It can sometimes be hard to innovate in the National Health Service, but the suggestion of nursing report cards seems to have received a warm welcome. The idea is that patients would be asked their views on the care they are receiving in hospital and that the results would be displayed outside hospital wards for all to see. Unison Scotland says the cards could have a positive effect on patients' health and wellbeing and Theresa Fyffe, director of the Royal College of Nursing Scotland, says she also fully supports the idea. "We have been arguing for it for some time," she says.
It should probably come as no surprise that the nursing community has given its support in this way, because the idea of report cards is a strong one in principle. As proposed by the chief nursing officer Professor Fiona McQueen, it would work by asking patients for their views while they are on the ward, possibly through an electronic system to make it as easy as possible. The intention would also be that the cards would be uniform across Scotland to allow easy comparisons hospital to hospital and ward to ward.
The potential benefits of such a system are obvious. Firstly, a strong NHS is a transparent NHS and report cards would offer as much transparency as possible about the views of patients. The report cards would also include information about staffing levels, revealing whether patients feel the staff have enough time to care for them. Staff shortages in nursing have been a particularly pressing problem in recent years, with nursing leaders claiming that the majority of staff say they are too busy to provide optimum levels of care. The more information we have on the problem, the better able we will be to demand a solution.
However, any welcome for report cards comes with some caveats, and the first concerns the practicalities. The Royal College of Nursing Scotland says an effective, evidence-based assurance system is welcome but Unison Scotland is right to express some concern about potentially increasing the workload for nurses. Unison's Danny Phillips says his members are not against the idea, but compiling a report will be another daily task in an already busy day. If report cards are to be introduced, staff should be given the time they need to complete them.
There is another potential risk with report cards which is that staff who are already working hard will be demoralised by seeing a report card criticising them and the care they offer. It is a good sign that Professor McQueen appears to have anticipated this problem and says that nurses have to be offered the support they need. The theory, says the professor, is that the data will be used for improvement rather than judgement, which will be a useful principle to remember when the system gets underway.
When it does get going, there will be potential for it to encourage change where change is needed, but there will be little point in highlighting where care is falling short without also being prepared to tackle staff shortages. Last year, an official survey found that two-thirds of NHS Scotland staff feel they cannot do their job properly because of shortages, but in response NHS Scotland says staffing levels are high. The Scottish Government also claims that they have increase the NHS workforce.
It is hard to determine what is really happening when there are such contradictory messages, but it may be that staffing is indeed rising but that demand on the NHS is out-stripping it. They will need to be introduced with care, but hospital report cards may just help us get to the truth of the matter once and for all
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