Tractor Stats and the NHS
Lately I have been frothing a lot and jiggling about in a most agitated manner. Some have put this down to the hot weather – most unexpected in a summer – coupled with too much excitement about the Ashes.
In fact I know better. I have developed a nasty condition known as Brass Necked Cheek Interview Syndrome. This syndrome has been around for quite a time. My usual symptoms are the aforementioned frothing at the mouth, reddening of the face, am extreme form of Tourette’s syndrome, involuntary clenching of the fists and the urge to throw the radio/TV/computer out of the window.
Whilst there is no known cure, my specialist is quite clear about the cause. It is invariably triggered by some politician or quango-apparatchik who, whilst scooping an inappropriate and highly offensive salary and pension will have presided over a gross cock up and failure, such that billions of pounds or hundreds, if not thousands of lives, have been wasted. The symptoms are normally triggered by the omnishambles – monger appearing to “defend their record”, say that there were “systemic failures” and that “on the contrary that they are proud of their record” and – most dangerous of all – state the mantra that “lessons have to be learned going forward” and that they will not resign, because they are duty bound to stay in post to correct the ghastly damage they have already inflicted, scooping ever larger amounts of public money into their huge and well lined pockets.
Onset is often triggered by common or garden infestations such as Sir David Nicholson, and former Secretary of State for Health “Andy” Burnham, but Sir Chris Patten is also a singularly toxic agent.
There is also a particularly virulent sub-form of the syndrome called Balls Disease, in which near fatal apoplexy can be induced by who himself appears to be exhibiting a form of late stage rabies repeats the phrase “flat-lining” and “too deep too fast” whilst suffering from total amnesia concerning the scandalous wreckage of public spending he and his ilk left behind.
Today sees the publication of a report into the failings of 14 NHS Trusts. It seems that Mid Staffs was not alone in treating many of its patients, particularly the elderly and vulnerable, as off cuts of meat to be casually discarded and starved of food, care and water.
So for reasons of my own mental and physical well being therefore I kept largely clear of the radio this morning. But I did catch an interview with Professor Sir Brian Jarman, whom I believe has lent a helping hand in compiling the report. He was interviewed on Radio 5Live by Nicky Campbell.
A stout defender of the NHS, he actually sounded quite sensible, balanced and rational. Amazingly, I found my blood pressure lowering, as presenter and guest had a proper, rational, and grown up conversation. Though what Sir Brian had to say was pithy, to the point, but not surprising. I have done my best to transcribe the main points below. In response to sensible questions and points he said this (I do my best to quote):
“I think there has been politics in the NHS for years…
I think Andrew Lansley’s attempt in 2010 to get Clinical Commissioning Groups to take responsibility both for the funding they were allocated and also commissioning care according to quality was an attempt really to devolve down from the centre to the CCG’s that responsibility…
One of the problems I’ve had is that the current chief exec of the NHS who used to be chief exec of the [trust] that managed Mid Staffs [i.e Sir David Nicholson] has said that he will have Stalinist control from the centre… And also that he has “seen off” four Secretaries of State and I think that centralised control is just not working and also it’s a major problem that neither patients nor clinicians have any significant input. I mean, if a doctor reports a problem they’ll be dismissed and they’ll have to sign a gagging clause – this has been going on for too long. It is utterly outrageous. [My emphasis]
If a patient makes a complaint…from about 2004 onwards, there were about 13,000 complaints which were not resolved locally with the hospital concerned every year…only 223, less than a third of one per cent were formally investigated. Now that is an outrageous situation we’ve got into, and I think we need to change that and we need to try to devolve the responsibility down so that at the local level you will have patient groups, clinicians, doctors and nurses involved in improving the quality of care in your local area within the resources that they are allocated. And also, you don’t really need to have a situation in which hospitals have to get as many people admitted as possible because if they are working with their local GPs they are going to help to keep people out of hospital, which will end in a lower cost of health care….”
It is no surprise that the brass necked and pension hoarding Sir David wants what the Professor calls Stalinist control; he is a former member of the Communist Party of Great Britain.
In short, what we have is an organisation which, in true New Labour/Stalinist style, has for years been chiefly concerned with that old Socialist obsession, Tractor Stats. As long as the Secretary of State can pour out favourable figures for the number of tractors, or in this case the number of patients fed trough a sausage making, meat grinder of a system, then the politicians are happy. That a great number of them maybe lying de hydrated or festering in their own faeces is an unfortunate, but largely irrelevant detail.
Sunday Time journalist Camilla Cavendish has been writing in recent weeks with deep insight and no little experience about the hugely variable standards of NHS care. In one article she gave her first hand account of care for two relatives who faced their last days in two close but very different London Hospitals. In one, state of the art, all mod cons, doubtless funded by a colossal dollop of public money in some hideously expense PFI scheme, the standard of care and compassion were so low the place was virtually a gulag. In the other, a battered old fashioned hospital a few miles away, a strong and committed nursing team with strong leadership on the ward delivered excellent care and eased their patients’ woes.
Writing this weekend the excellent Ms Cavendish, who is both experienced and perspicacious, pointed out that what the culture of many – not all, but many – parts of the NHS lacks is simple human kindness.
The institutionalised carnage that was mid Staffs could not flourish without a culture that had forgotten this simple, basic tenet of medical and nursing care. She cites the example of a lead practice nurse at a hospice who overtly advertises jobs seeking applicants who are “kind”. Everything else, she said, can be taught. A medal for that woman.
Indeed, as I write, I am listening on the radio to the account of one relative who witnessed an elderly patient being deprived of all food. The patient was struggling and could not face one cup of rather appalling sounding gunk which passed for tea, but was plainly hungry. When this was reported as a complaint to the nursing sister she was told that the refusal of the cup of tea was deemed a refusal to take any food at all. The witness described what she witnessed on that and other occasions as little short of torture.
My every instinct is that people like Nicholson and Burnham are psychologically incapable of understanding that. They are creatures of statistics, of mission statements, of sound bites, of committees, of plausible denial, of systemic failure, of lack of personal responsibility. Of course there need to be proper staffing levels and so forth. But that is far from the only issue. The NHS needs a cultural shake up, and the dead hand of insensitive bureaucrats like Nicholson. It is the clinicians who must take control. That does not mean a free hand on budgets, but it does mean that care, not tractor stats, is to the fore.
