The times they are a'changing.
Or, at least, they ought to be, according to Dr Jason Leith, the Scottish Government's new health czar. In an interview in The Herald today, Dr Leith asks a challenging question: "Can we force the system to be nicer?" His appointment comes in the wake of the exposure of serious failings in the standards of care in Scottish hospitals, particularly in geriatric wards.
Not all changes are about hard cash. Dr Leith cites restrictive visiting hours as an area where patients and their families could benefit from change.
Scottish hospitals vary considerably when it comes to visiting hours and there are even variations between one ward and the next, with critical care, paediatrics and maternity most likely to offer more flexibility. Meanwhile, some wards managers oblige visitors to wait in the corridor until the appointed hour, eject them as soon as the bell rings for the end of the allotted timespan and give the distinct impression that they regard patients' loved ones as an impediment to their work.
The Critical Care Unit at the new Forth Valley Royal Hospital in Larbert is at the opposite end of the spectrum. Staff there have gone out of their way to write "welcome" on the mat, with family visitors admitted at literally any hour of the day or night.
Understandably staff have mixed views about such a radical departure from convention. Some welcome the opportunity for closer contact with relatives. In assessment and geriatric wards, relatives can play an active role in helping explain treatment to an elderly person who may be confused and, given the concern about nutrition, they can support staff by helping with feeding.
Other medical staff may regard relatives as a distraction or an interference with the smooth running of the ward. Perhaps they fear that the more relatives see, the more they are likely to complain.
In the 21st century and at a time when the care needs of patients are a subject of real concern, flexibility should be the rule rather than the exception. Clearly, some restrictions are needed to safeguard patient safety and dignity. Visitors need to understand the need to move away when a confidential discussion is going to take place nearby or during certain medical procedures. However, in general, patients are likely to benefit from longer or more frequent visits from those they love. Meanwhile, the presence of relatives takes some of the mystique out of the hospital experience. Inflexible visiting times often prevent those who work shifts or antisocial hours from visiting hospitals and a more flexible regime can accommodate more shorter visits.
In a target-driven culture and a service that has witnessed the professionalisation of nursing, there is a danger that compassion gets relegated, especially when staff are overstretched. The presence of relatives should never be a substitute for professional staff. Over-dependence on relatives for tasks such as feeding and helping a patient walk to the toilet risks resulting in the neglect of patients whose relatives are not willing or able to visit. However, in the second decade of the 21st century, the NHS should be able to offer person-centred care, not rigid ward routines and institutional culture. Times must change.
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