Thursday, 14 February 2013

Soul Dead NHS

A few years ago I had something of a religious experience. I say religious but this was more beautiful and profound than anything that’s happened to me behind church doors.

I had to travel from London to the West Country for an eye operation. I took the scenic route and arrived that evening at the hospital only to find that my operation had been cancelled and that they’d been trying to contact me about it all day.

The first thing that struck me was that several people I’d never met cared about my predicament and inside an hour I was rescheduled and a bed was added for me at the end of the ward.

Then a couple of days later, waking up from the anaesthetic I was sick all over myself and the bed. In seconds there were two nurses at my side looking after the stinking woozy wreck that was me with what I can only describe as feminine tenderness. There is no substitute. Very soon I was back in the land of nod leaving those angels with only my vomit to clean up by way of payment.

Shared by many Brits, that sort of memory restores your faith in the essential goodness of people. It is such experiences that have made the National Health Service (NHS) something of a religion in our soulless country. And the NHS ethos of serving and caring for all regardless of income is not a bad basis for a religion at that. That’s why Danny Boyle’s romantic take on the NHS in the Olympics opening ceremony struck a chord with most Brits while leaving the rest of the world confused and vaguely uneasy at the sight of sick moppets twirling and singing on hospital beds.

A few years after my own NHS epiphany a journalist friend of mine who was working in Poland visited a doctor over here who diagnosed a nonlife threatening condition affecting his liver. He could have a corrective operation then or in 10 years, but at some point he would have to sort it out.

He decided to get it done right away and as his father was a surgeon in the NHS, he returned to England for treatment, though not to his father’s hospital.

Three months later he was dead.

He caught an infection at the hospital and despite his father’s moving him to his own hospital and personally directing his treatment, his life was lost. The best care in the world couldn’t save him; the damage had been done.

In former years the NHS was loved, because many shared my own experience of the disinterested compassion of its staff, particularly of the nurses. The hospitals were run down and poorly equipped, but the staff cared.

But now in the words of the poet Oliver Goldsmith:

“Ill fares the land, to hastening ills a prey,
Where wealth accumulates, and men decay: ...”

Now in the vast, shiny, new hospitals the only thing that neither free enterprise nor socialist bean counters can provide is in short supply. Most of us have seen at first hand that the ethos that made the NHS special is dying in some places, and dead in others.

But inured to NHS horror stories though they are, the British have been shocked by the sheer scale of the Stafford scandal. It’s estimated that between 400 and 1200 people died as a direct result of the treatment they received at Stafford hospital between 2005 and 2009.

What that treatment amounted to is no Tarantino epic of dastardly villains with machetes, but banal in the extreme. People simply died from callous neglect. Their screams went unanswered, medicines went unadministered, patients unable to move were left to soil themselves. Vulnerable people starved and thirsted. And hundreds died as a result.

And according to reports today, inquiries are being made into 10,000 similar deaths in hospitals across the country.

But never fear, “lessons have been learned”. The government appointed  Robert Francis QC to head an inquiry into what went wrong. And now 31 months later the learned barrister has published his exhaustive 1782 page report.

In it he concludes that the NHS “failed at every level”. And with this in mind, he makes 290 separate recommendations to fix the broken system. Every conceivable solution is outlined, apart from the only one that would actually work. That is, punishing the guilty. In his own measured words:  

“When examining what went wrong in the case of a systems failure as complex as that surrounding the events in Stafford, the temptation of offering up scapegoats is a dangerous one which must be resisted.”

Is this is another example of a sad failing in British education? Perhaps Robert Francis is not aware that “scapegoats” are by definition innocent and nobody, so far as I am aware, is calling for a few scapegoats to be sacrificed.

On the other hand, maybe this liberal barrister thinks that nobody, victims as we all are of an unjust system, can possibly be thought of as “guilty”. What a barbaric notion! If that is the case, I’m confused about what Robert’s been up to in our justice system these last few decades.

Here’s the thing Rob. It isn’t systems that are callous, but people. It was people who ignored screams of agony, it was people who refused to investigate that, and it was other people who demanded that nurses do paperwork rather than nurse patients.

In many cases these people were highly paid because of their important responsibilities. But mysteriously Francis doesn’t consider that they should be held accountable for their actions and inactions. Some, in fact, have been promoted despite their failures.

Strangely enough several of Francis’ recommendations call for hospitals to “ensure proper accountability”. How serious can we take these suggestions when the investigator himself, who has uncovered gross abuses and hundreds of deaths, refuses to point the finger at anyone in particular?