As for Mr. Burnham, he can go on and on with his political points scoring today, manoeuvring, positioning, excusing. He is rather good at it. He does “good interview” with those “man of the people” Scouse tones. But I wouldn’t want him to look after me if I was ill, thank you. I don’t think I would last long, though doubtless my demise would be trumpeted as having been, statistically speaking, a success. Or the fault of the Tories.
Gildas the Monk
July 18, 2013 at 14:27
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Mr Pournelle nailed it. The NHS is staffed by managers and administrators
whose sole commitment is not to the patients but to the NHS. As an example,
any honest organisation would not need spin doctors whose sole aim is to put
their firm in the best possible light.
When medicine and nursing ceased to
be a calling but became a job, a career, a way to earn money and pay off the
student loans, the rot set in.
There are many dedicated people working in
the NHS. I owe my life to them. But they are marginalised by the
bureaucracy.
I was speaking to a medical professional recently. I remarked
that every time the government gave extra funding to the NHS the strings
attached included another level of bureaucracy. Their sole aim from then on
was to keep their job. What if patient care suffered? Nothing to do with them.
We’re just the paper pushers and bean counters.
Pournelle was right. This
is what he wrote
“In any bureaucracy, the people devoted to the benefit of
the bureaucracy itself always get in control and those dedicated to the goals
the bureaucracy is supposed to accomplish have less and less influence, and
sometimes are eliminated entirely.”
- July 18, 2013 at 09:18
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@Zero Tolerance
It must certainly be true that if there is only ever one
political party in power then nothing can be seen to be wrong, I suppose.
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July 17, 2013 at 18:04
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Anna, as with most issues, the in-tractible FACTS are all on the Net.
The NHS 1980s-ongoing Tory (NuLab=Olde Tory) agenda of uncaring false
economy fraud markets, mean’t bean-counters and petty managers ruling highly
qualified doctors and caring staff.
Leading to the Tory 1990 (Don’t) ‘Care In The Community Act’, and Tory 1991
NHS Trusts (which we can’t trust).
Nationwide hugely valuable real estate was sold off to private developers
by closing long-established large institutions. Internal markets were
introduced into the NHS, with accountants typically knowing the cost of
everything and the value of nothing.
Meaning that health authorities managed/mismanaged their own budgets and
bought-in health staff and care products. In order to be deemed a “provider”
of such healthcare, self-managed/mismanaged organisations became NHS Trusts
(which we can’t trust). This Tory policy of mistreating and not caring for the
lower-income physically and mentally disabled was the target of widespread
criticism. Both Liberal and Labour, demonstrated that the care in many such
sold-off institutions had been satisfactory or good.
As with the early-1960s Tory ‘hatchet man’ Dr Beeching changing the train
timetables so that mainline and branch line trains no longer coincided and
became under-used; so, by typical smoke and mirrors manipulation the
deliberate underfunding and mismanagement of the NHS by the Tories was used as
an excuse to shut down and sell off many institutions.
NHS ‘markets’ and so called ‘care in the community’ were falsely presented
as a more cost effective way of helping the sick and disabled. Despite which
the number of patients mistreated at-home and in large hospitals and
residential establishments including young children and babies; continued to
rise.
- July 17, 2013 at 19:00
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@zerotolerance
All which suggests that the best thing we could do for
the NHS is get the politicians out of it. But instead we seem to be spawning
a National Health Party. What next I wonder, The Motorway Party? Party on
dudes…..
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July 18, 2013 at 09:02
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CC: Balanced Blogs; Moor Larkin.
With all due respect.
Due to longtail/short brain Ms Raccoon’s unbalanced failure to find the
source of so much rabid-Right Brit dysfunction. Now sooo CONveniently
blamed on non-Brit Rupe’s sad pawns NuLab=OldeTory 1997-013 R ot I n P
ieces. Here to HELP, are some balanced FACTS.
About what happened just the day before yesterday.
Tory Mag’s 1980s-ongoing agenda of uncaring false economy fraud
markets, selling off cheap the UK ‘Family Silver’; included many valuable
NHS properties. While introducing (untrustworthy) Trusts with
bean-counters and petty managers ruling eminent medics and caring
staff.
Leading to the early-1990s Tory (don’t)Care In The Community Act, and
NHS (untrustworthy) 57 Trusts.
Nationwide hugely valuable NHS real estate was sold off to private
developers by closing long-established large institutions. Internal
markets were introduced into the NHS, with accountants typically knowing
the price of everything and the value of nothing. With new health
authorities managing/mismanaging their own budgets and bought-in products
and health staff, often non-British. In order to be deemed a ‘provider’,
self-managed/mismanaged health organisations became NHS
(untrustworthy)Trusts.
This vile Tory policy (merely continued by non-Brit Rupe’s pawns
NuLab=Olde Tory) of mistreating, not caring for, and killing the
lower-income physically and mentally disabled, was rightly criticized by
both Liberals and true Labour in the late-1980s. They demonstrated that
the care in many such sold-off institutions had been satisfactory or
good.
As with the early-1960s Tory ‘axeman’ Beeching deviously changing the
train timetables so that mainline and branch line trains no longer
coincided and became under-used, with lines closed and sold off to private
developers. So, by typical smoke and mirrors manipulation the deliberate
underfunding and mismanagement of the NHS by the 1980s/90s Tories was used
as an excuse to close and sell off many former health institutions to
private developers.
NHS ‘markets’ and so called ‘care in the community’ were falsely
presented as a more cost effective way of helping the low-income sick and
disabled.
Though the number of patients mistreated at-home and in large
hospitals and residential establishments including young children and
babies dying; continued to rise.
In a democratic cause of good manners and freedom-to-distort, all are
rightly encouraged to look foolish by spreading LIES. While all the FACTS
are known elsewhere WebWide for all to learn.
