Opinion: Sometimes we should all try to go back to basics

Julia Neuberger, a Liberal Democrat peer and chair of the Commission on the Future of Volunteering

The Nursing Standard reports that Guy's and St Thomas' NHS Foundation Trust's initiative of senior nurses working on the wards with junior colleagues on a regular basis has been a huge success.

A hundred or so senior nurses work on the wards on Fridays, and have saved the trust £350,000 since June on employing agency staff.

Director of nursing Eileen Sills said she had been concerned about the visibility of senior nurses and wanted them to have a greater presence.

After their Friday sessions, the nurses meet to discuss their concerns.

Ms Sills has now appointed a second elderly care matron and seconded another matron to act as older people's champion. But the most important outcome seems to be that the incidence of falls amongst older patients has fallen by an astonishing 70 per cent.

Voluntary sector organisations working with older people ought to be asking themselves some serious questions in the light of this. Would bringing senior people into everyday working practice have a similar effect in their institutions? Would asking more experienced people to spend time at the coal face get things dealt with that junior staff do not notice - or, worse, feel a lack of power and influence to change?

I do not believe the NHS in general, and Guy's and St Thomas' NHS Trust in particular, is so different from voluntary sector organisations. Indeed, I do not believe that looking after vulnerable older people and reducing the number of falls so dramatically is different from getting senior people on board at the front line with people with learning disabilities or severe mental health problems. One key advantage senior people have over junior staff is knowing how to work or influence the system. If they can reduce the falls rate by 70 per cent at St Thomas', perhaps we can reduce the distress rates among vulnerable people with mental illnesses or make sure people with learning disabilities do not get excluded from health services.

This is important for the voluntary sector, particularly for the service-providing part. Most people who provide front-line services are relatively junior. Senior staff are in management and get distanced from what goes on in people's own homes, hostels or rooms in care homes. Guy's and St Thomas' has demonstrated something important.

Will Age Concern, Help the Aged and other older people's charities take note and encourage voluntary sector service providers to do something similar? And can we extend this beyond older people to the wider care-providing organisations? I hope we can. Senior people need to see what goes on, and they know how to improve things. Junior staff feel enthused by seeing senior people working with them. It's a no-brainer for the voluntary sector to follow suit. If it happens on a large scale, that would put pressure on the NHS to do the same, more widely than just at Guy's and St Thomas'. And that really would influence practice for the better.

AND WHILE WE'RE ON THE SUBJECT ...

- The practice of senior people going back to do more junior jobs is not believed to be as widespread in the voluntary sector as in the private sector. It has been the subject of the BBC programme Back to the Floor, which has run through five series and recently showed Eric Bonnot, chief executive of Burger King, doing a shift at a Liverpool branch.

- Bonnot's lack of experience showed. "I can't get my feet, hands, brain and smile to work all at the same time," he confessed. In an earlier series, Luke Johnson, millionaire owner of the Belgo restaurants, got fed up with peeling onions for a moody chef, ripped off his microphone and told the producers to "shove your programme".

- One voluntary sector boss who goes back to the floor is Peter Cardy, chief executive of Macmillan Cancer Support. He recently spent three days going out with care support workers in south London to the homes of Macmillan clients, where he made cups of tea and talked to people about coping with their illnesses.

- Cardy says: "I do it because I don't believe you can run an organisation that is about helping real people from the top floor of a tower block by the Thames. You have to remind yourself frequently of what the business of the charity actually is, which means getting out and rolling your sleeves up."

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