Where do we go from here?




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Children's nurses like most nurses are recovering from the shock that the reports from the Care Quality Commission (CQC) on the care of older people have generated. They are also reeling from the appalling abuse that the television programme Panorama revealed in a documentary on an independent facility for learning difficulties. The image of nursing and care has been badly affected. Poor care cannot be condoned, but what has brought some nurses and carers to this point?

A defensive response might be that staffing levels, burnout, recruitment, overwhelming bureaucracy and managerial difficulties in addressing poor performance are to blame. There may be issues with nurses' attitudes, culture and education but some apportioning of responsibility has to go higher. The loss of the ward kitchen did not enhance patient nutrition just as the loss of the ward cleaner did nothing for infection control.

As horrific as the evidence uncovered by the CQC reports was, it accounted for only one quarter of care seen by the CQC. The provision of satisfactory, even excellent, care was in the majority.

However, that does not make great news. The cases have come at a time when the NHS is being reformed and, perhaps, they add weight to the arguments of those who believe reform is overdue. The CQC has also safeguarded its position, while other quangos are being disbanded, are under review or have had their funds or roles scaled back.

Where do we go from here? Children's nurses need to take the reports seriously and not view them as isolated incidents in someone else's backyard. We need to look at ourselves and what we do. Would an outsider approve of actions taken for containing or comforting a child? Might they interpret what we do differently to what is intended?

We cannot be complacent - an investigation into London's specialised services for children has uncovered some worrying case studies (page 6), quality needs to be kept firmly on the agenda with good placements for students (page 20), and examples of excellent palliative care (page 14).



Care Quality Commission, CQC Reports


Crawford D. (2011) Where do we go from here? Editorial. Nursing Children and Young People, 23 (6) pp. 3


Research Institute