- July 18, 2013 at
09:28
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“This vile Tory policy (merely continued by non-Brit Rupe’s pawns
NuLab=Olde Tory) of mistreating, not caring for, and killing the
lower-income physically and mentally disabled, was rightly criticized by
both Liberals and true Labour in the late-1980s. They demonstrated that
the care in many such sold-off institutions had been satisfactory or
good.”
Have you seen the way some of those Top Totties talk about the ‘lower
classes’?
There is only one fitting description; they are almost like human
vermin. They crawl about, doing absolutely nothing, except polluting
and corrupting everything they touch. We talk about the liberty of the
subject. What nonsense! What waste of words! We ask that you should
take these people and have proper control over them, because they have
no control over themselves. They are verminous, dirty, with no idea of
washing or cleansing themselves. Yet they are human beings, and you
could, under proper control, so far improve them that they could be
put to some employment, not enough to keep them—I never expect
that—but sufficient to maintain themselves partly, and to give them a
human existence which they have not got now. Above everything else,
you would stop the supply of these children—a very important
thing.
Utterly disgraceful.
Edited to add: Whoops, Sorry Zero, gave you a bum steer there, that
was the LABOUR minister Will
Crooks speaking about the lower income physically and mentally
disabled….I guess that’s why you never quote him!
- July 18, 2013 at 10:43
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‘Utterly disgraceful’ longtail, are CONtinued distortions of
FACTS.
1: The well known term ‘Top Totty’ usually refers to macho sexist
Tory males utterly disgracefully grunts about pretty ‘young gels’.
2: The less well known humanitarian Will Crooks, 6 Apr 1852 – 5 Jun
1921, was never a Labour Minister, and his utterly disgraceful grunts
about the mentally disabled merely echoed many eminent also utterly
disgraceful grunts of his era. Born in Shirbutt Street, Poplar, Crooks
was the 3rd son of a ship’s stoker, George Crooks, who lost his arm in
an accident when Crooks was aged 3. His mother then supported the
family by working as a seamstress, but money was scarce and five of
the children were temporarily forced to enter Poplar workhouse in
1861. This experience had a profound influence on Crooks’ views on
poverty. Educated at a local Poor law school, Crooks worked initially
as a grocer’s errand boy, then a blacksmith’s labourer and then as an
apprentice cooper. A keen reader, Crooks learned about reformers such
as Richard Cobden and John Bright, and was asked by his fellow workers
to speak out about their working conditions. Consequently, he was
sacked for being a political agitator. He remained a member of the
Coopers Union from 1867 until his death. After a short spell working
in Liverpool, Crooks returned to London and found work in the docks.
He also began to give political lectures, and his speaking abilities
proved helpful in raising funds for 10,000 striking dockers in the
1889 London Dock Strike. Earlier that year, Crooks, a candidate for
the Progressive Party, successfully stood for election to the London
County Council, and joined Sidney Webb and other labour movement
leaders in the LCC. He also became the first working-class member, and
later chairman, of the Poplar Board of Guardians. With support from
friend and fellow member George Lansbury, Crooks set about reforming
the local workhouse, creating a model for other Poor Law authorities.
A prominent local politician, he helped bring about many local
improvements. On 3 August 1895, Crooks formally opened Island Gardens,
a park at the south end of the Isle of Dogs, opposite Greenwich
Hospital. He also campaigned for the first Blackwall Tunnel, and as
Chairman of the LCC Bridges Committee in 1898, he helped provide the
Greenwich and Woolwich foot tunnels completed in 1902 and 1912
respectively. In 1901 Crooks became the first, of then new Labour
Party mayor of Poplar, and 2 years later was elected to Parliament as
Labour MP for Woolwich. This success was the result of a pact between
the Labour Representation Committee and the Liberal Party, which
wrested the seat away from the Tories. At the time, he was only the
4th Labour MP, preceded by Labour-founder James Keir Hardie, Richard
Bell and David Shackleton.
As an MP, Crooks retained his
working-class roots and contacts, campaigned hard for workers’
pensions, supported reforms to limit the powers of the House of Lords,
and supported Balfour’s Unemployment Bill in 1905. Re-elected in 1906,
he supported the reforming Liberal governments of Campbell-Bannerman,
1906–1908, and Asquith, 1908–1910. Crooks lost his seat in Parliament
at the January 1910 general election, but was re-elected at the
December 1910 general election, and remained an MP until ill-health
forced his retirement in February 1921. He died 4-months later in the
London Hospital, Whitechapel, and was buried in Tower Hamlets
Cemetery.
- July 17, 2013 at 17:18
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Aspects of our National Health System may be crap but at least every person
in the UK has access to some medical facility when they need it. These poor
folk’s nearest hospital was 50 miles away
http://news.sky.com/story/1116722/india-22-children-die-after-eating-school-meal
- July 17, 2013 at 12:07
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It is my (forlorn?) hope that as more and more British people experience
healthcare* as provided in other countries, they will refuse to accept an
inferior standard at home. I am thinking of the vast improvements in UK
catering standards over the past few decades that have followed the advent of
mass tourism to mostly Mediterranean countries. Of course this would work only
if there were a choice of where to go for healthcare in the UK, something that
the vested interests will do their best to prevent.
*By healthcare I mean the totality of care, including “hardware” such as
the buildings, machinery, etc., together with the people-based “software” of
clinical and nursing services.
- July 17, 2013 at 08:33
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It is a needless irritation which stems from etymological confusion,
Gildas. The term ‘service’ which appears to suggest specified care for
non-employees, owes everything to the founding (defunct) principle, retained
purely to acknowledge lavish maintenance of lawyers and other wastrels. The
closest we can come to sharing the final reflections of liner passengers as
they sink beneath the waves after contributing for decades towards
non-existent lifeboats.
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July 17, 2013 at 00:10
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No doubt that as a journalist Camilla Cavendish does good serious
reporting.
As someone who contributed to her review on care assistants recently and
read and saw her talk about it in numerous tv programmes, including the
unhappy discourse with the daughter of a patient who suffered and died at the
hand of Mid Staffs staff, I found her public arguments did not convince..
