Having the courage to care—lessons learnt after Mid Staffordshire

Abstract

G ood nurses need to work with their ‘hearts and heads’. They should be thoughtful as well as respectful practitioners who can deal with the complex and specialist needs of patients, but who also have advanced interpersonal and teamworking skills to enable them to work with and support others. Nowhere is this more important than in the care of older people. It was the frail and vulnerable who were most failed by the system and by nurses in Mid Staffordshire NHS Trust in the period covered by the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Department of Health, 2013). There is much to be learnt from the report’s findings and recommendations, but the question I want to ask here is, why did so many people, among them nurses, stand by and not raise concerns? When questions were asked, why did so little happen? And how should students, with their fresh eyes, be helped and supported to challenge the system should it be necessary? One of my early academic jobs was as a senior lecturer in a medical school. I remember my boss at the time, the head of department and professor of general practice, an eminent leader in the field, saying that medicine recruits young idealistic students and turns them into qualified doctors who have lost the ability to communicate and show empathy. He was exaggerating to make the point that individuals can become institutionalised. The inquiry report criticised the culture at Mid Staffordshire that prioritised performance and targets over people and quality. This was enough to create conditions in which neglect and poor care prevailed, despite the fact that there was variation and were patches of good practice. But why did so many nurses stand by and not raise concerns? It suggests collusion and a culture of indifference that fostered a regime of neglect. The inquiry report describes a culture of habituation and passivity in the face of real suffering. It took brave individuals to make a stand; a few did, but were not heard. Nursing as a profession struggles to Fiona Ross