Are 12-hour nursing shifts harming care? Plus a tribute to a popular manager.

Quality shift

There’s much talk about a lack of quality care for patients, and everyone offering advice as to how we could do it better. Good care has been significantly challenged by the expansion of 12-hour shifts into the day time routine of care for nurses. At a time when the European working time directive has reduced lengths of shifts for junior doctors, they have lengthened for nurses, often at their own request.

I wonder how many medication errors and back injuries occur in the last 4four hours of a 12 hour shift, when staff are weary. How many of us as patients would like to be cared for by a nurse who is in her tenth hour of work, probably with no real break?

Equally, the lack of an afternoon overlap has removed all chance of training opportunities, with consequent effects on care. Even more worrying to managers as well as patients is the notion that a nurse now expects to spend more days away from work in a week than there. This doesn’t help the work ethic, or the idea of continuity of care - especially when ward managers are doing this too.

As senior managers, let’s have a long hard look at whether being away more than being there, is really good for patients.

Veronica Corben, assistant director of nursing, Chelsea and Westminster Hospital

David Kenny – a tribute

On 27 March, in the Great Hall at Bart’s Hospital, there gathered some hundred NHS leaders – past and present – to mark the death of David Kenny and celebrate his life. The event was remarkable because it is 20 years since David Kenny retired from the NHS on the grounds of ill health. He was then regional general manager for North West Thames Health Authority and only in his forties.

The occasion recorded both the passing of David Kenny and the passing of a collegiate style of management. I joined the NHS from industry as part of Kenneth Clarke’s drive to introduce general management to healthcare. I was welcomed into North West Thames by David and enjoyed not only his support, but also that of the regional officers and my fellow District General Managers. As district general manager for the people’s republic of Brent, I certainly needed it.

In these days of corporate identities, it is fashionable to scorn the interference of “region” and the Department of Health. There were probably few in the Great Hall who regretted the separation of purchaser and provider, but many would have missed the corporate and collegiate nature of healthcare management over which David Kenny presided so effectively. As an outsider who frequently broke the rules – not always unintentionally – I found the commitment and ability of senior managers far superior to my experience in industry. We also benefited in North West Thames from David’s support from the centre. Monthly meetings were both valuable and fun.

As DGM in Brent I did not always appreciate David Kenny’s foot on the brake or his sometimes less than gentle tap on the shoulder, but I got to appreciate that he was always acting in what he perceived to be the best interests of the NHS. Although no older than most of us DGMs, he paid special attention to developing our management skills and social networks. David Kenny’s influence has been long lasting and many of his friends and colleagues would acknowledge their debt of gratitude to him in advancing their careers. As do I.

Lorne Williamson, Cambridge

The solution to IT failure?

It is indeed the goal of every NHS organisation to deliver locally responsive, patient centred services (Resource Centre, page 32, 22 March). However, in order to do this, organisations do indeed need to invest in IT projects to generate better information to enable them to perform to this standard of delivery.

Yes, the concept of any new system within an established organisation is a daunting one, but it is also a necessary step towards driving down costs and improving efficient and patient care. IT solutions can provide multiple benefits for integrated care – they key is in the careful execution of these projects by a suitable a supplier.

As we are all aware there have been many well publicised cases of when IT solutions have not achieved the benefits sought and needed within the NHS. But local NHS departments need to see beyond past mistakes to maximise the benefits that effective IT solutions can provide.

By working on local systems, NHS organisations can escape the bureaucratic burdens associated with designing, commissioning and implementing systems on national scale increasing the speed of delivering a project driving down costs and not jeopardising the quality of service. And clinician engagement at every stage is, indeed, the key to success.

It all comes down to a simple yet effective back to basics approach. Technology can only be a means to an end for the healthcare service and by employing a niche supplier that is experienced within the healthcare market – and that inevitable fast-moving NHS landscape – with a proven understanding of the NHS, to design and create specialised solutions working with clinicians on clinical-led projects, real benefits for patient care can be delivered.

John Sanderson, director, Hicom