The relative of someone who actually was ‘killed’ by the NHS rightly
pointed out that the Francis Report cost £15 minillion,, report after report
has long been saying the same with nothing changing. Then a journalist is
asked to do more of the same at yet more cost to the public purse. Ms
Cavendish’s report will get ‘kicked in the grass’ or fail to progress action
precisely because she does not fully understand how things join up or opertate
in the ‘care world’, besides pointing out the obvious – ‘a lack of kindness’.
My own experiences with relative are not dissimilar to Ms Cavendish with
respect to the competence and attitudes of staff at different but nearby
hospitals, one where each time formal complaints have been raised to no avail
and the other where I found no fault because of the higher level of staff
competence- even doctors. Why is this? Comptence as well as kindness and
understanding is necessary.
As to Anna’s views on why families are ‘absent’. Some clearely do not care
much. I today yet again had to have relative taken to hospital where relative
was admitted, I was lucky the ambulance crew diverted, on my request to go the
hospital I prefered- it is not so close as the local one , whose standards
have been unimpressive. The difference in attitude of the staff on the ward to
my presence at preferred hospital was to welcome me as a relative and to
immediately jot down relevant informtion for handover to staff of the next
shift- to whom I stated I could be called anytime for anything they wanted to
know. Contrast this with the other hospital of several previous unhappy
inpatient experiences; my wanting to give relavent information to ward staff
was not immediately encouraged and I was later given some stupid form to fill
in which was filed and ignored. The only interest shown was my relieving staff
feeding duties, so the one time I was late relative was sitting alone in the
room with food tray in front on a table left to fend for self. Relative lost
significant weight in a short time- surprised? It is not families who should
be taken to task but people working in ‘caring professions’.. On the same ward
I saw a junior nurse get shirty with the senior when asked to do some work.
This is the real NHS which no report will manage to improve.
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July 17, 2013 at 07:56
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Spot on
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July 17, 2013 at 09:53
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The huge disconnect in public servants (read Department of Health) and
govrnment ministers / MP’s regarding ‘Safeguarding’ is the central
problem. Too too much influence of vested interests, (they get their jobs
from this), pushing for laws, powrs of entry into homes of even competent
adults on mere title tattle of oft maliciously angry individuals or people
who report anything because they are that way inclined. Basically if
public servants cannot get their ‘own house’ in order to ensure 100%
safety of those they are entrusted to ‘guard’, what right have they then
to run amock in society breaking up perfectly adequate families by
harrasing people on mere suspicion. They cannot even act on fact. Social
workers are often in my experience so incompetent/ unskilled and
restricted by back covering management that what families will get is
bullying by them- but they never bully their health colleagues or the
police when real abuses occur.
The whole system is corrupt and unhelpful and as others here note the
only winners are the legal people and those whose jobs are promoted on
their work under the agegis of ‘safeguarding’ the vulnerable. So the
question is what will change it… in the end like in some other countries ,
I predict the ‘control and coerce’ methods now common in the UK will
result in civil unrest- or suicides.
Please note that Sally Greengross (I do not use titles as I do not
believe in them), late of Age Concern, has tabelled an ammendment in the
house of Lords to the Care Bill to bring in Powers of Entry for social
workers, which the government decided was not needed. The vested interests
lobby has gone to the HoL to lobby, even though from the public and
government perspective there is no case. This is how laws are being made-
unelected individuals with vested intersts not listening to their public.
Her degree appears to be in political science- like some directors of
adult services- not a professional qualification degree or one connected
with care, does this surprise anyone? No doubt if someone reported her
children for ‘influencing her’ she would not object?
- July 16, 2013 at 23:07
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If you think that the wonderful clinicians who might replace these horrible
bureaucrats are anything other than similarly nasty little politicians of
similar ilk, you haven’t met too many of them
- July 16, 2013 at 21:30
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My late mother had excellent treatment in a very old annex that had been
turned into a geriatric ward. When I first saw the place I was horrified but
the nurses couldn’t have been kinder or more caring until her death, the way I
remember hospitals used to be. Personally I have had no problems and I have
been a lot of hospitals over the past three years but the stories we are
hearing are horrific. I totally agree about stopping the Enrolled Nurse
programme. Last time I was in I kept having to look at the name tags as all
were in uniform and you didn’t know what position anyone had until you asked a
question the HCA’s couldn’t answer. We must get politicians out of the health
service, I lived in Germany for a while and it was very good as Anna says it
is in France. Where the patient/customer has choice things will soon improve,
I cannot believe Labour are trying to wriggle out of the mistakes they made,
seems obvious to me especially the lack of after hours GP care. I only hope
this horror story brings some improvement.
- July 17, 2013 at 00:14
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‘We must get politicians out of the health service’
They have been trying to get out for years, but unless someone blows up
the offices of the Daily Mail, the Sun and the Guardian, it’s unlikely to
happen. Such a shame, really, as that would cure all sorts of evils in one
go
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July 16, 2013 at 18:52
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You know, you can dick about all you like with the training and you can pay
whatever the public purse allows – but as the Hospice lady says, if the
nursing staff are mean people who take delight in leaving patients without
food, water, pain relief or a kind word then it matters not one jot.
I have had the misfortune to be in hospital being ‘looked after’ by a bitch
from hell who made it clear that patients were a nuisance and their demands
cramped her style. More senior staff appeared to be scared of her. In any
case, she was never pulled up over her behaviour and it seemed to me that it
was being emulated by younger staff.
All prospective NHS staff should have
a compulsory heart scan – just to make sure they actually have one.
- July 16, 2013 at 19:23
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Well, quite agree – but given that the NHS employs more managers than any
other organisation in the UK, why are some of the said managers not taking
the responsibility of ensuring that suitable people are doing the jobs they
are emotionally equipped for? Far from being scared of the ‘bitch from
hell’, they should be moving her to a role in which she can’t harm patients,
and finding a nurse with some human feelings to do her job.
It’s a basic failure of personnel management, pure and simple.
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July 16, 2013 at 21:10
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The whole NHS problem comes down to bad management – too many doing the
wrong things. They may try to seek out efficiency, but they’ve never
sought effectiveness first. It’s no good doing the thing right, if you’re
not doing the right thing.
