You won’t have failed to see the NHS in the news yesterday. I find it difficult, as a former nurse (and as a mother and a daughter), to comprehend how hundreds of patients can die needlessly in the care of the NHS. The day the ‘Francis report’ is issued has been long awaited and not without trepidation within the NHS. More accurately described as the Independent Inquiry into care provided by Mid Staffordshire NHS Foundation Trust January 2005 – March 2009, this is the public inquiry instigated almost entirely by the carers and patients of the Trust following months and years of concern over bad care, denials of dignity and unnecessary suffering.
These weren’t deaths resulting from cutting edge clinical trials or even malpractice. They were due to systematic denial of care; food, fluid, medication and safe environment.
This is surely unprecedented in the NHS but can it be explained rationally? Probably not, but the recent history and current culture of the NHS has some bearing on the systematic failure at all levels to prevent this national disaster (my words). Yet we hear that there is to be an immediate review of a further 5 hospitals, based on their standardised hospital mortality rates being the worst in the country – a pertinent position for Mid Staffordshire NHS Foundation Trust. However good your finances are or your performance target achievement or your quality rating: if more patients are dying in your organisation than your peers; you are doing something wrong.
Many of the ingredients that led to ‘Mid Staffs’ – that’s a new adjective in the language of the NHS, meaning “disaster waiting to happen” – are seen across the NHS: costs seemingly out of control, demand for services rising beyond the that predicted, downward pressure to come in on-budget and on-target, quality outsourced to external agencies without the clout; or confidence; or expertise to challenge.
If I were to use one word to summarise the root cause I would use “pressure”. There is downward pressure from the Department of Health, through the (then)Strategic Health Authorities; via Primary Care Trusts to NHS provider organisations to not only deliver on-target and on-cost but to not fail; not to be seen as failing. A failing organisation on your watch is career limiting. Conversely, or perhaps as a consequence of the culture of not being able to fail, there is pressure to dilute and generalise issues as they are reported upwards from the provider to the commissioner of services. Overspends are not fully transparent until it’s too late to do anything about them other than cost saving initiatives that usually involve the human resource as the major cost of the NHS; targets are worked, rather than genuinely met; and remedial action plans are abundant.
It’s all about culture: the NHS needs to re-find its caring culture, yes, but also to develop a culture where commissioners, providers, services and individuals can raise their hand and say; “We need help here. We have an issue we cannot solve ourselves”. Some of the solutions will not be palatable to all; it may mean radical change to how the NHS is funded and delivered but that is surely better than a “Mid Staffs” happening elsewhere. Primarily though it is about seeing the patient as central to what we do in the NHS; why we are all here; why we all get paid; why we have a career:- if we don’t put that patient central to our raison d’être, then we will not be learning the valuable and painful lesson from this tragedy.
Patricia Gartside is a former nurse, now working as Assistant Director in the BDO Healthcare Advisory work-stream