According to their latest survey, NHS nurses are still "drowning in a sea of paperwork". Nearly one day in five is spent filling in forms, ticking boxes and ordering supplies. RCN general secretary Peter Carter says:
"These figures prove what a shocking amount of a nurse's time is being wasted on unnecessary paperwork and bureaucracy. Yes, some paperwork is essential and nurses will continue to do this, but patients want their nurses by their bedside, not ticking boxes."Yes, indeed. And visiting Dad in two NHS hospitals over the last several weeks we've been able to study the process up close and personal.
The first stop was a large acute hospital just beyond the M25. It suffers all the usual problems: decrepit buildings, huge financial deficit, and a chronic - and I do mean chronic - lack of parking for visitors. Admission even for blue light emergencies like Dad is via a 12 hour plus trolley wait in A&E, and once finally admitted, care is in the hands of those overstretched uncontactable doctors. The nurses spend huge amounts of time behind the counter filling in forms rather than being out on the ward with patients, and you virtually have to book an appointment for one to stop by your bed. The whole impression is of an operation struggling barely to keep its head above water.
The second stop was one of Britain's top specialist heart hospitals, and it is much more impressive. What's done there in terms of heart surgery is truly world class, and its clinical staff are the business. The doctors are top notch, and the nurses do real nursing (Dad even attempted to take one home with him). Morale seems high, with junior nurses actually on first name terms with the top consultants. True, it's clear that staffing ratios are higher than in the general hospital, but much more striking is the excellent attitude and commitment of staff members.
Yet even here, the nurses told Dad they have a complaint. It isn't the hours, or the inconvenient shifts, or the stressful sometimes stomach-churning work, or even the pay. Their number one complaint is excessive paperwork. And even though they don't let it interfere with patient care, we watched them filling in great piles of paper in every spare moment.
So what's it all for? Why do we need all this paper?
Back in the dark days of the Commissariat, much of it was to satisfy the central planners that patient pathways were being rigorously followed, that prescribed risk assessments were being fully documented, and that every bedpan could be duly accounted for. Or rather, to provide a full audit trail which could be filed away to protect bureaucratic backsides in the event of a system malfunction.
But surely we're now three years on from all that. Surely we don't need all that now?
It's not that Jezza Hunt isn't aware of the problem. He's told us before of the million nursing hours a week spent on form filling rather than caring for patients. Of the nurse who had to fill in a 22 page form and 10 additional forms to get a desperately ill patient admitted to a trauma ward. And of the Hospital Trusts who have to report to, and comply with, 60 different regulatory, licensing, commissioning and public scrutiny authorities. Why, he's even ordered a review of NHS bureaucracy.
But he's attempting to tame a monster. The NHS is far too big, and the bureaucracy far too entrenched, for one single weedy minister to prevail.
The only way of getting on top is to break it up, give us choice and competition, and allow the hospitals themselves to find ways of managing their own affairs. They must be held accountable for results, not for how many boxes their nurses have ticked.