Not only do they not take responsibility, there is no accountability –
when they screw up, how many get fired ? Sir David Teflon-Nicholson is
still there, biding his time to collect his vast pension, yet all this
calamity was allowed to build up on his watch. Examples start at the
top.
Maybe the trick would be to fire the worst 10% of managers each year,
not replacing any of them. After a decade of that, the NHS might just have
got down to a core of professional managers who can actually manage things
and who would recognise that failure hurts.
- July 16, 2013 at 23:36
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I tried to find out a little about the numbers of people employed by
the NHS because of something Moor Larkin said above.
It appears there are about 1,400,000 employed in total of which there
are about 150,000 doctors, 370,000 nurses and 37,300 odd managers so
what are the other 800,000 doing? We can take a few thousand off for the
ambulance service and another few thousand for the technicians but
however you look at it there are far too many unaccounted for – are they
all part of the managers staff? I think they have to be, they can’t be
cleaners because that was outsourced by the last government.
With trusts overseeing other types of trusts there is far too much
duplication of effort which is totally unnecessary and that is before we
get started on CQC and NICE and none of them can get a universal IT
system to work either.
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July 17, 2013 at 00:10
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http://www.bbc.co.uk/news/health-12819538
Please to remember the people who meet you at the GP surgery, the
hospital clinic, those who maintain the ambulances, keep the buildings
waterproof, check for H&S and Legionnaires, and so on. I’m sure
that some are an odd few Red Army infiltrators too, the advance guard
who will tend to the invader’s casualties and mend their tanks
- July 17, 2013 at 13:16
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X-ray, laboratory, other diagnostic services, accounting, payroll,
human resources, maintenance for buildings and medical equipment, food
service, secretarial and clerical, medical records, pharmacy, laundry,
portering, staff orientation, occupational and physical therapy,
warehouse, discharge planners, in-service education, infection
control, switchboard, etc.
- July 16, 2013 at 18:08
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Hospitals in special measures:
North Cumbria University Hospitals NHS Trust, Northern Lincolnshire and
Goole Hospitals NHS Foundation Trust, Tameside Hospital NHS Foundation Trust,
United Lincolnshire Hospitals NHS Trust, Basildon and Thurrock University
Hospitals NHS Foundation Trust, Burton Hospitals NHS Foundation Trust, East
Lancashire Hospitals NHS Trust, George Eliot Hospital NHS Trust, Sherwood
Forest Hospitals NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust,
Medway NHS Foundation Trust.
Hospitals not in special measures:
Colchester Hospital University NHS Foundation Trust, The Dudley Group NHS
Foundation Trust, Blackpool Teaching Hospitals NHS Foundation Trust.
http://news.sky.com/story/1116463/nhs-report-teams-sent-in-to-11-failing-trusts
I wonder what they mean by ‘special measures’ ?
- July 16, 2013 at 18:06
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It’s not about Labour, Conservative, putting doctors in charge, bureaucrats
in charge, Royal Commissions or any of that.
It’s ALL about having a regulated free market. That’s it. It’s about
patients having the power to take their business elsewhere and for the people
who caused them to take their business elsewhere to suffer as a result.
I’ve made complaints to the NHS and they were treated with less seriousness
than how my complaints get treated at Tesco about a corked bottle of wine.
I’ve seen more commitment to diagnosing a problem with my car from my garage
man than I’ve seen some GPs make. It’s not because Tesco or my garage man are
nicer. It’s because I have the power to take my money elsewhere, or on the
flip side of the coin, they know that some of their customers will recommend
them to their friends.
- July 16, 2013 at 17:48
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The conclusion I draw from all this is this-
Because the state provides
free healthcare it has now assumed ownership of your body.
You thought your
body was your own? Forget it.
When the state has invested so many resources
in keeping your body healthy and in good working order?
You can’t pay for
the treatment so they’ve assumed ownership
The state has decided that too
many old people are blocking beds and a cull is needed.
There will be
enquiries. Lessons will be learned etc etc.
And the cull will continue
- July 16, 2013 at 16:53
-
A look at other countries medical error stats is instructional.
The UK
is not the worst, by a wide margin. With some 98000 cases in the US each year
…
Maybe a look at staff levels, which at night are abysmally low.
My
local hospital has no objection to relatives being present all day, with a
small exception being constant rounds.
- July 16, 2013 at 23:29
-
‘The UK is not the worst, by a wide margin.’
Nice try. But few are listening.
Our Hostess herself pointed out on the Zimmerman post, much worse can be
found elsewhere in respect of almost anything. However, she politely passed
over the parallels available in this instance. Maybe USA Today’s report on
the Zimmerman case has some insight, some glimmer, on the truth of such
matters
‘ A healthy dose of skepticism should always be part of the journalism
process. And in this case there was a particularly strong reason for
caution. While some residents of the complex saw some parts of the conflict,
only two people knew, really knew, how it went down. And one of them was
dead. Under those circumstances, certainty was elusive.
Back in 2006, the nation’s media gave huge play to a saga in which three
Duke University lacrosse players were charged with raping a stripper at a
team party. But the case collapsed, the prosecutor was disbarred and many
news organizations looked seriously foolish.
Asked what had gone wrong by journalist Rachel Smolkin for a
reconstruction of the episode in American Journalism Review, Daniel Okrent,
a former New York Times public editor, responded: “It was too delicious a
story.”
Sound familiar? ‘
Indeed it does…….
- July 16, 2013 at 15:51
-
Absolutely spot on, as usual, Gildas.
One point of optimism. At least behind all the political mud-slinging and
dodging of accountability, someone has been prepared to accept that things are
not universally as they should be in the NHS, and commission a report
identifying problems. The first step to solving problems is to admit that they
exist. Now, nobody can claim that problems do not exist, or are ‘isolated
incidents’. Whether steps are taken to solve the problems, and whether those
steps work is yet to be seen, but at least we’ve made some small progress in
the right general direction.
-
July 16, 2013 at 16:03
-
Good points all round. Clearly there is a great deal of excellent work
done by the NHS and many staff, but what seems to be happening is a climate
of lack of basic compassion, even cruelty, in some parts. The elderly seem
disproportionataly vulnerable, yet this is the group that should be getting
the most considerate care. What does this say about the modern world? And
what is to be done about it?
