Accountability

February 5, 2006

I think NMC are revisiting the code of conduct at present; somethng in

NMC news about it.

Margaret Buttigieg wrote:

Dear all

I was quite concerned about the implied implications of the

discussions earlier in the week around accountability - as some people

reading the discussion might think that a qualified HV or SN holding a

caseload was ultimately accountable for everything that happened to any

clients on that caseload whether she had had contact with them, knew

them or not.

Obviously this is not true - a HV/SN can only be held

accountable for work she does and this might include inappropriate

delegation to a team member or failing to follow the agreed programme

of visiting and not raising it as an issue if she does not have the

time to do so - she cannot be accountable for missing something on a

family she has not seen if the policy is to only do so many visits or

to delegate work to others in the team. The issue is the competency

and of course the education and training of the team member the work is

delegated to. If that person is a registered nurse then he/she has

their own accountability and to only do things they feel they are

competent to do.

IF the team member is a nursery nurse or an HCA and the trust

policy is for them to do the work as a delegate task then they as an

employee and the Trust has the accountability as does the manager of

the service.

Lamming in his report on Climbie was very clear about

managerial accountability - and it is well worth a revisit.

I feel very strongly that accountability today within a multi

agency and multi professional agenda is a much wider issue than the NMC

imply in the code of conduct and I think requires much wider debate.

Margaret

February 5, 2006

I think this is very helpful . It makes clear that when

registrants delegate an activity, they are accountable for assessing

both the needs of the person receiving the service, and the skills of

those delivering it. Margaret's points are well made, too; but I

wonder how many managers and PCT clinical governance leads realise (or

would accept) that they are accountable, if they are registrants, for

the level of delegation in their policies?

I am thinking, if the policy is for only one visit/contact by a health

visitor, and subsequent contacts that may be all by more junior staff

or not at all, then if something goes wrong (child protection,

developmental delay etc) then the Trust and managers should be

accountable. The abstract of the Cantrill review of the four badly

neglected children in Sheffield, published a bit over a month ago,

implied only that it was 'bad practice' that led to the case being

missed by the health visitor. The required number of contacts had been

carried out, but the family did not voluntarily renew contact between

them. Management was completely exonerated, which seems very different

to the take of the Laming Report, but perhaps the full review (not

published) gave greater insight into why that was so.

best wishes

Tom Lund-Lack wrote:

From Lund-Lack

I totally agree with you Margeret. As far as using non-NMC

registerd staff we have a quality standard that addresses this issue.

The strategy is that they work within agreed competencies (A4C will

also support this) and that they have adequate training, supervision

and personal development opportunities. We give clients a leaflet about

the health visiting team and what the role of nursery nurses is. This

makes clients aware that they may recieve services from non-registered

nurses but that does not mean that they get any less of a service,

actually they get added value. They are also aware that these members

of staff work under supervision and that the named health visitors

delegate the work to them. Locally we feel that it is important that

delegation is as a result of initial assessment work by a registered

nurse or health visitor therefore antenatal and transfer in visits are

not the responsibility of non-registered staff.

Some nursery nurses run Baby Clinics but this depends on the

level of their experience, training and the client group. Clients know

that the nursery nurses will defer to the HV if necessary. Most nursery

nurses are more than competent to know when something needs referring

for more specialist advice, it's not rocket science. Parents do it all

the time without any training.

accountability