consider requiring independent advocates for older patients in service specifications, who would then give feedback to both the commissioners and the providers.

Readers' comments (11)

Tom Dewar | 18-Jun-2012 1:18 pm
Good stuff. Though does give the false impression that NHS managers are currently not available out of hours. All the hospital's I've worked in have on-call rotas for their Execs and senior service managers providing 24/7 cover.
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Anonymous | 18-Jun-2012 2:46 pm
Having worked in both acute and commissioning organisations I can safely say that on-call rotas for execs and senior managers are a normal feature in both. Assume the same is true in mental health trusts (which one might expect to have a particularly high proportion of older patients). Very much doubt many (any?) NHS organisations would expect the same of their non-exec directors however - this isn't normally part of the role of a NED and probably wouldn't fit within the usually fairly limited number of hours/days per month that NEDs expect to devote to Trust business.
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Anonymous | 18-Jun-2012 3:30 pm
But aren't the on-call rotas about covering emergency/non-standard situations? Observing the realities of normal in an abnormal situation doesn't usually work.

I think this is commending management to be nore avaibale out of hours in normal, not 'on-call' situations
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Blair Mcpherson | 18-Jun-2012 3:47 pm
Management is about promoting good practise and challenging bad practise. That's why the recommendation is for managers to be seen and seeing in the evenings and weekends not just 9 till 5 Monday to Friday.
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Anonymous | 18-Jun-2012 9:37 pm
If only it was 9-5!
After starting at 8 this morning I finally left work at 7. This is not unique to myself or any other managers, we do this because there is work to be done.
This does not distract from the recommendations - just dont assume its only 9-5.
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Anonymous | 18-Jun-2012 9:42 pm
Re third paragraph. Non executive directors are not managers. They are not there to manage. They are there to develop strategy, hold management to account for delivery of the same and get assurance on governance and quality. The role of NHS Boards has become inceasingly confused in recent years, and I've no doubt this has contributed to some of the issues we now need to sweep up. We need to separate the roles of Boards and management teams, not make them increasingly and confusingly convergent.
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Anonymous | 18-Jun-2012 11:23 pm
This is an excellent report very comprehensive covering many aspects and it would be wrong to just concentrate on one particular aspect But you would be surprised how may managers and board directors do not spend time in their facilities out of normal hours ( which may be 8am -8pm ) There is aneed to ensure policies and processes are being delivered 24hrs /dayand 7 days aweek But also the emphasis must be on assessing older people quickly so that they can be treated in the most appropriate setting and hospitals should be last resort not the first More effort should be given to admission avoidance
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Michael Boyd | 19-Jun-2012 1:02 pm
In my early career in hospital management (in the 1980's) before and after the days of Griffiths and normative formal on-call rotas, adminstrators/managers of all levels of seniority would occasionally make a point of being in the hospital at weekends and at night, not just to deal with crises, or tick a "visibility" box, but because they genuinely perceived the NHS as a 24/7 service and did so to speak to patients and relatives and recognise and value the people who worked in the hospital 1700-0900 and Saturday/Sunday. We appear to have lost that vocational aspect. Sadly - but welcomed - we now seem to need a report to get it back on the agenda.
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Anonymous | 20-Jun-2012 1:55 pm
Makes me smile. I know what the commission is trying to say but..... already on-call 1:3 to 1:4 and often in on top of a 60 hour a week job. Maybe they want managers to move in and live resident on site with their families! Can I work for the commission?
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Anonymous | 20-Jun-2012 2:19 pm
I'm sure many of us would not mind working at the best times (evenings and weekends) to be visible to families, staff and anyone else. Taking the time out of the Mon- Fri 9-5 workload and meetings is the problem. I've done this is the past and always ended up taking time back at the job's convenience, which was not necessarily mine. If at all. Maybe we should just work even longer hours?? Or, heaven forbid, maybe there could be a small recognition that just sometimes there aren't enough senior people to be everywhere at once......
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Anonymous | 21-Jun-2012 5:11 pm
The managers and Execs in my Trust all work well outside weekdays 9-5 and will smile ruefully at this article. When the going gets tough at weekends, Bank holidays and the like the on call Manager is on site with the Exec on call not far behind them. They do it because they care about the hospital and supporting the front line staff. My team also do "dawn shifts" arriving in the early hours onto wards to ensure dignity and care is being maintained at all times. To work a shift system we'd need more managers (which I'm sure would be politically unacceptable!) as I certainly would not want my team to do yet more. They do way over already because they care about the job
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