-
July 16, 2013 at 19:35
-
Quite often when problems develop, it’s a good plan to concentrate on
doing the basics really well, and forget any fancy stuff. Once the basics
are under better control, start looking at how to improve them, and
closely involve those actually doing the job in developing the ways of
improvement. Often, when the ‘shop floor’ are allowed to just get on with
their jobs in the manner they want to, morale improves, and with it,
performance. Too much micro-management can be very sapping of morale.
Whether this can happen in an organisation bloated with middle and
senior managers all with a salary and pension to protect is somewhat
doubtful. It may take some very strong, single-minded and determined
leadership from somewhere. I’ve not seen where, yet, though.
-
July 16, 2013 at 16:40
-
But see the comments over at the Groan CiF site. This is either all a
ruse to privatise the NHS or the evil tories have made so many cuts that
this is the result. Unbelievable!
- July 16, 2013 at 15:14
-
Sometimes when reading this blog I discover I have stop reading altogether,
because I have instead wandered off into a daydream about Anna and Co taking
over Current Affairs at the BBC and being the ones that guide news programming
in this country.
Coming back to reality is always unpleasant, when I suddenly realize that
the BBC is working tirelessly to brainwash people into accepting the NHS, EU,
all that tax etc.
- July 16, 2013 at 14:35
-
Thanks Gildas. You put into words, what I thought, but was incapable of
expressing so lucidly.
-
July 17, 2013 at 07:55
-
Thank you Joe – I am honoured
- July 16, 2013 at 14:31
-
I wondered how many NHS Trusts there were, not having the foggiest idea.
One figure I got was 530, which means there are 2.6% under criticism.
I personally totally agree that each and every Trust should be left to it’s
own devices and all the layers of regional and national quangocrats tossed out
the window, but Britain being Britain, the pressure against this will be the
cries of “Postcode Lottery”, and I freely confess to having no more idea about
how the NHS works than any other citizen, but the Olympic Opening Ceremony
seems a lifetime ago…..
I wonder if the National Health Political Party will gain any traction with
the electorate in 2014:
http://en.wikipedia.org/wiki/National_Health_Action_Party
“The
party intends to fight in a number of constituencies at the next general
election, with the aim of replacing MPs who favoured the Health and Social
Care Bill as well as having significant influence in the event of a hung
parliament.[6] The party plans a social media campaign and attended the
Netroots conference in June 2012.[7]“
- July 16, 2013 at 16:32
-
Do remember that the Ambulance Service, laboratory services etc are
organised into NHS Trusts. Look at
http://www.nhs.uk/servicedirectories/pages/acutetrustlisting.aspx
There
are 159 hospital trusts, of which 7% are now in special measures and a
further 2% deemed able to fix their own problems.
Bear in mind also that
of these some, including Stafford had been given ‘Foundation’ status, a mark
of management excellence. Managing what precisely?
-
July 16, 2013 at 14:30
-
The patient was struggling and could not face one cup of rather
appalling sounding gunk which passed for tea, but was plainly hungry. When
this was reported as a complaint to the nursing sister she was told that the
refusal of the cup of tea was deemed a refusal to take any food at all. The
witness described what she witnessed on that and other occasions as little
short of torture.
Perhaps the patient didn’t like tea and could have been offered something
else? But why didn’t the family member bring something else for the patient to
eat, or was the patient in fact not allowed certain types of food, or on a
liquid-only or puree diet, or fasting pre-operatively. We never get the other
side of the argument in these cases.
We keep hearing from the UK press about cases where people have died of
dehydration because they could not reach the water jug, but why are their
family members not helping them, and more to the point why are they not
getting lab work that would identify the dehydration and then intravenous
fluids to rehydrate them? This, if true, is the real scandal. That is basic
medical care these days even in third world countries. A few weeks ago I had
severe diarrhea, gastritis, and vomiting and went to a neighborhood walk-in
clinic here in the Dominican Republic. My blood pressure was low, indicating
dehydration, so they immediately gave me 2 litres of IV fluids, Zantac, and an
antibiotic for an amoeba, and after three hours I was able to go home feeling
much better. The next day I went back for another round of IV antibiotics and
that was it.
- July 16, 2013 at 14:56
-
“but why are their family members not helping them”
For a start, the family are ‘not welcome’ on the wards 24 hours a day,
only at designated times. The UKs not like normal countries where the family
accompany the patient at all times, into consulting rooms – anxious to hear
what the doctor has to say,or onto the wards to sniff at the food, and
checkout the facilities. In the UK, ‘families’ have more important things to
do, and leave these menial tasks to anyone or no one.
You have to remember that in the UK, your corporal entity does not belong
to you, nor to your family, but to someone else, no one is quite sure who,
but whoever they are, they have designated ‘Doctor’ to do whatever he thinks
best with it.
Thus the ‘family’ are getting on with earning the money to pay for Sky TV
or the new super duper mobile that you wear in your left ear.
Horses for courses, Jonathan, that Philippino nurse who trained in Jeddah
has got far more patience with grandma than the family ever would.
Pity she’s an agency nurse….
- July 16, 2013 at 15:16
-
You remember when you were on the psych ward, Anna? What were the
nurses like there?
Just curious.
- July 16, 2013 at
15:50
-
July 16, 2013 at 16:08
-
We have a plethora of Filipinas here in the nursing profession. Some
are very good, the others completely sub-par. The latter are in the
majority.
-
July 16, 2013 at 18:10
-
Mewsical, please refrain from commenting on a story about the NHS, as
the NHS is only tolerated in the UK, and you said yesterday that you can
only comment on a story if you live in the same country as the subject
matter originated. Well you as made it plain yesterday that you
currently live in the US, so any attempt by you to discuss a subject
concerning the UK would make you into just another typical snivelling
leftie.
“Mewsical July 15, 2013 at 16:32 – Zimmerman framed – ‘Obviously, one
has to live in America to comment.’”
-
July 16, 2013 at 18:17
-
Sorry Mewsical, I meant to say ‘hypocritical leftie’, no idea where
the other came from, must have just popped into my head unbidden.
- July 16, 2013 at 13:46
-
A subject dear to my heart. Nursing started going down the tubes in the
1990s with ‘Project 2000′ – ‘All nurses must be graduates’ and there was no
place for the State Enrolled Nurse who actually mopped the fevered brow and
emptied the bed pan. Instead we have unqualified, yes totally unqualified
Health Care Assistants. To recruit them the NHS is competing with Tescos etc.
Nurses, bless, in the ‘old days’ used to work on the wards for up to 40 weeks
a year and were paid as students. Student nurses now on degree courses do as
much as ten weeks a year on the wards, but still get paid a salary. Not
surprisingly people go into nursing to get a BSc with little intention of
actually working on the wards. Hence the student at one centre of excellence
who said that she ‘didn’t go into nursing to mop the fevered brow’. She passed
out top and won all the prizes. That was the same school that at one time had
a one week module for its student nurses on witchcraft!
That would have
been bad enough enough and a potential disaster but then add the process
obsessed New Labour, and you have the present mess. Everything has been
sacrificed on the altar of pushing numbers through against targets. I know of
an instance when an administrator took it on himself to cancel an emergency
operation over the objections of the surgeon to get two hernias repaired to
avoid them ‘breaching’ the waiting list target. Casualty is now a joke, you
have a target of four hours, so if a patient is ill, they are admitted to a
medical or surgical assessment unit. Then it doesn’t matter how long they wait
to be treated, there isn’t a target for that. Add to it the great idea of
taking away GPs independence by making them an offer they couldn’t refuse on
out of hours care because the government wanted to run it and reduce GPs to
providers rather than independent clinical practitioners. Not only do you get
c..p out of hours care at inordinate cost, but more patients (sorry clients,
must remember my newspeak) take themselves off to A&E.
As for medical
training, Stalin would have been proud of what Blair et al came up with.
Suffice it to say that doctors had to go to driving test centres (I kid you
not) to apply for higher training, e.g. to become a surgeon. They are chosen
without interview, little if any weight is given to their CV, mostly what
counts is their personal statement (thus to be a surgeon you have to be good
at creative writing) and then allocated to a post somewhere in England. From
personal experience once someone gets into training, it is extremely difficult
to get them out. So if someone has ten thumbs, the road is clear to becoming a
consultant surgeon, as long as they can write well.
Things may have changed
since I retired, but I think not. More than one colleague half joked about
retiring to anywhere close to a chunnel stop so they could go to France
if/when they became ill.
- July 16, 2013 at 14:17
-
A subject dear to my heart. Nursing started going down the tubes in
the 1990s with ‘Project 2000′ – ‘All nurses must be graduates’ and there was
no place for the State Enrolled Nurse who actually mopped the fevered brow
and emptied the bed pan. Instead we have unqualified, yes totally
unqualified Health Care Assistants.
Yes, but medicine has changed dramatically over the last few decades,
requiring a higher level of technical skills for those who have to act as
go-betweens between patients and physicians. Consider that I am now 61 and
had my first ever blood test drawn when I was in my mid 40s. Now compare to
my daughter, aged 9 months and living in a third world country, who has
already had two or three of them plus a few visits to the pediatrician, a
luxury unheard of when I was a child.
However you are right that the NHS seems to have gone badly wrong in
getting the right skill mix and training its employees to the appropriate
levels. In the US the bottom level of care is provided by Certified Nursing
Assistants who do a 90-day course, pass and exam, and then deliver basic
care like emptying bed pans and mopping fevered brows.
They are educated enough to know that there are five components to basic
activities of daily living–DEATH: dressing, eating, ambulating (walking),
toileting, hygiene support for which can be carried out by CNAs after an
initial assessment by a Registered Nurse.
Since the pay for CNAs is much lower than that of Registered Nurses, this
makes a lot of sense.
CNAs can then study for another 9 months to become Licensed Practical
Nurses which means they can do all the same stuff PLUS give medications and
perform certain other clinical tasks, for example some make take additional
training in intravenous therapy or in specialist areas. LPNs are paid more
than CNAs but still less than Registered Nurses.
Registered Nurses CAN do all that CNAs and LPNs do, just as doctors can
do anything that nurses can do, but in reality most of their time is
directed to assessing admissions, communicating with physicians and
implementing physician orders, patient and family education about the
illness and treatment, discharge planning, and the like. The job title of
the RN may actually be Patient Care Manager, which is not a bad
description.
I don’t know why the NHS does not reform in the direction of the US
system. Presumably it is all to do with money. It is ridiculous that
patients should be handed over to untrained Health Care Assistants, because
then there is no chain of responsibility to answer to. However going back to
the days when Hattie Jacques was Matron and Registered Nurses emptied bed
pans and mopped brows is not the answer either.
[Incidentally, fevered brows were mopped when there were fewer anti-fever
drugs available, and administration of a couple of Panadol tablets ever
6-hours is probably more effective, as is assessing the underlying REASON
for the fever and treating that. In modern hospital design there is usually
a toilet close to the bed, and if the person cannot get there, they are more
likely to use a commode than a bed pan. In cases of urinary incontinence,
patients are often catheterized and the urine drains into a bag, which has
to be MEASURED, RECORDED, and emptied, which is something that can easily be
done by a CNA who has been properly trained.
So the real answer is not to have Registered Nurses going back to
emptying bed pans, but to design both the physical and human environment of
the hospital to meet the basic needs of patients.]
- July 16, 2013 at 16:21
-
I think we are in danger of agreeing. Nurses used to be trained to an
appropriate level, that is appropriate to the level of medical care. The
hospital where I trained in the late 60s didn’t have an ITU, nor did any
of the other London Teaching hospitals, so there were no ITU nurses. The
problem arose when the powers that be (and I knew one of them very well –
professionally) wanted all nurses to be graduates. Fine, but they forgot
that basic nursing still had to be done. The ‘new’ nurse with a BSc in
nursing thought (yes they did) that hands on patient care, the
compassionate bit, was not their job, they were now taking over some/many
of the doctors role. A gap opened up at the bottom of the healthcare
structure, and nothing has been put in its place. Yes, I agree the US
structure is a good one, but frankly anything would be better than taking
a girl (and it is mainly girls) off the street, putting them in a uniform,
giving them a Health and Safety briefing and putting them on the wards.
The big mistake was getting rid of the State Enrolled Nurse, the SEN.
Separately, it is of interest that there is no recognised training
package for those undertaking dementia care in the UK. This is the coming
epidemic, and we have done nothing about meeting an obvious need. In most
care institutions care of dementia patients is given by Health care
Assistants, fresh from working on the checkout at Tesco’s. That is not to
decry Tesco’s, I believe they give good training in inter-personal skills,
which are transferable to the NHS environment.
- July 16, 2013 at 17:24
-
Yeah, probably we do agree. It is just that we see so much in the
Daily Mail and The Guardian about nurses who are “too posh to wash”, and
yet no one explains that if you adopted a system by which every patient
received total care from an RN, the costs would go through the roof as
every patient would basically become an Intensive Care Unit patient.
In the US it is often the case that an RN, LPN, and CNA will work
together as a team of three, with possibly a caseload of 10 patients,
thus allowing the tasks to be divided. While an RN can pinch hit for a
CNA, the reverse is not true, and if an RN is bathing a patient, they
will not be available to receive a report from the Recovery Room when a
patient is returning from the operating theatre, or to assess a new
admission who arrives on the ward from Accident & Emergency. A lot
of non health care persons don’t understand these finer points of how
the work is organized and it is a pity that the media does not carry a
more instructive level of public discussion.
-
July 16, 2013 at 14:37
-
Casualty is now a joke, you have a target of four hours…
But that is absolutely awful. I have been to Casualty (called Emergency
Room in the US) at various different hospitals in the US and the Dominican
Republic both as a patient myself and with other people, and never had to
wait more than a few minutes to be seen by a doctor. Why are the Casualty
Wards in the UK so inefficient, that is the question? Perhaps they need more
neighbourhood clinics like they have in Cuba.
-
July 16, 2013 at 16:06
-
Let me assure you that the ERs have become the equivalent of the
doctor’s office and the waits can be agonizingly long nowadays. We have
stand-alone facilities known as “urgent cares” as well. Fortunately, I can
now go to a regular doctor with my insurance, but before that, I would
have been stuck with those choices myself.
- July
16, 2013 at 17:27
-
American ER’s work on the principle of television news– “If it bleeds,
it leads.”
The general rule of thumb in an American hospital is, where
loss of consciousness has occurred or the patient is in an altered state,
or there is a wound requiring immediate assistance to at least prevent
exsanguination or loss of function of a body part, everything else is
placed on hold.
I had occasion to use an ER in an American hospital
once. What happened was that, as a result of a traffic accident, I broke
my forearm. While the bone was displaced, it was not a fracture which
punctured the skin. Thus, because I neither was unconscious or likely to
be, nor spilling blood all over the place, I was immediately triaged to
the urgent care and was put in the pile to be seen ASAP instead of
“today.” At that, I still waited two hours, in considerable pain,
attempting to self-splint. Once being seen and x-ray’d, showing a fracture
had indeed taken place, I was brought immediately to the ER where my
fracture was set and properly splinted within minutes of arrival and I was
administered analgesics. I was told that the reason my case was handled as
it was was that “you would not be able to imagine how many people come in
here with dubious complaints just looking for pain pills!” I cannot say I
blame them either. (However, you’d think that my having arrived in an
ambulance accompanied by police officers might have given them some sort
of indication that something had happened and that I wasn’t a malingerer–
but then again, all the “whiplash” lawsuits that come from people who
really are uninjured in traffic accidents conspires against that
fact.)
The reason for crowded ER’s is that, in many urban districts,
they have become outpatient clinics for those on Medicaid during hours in
which the urgent care clinic is closed and the patients have no patience,
forgive the horrendous pun.
- July 16, 2013 at 13:38
-
1 death is an accident, 1200 systemic failure, but 13000 is genocide. Any
other organisation and the senior management would be prosecuted for corporate
manslaughter
-
July 16, 2013 at 16:10
-
“… 13000 is genocide…”
It certainly sounds that way, but statistics can be manipulated to
support an argument and may not tell the whole story. Certainly if a person
is admitted to hospital for, say, a hip replacement, but is otherwise fairly
healthy and ends up dying from complications of bed sores, a definitely
preventable iatrogenic condition, then you have an excellent case. But it is
hardly ever that clear cut. If someone of 90 years of age is admitted to
hospital with a bowel obstruction and dies in hospital of pneumonia, than
might have been preventable too with an aggressive nursing regime including
mobilizing the patient and getting him or her walking right after hip
replacement surgery, but one also has to accept that a person of 90 has a
limited future and that if one thing doesn’t get him, then sooner or later
another will.
Almost any death in a hospital could probably have been delayed a bit by
heroic measures, but avoiding death today does not always mean that there
will be viable life tomorrow.
At my current age of 61, even though I am quite healthy, I am a lot
closer to death than I was 30 years ago, and am constantly having to have
running repairs. A few weeks ago it was cellulitis in my left leg, now
happily 100% cured, but now it is pain in my right knee that is keeping me
almost housebound. Such is life. I am very happy to live in an age when so
many conditions that would have killed me a hundred years ago, starting with
the pneumonia for which I received a shot of penicillin from a glass syringe
in 1958, have remedies that have made it possible for me to extend my life
beyond its “natural” span. I do not have the NHS, but at least the NHS makes
it possible for everyone, even the poorest, the handicapped, the mentally
ill, the debilitated to have a shot at a long and healthy life.
Having said that, it might not be a bad idea for multidisciplinary teams
from the hospitals with the best results to team up with their counterparts
in the poorest performing hospitals to see if there are implementable ideas
that they haven’t thought of that would improve patient care.
- July 16, 2013 at 13:18
-
Wonderful post. I really wish I had your talent for words.
I can only stress that every time I hear the phrase “…lessons have been
learned…” I have an almost irresistible urge to obtain a firearm.
A semi-automatic firearm.
With a large capacity magazine.
-
July 17, 2013 at 07:54
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Thank you Ted – that is really kind
{ 54 comments }