So, in short, Robert Francis’ inquiry is a disgusting attempt at misdirection. The barrister’s inquiry took 31 months and cost £13million only to discover that it was “systems” at fault and not individuals. Presumably, those people that came up with the faulty systems should not be held to account either. However, Francis doen’t give us his thinking on this point.

Though the NHS hasn’t dismissed anybody for their failings in this scandal it should not be thought that the NHS is always so reluctant to punish wrongdoing.

Sometimes there are crimes so outrageous that they simply can’t be brushed under the carpet. Last year, for instance, a doctor was fired for quoting the bible and emailing a prayer to colleagues. Personally, I think he got off easy. That case was particularly serious coming as it did in the wake of the exemplary dismissal of the nurse who offered to pray for a patient. And few people I’m sure  will have forgetten those doctors and nurses in Swindon’s Great Western Hospital who were suspended for taking pictures of themselves “lying down on the job”.

It’s not a fault, it’s a feature

So probably thousands have died and further hundreds of thousands have suffered at the hands of the NHS.

This is shocking, but not surprising. Not surprising, that is, if you have much recent acquaintance with the modern NHS experience. Not surprising if you have pleaded with unmoved nurses for an hour to locate a doctor to treat a patient hemorrhaging to death as I have.

What is shocking, though, are some reactions to this scandal.

Not the reactions of the British people who are united in anger and disbelief at the outrage.

No. The  shameful thing is the reaction of those who love, or say they love, the NHS the most.

Where are the good caring majority of the NHS’s 1.4 million employees. Shouldn’t they above all be calling for the punishment of their colleagues who not only caused the suffering of patients, but have also betrayed their NHS?

Where are the BBC and The Guardian on this? The NHS is the foundation stone of all they believe in. Shouldn’t all those who have betrayed that ideal be harried and excoriated to the ends of the earth? Blandly reporting some of the facts is treason to Bevan’s NHS.

Where are the professional bodies of doctors and nurses? How can they bear to keep such heartless monsters in their ranks?

And David Cameron? How sincere can he be about holding people to account when the head of the NHS in England, Sir David Nicholson, who ignored warnings of neglect remains in his job?

The fact that all these people are not burning with righteous anger against those who have betrayed the NHS tells us two things. First that they don't really believe the NHS can be fixed, so why bother prosecuting victims of a faulty "system". Second, and even more important, they are not burning with zeal to expell these traitors to the NHS ethos, because they themselves don't believe in the NHS anymore.

Without that belief, that beautiful ideal, which used to animate it, the NHS' condition is terminal. It is soul dead and only kept in existence by deceit and £126 billion a year of tax-payers’ money.

 At his press conference Robert Francis QC said that the NHS is “in danger of losing public trust”.

Too late, Bob.


Anonymous said...

You don't understand system failures and how they come about...

Anonymous said...

Agreed! Maloney's ranting clearly shows a lack of understanding in relation to constantly changing roles within large institutions and the impact even minor changes - have in the long term. Think in terms of a house of Cards with tens of thousands of cards and players - the domino affect of just one mistake is massive.In real terms it all goes back to funding and what funds can be used and where! More on training or less on new equipment? Thus when Maloney moved to Poland and ceased paying into the NHS taxes - was it not he and others who travel home for a free operation the route cause of the contributing rot and gloom he now blames others for? Stand up and face your own guilt my friend for the Gallows awaits you!

John Moloney said...

Ah. How refreshing. A true believer!

So it all goes back to funding. Well, they doubled funding before this happened. So if there's any causal relationship it would be that extra funding caused nurses to ignore screaming patients.

Hmm. With that logic I think you may have a career in Francis' chambers!

John Moloney said...

The only good thing about this story is that you don't have to understand system failures.

I'll say it again, Anonymous. The system wasn't there! It was people who behaved callously or with indifference. When managers ignored hundreds of complaints was it because of the system?

Anonymous said...

What more funding of cheap lease car deals for all the staff,bollocks the NHS is overfunded you can start by getting rid of that bastard in charge and not replacing him.

Gallery Violet said...

John Moloney - good on you man!

You are totally right - the NHS is made of people - who were badly managed by other people in the worst cases. And it is the NHS apologists who are wilfully blinding themselves to all the tragedy of the recent scandals (not that they were the first such episodes of course!). It is the Left which is and has been at fault for portraying personal 'rights' over duty - nurses had a duty of care over their patients - they were being paid to do a job, and callously failed to do it - putting their own 'right' to sit around doing nothing ahead of the rights of patients to be treated with decency by the people they had paid for through NI to do a job.

The state keeps on showing how badly it manages money - it receives billions in taxes, it is not as though we were truly a poor nation. It is just that the money gets wasted on unintelligent, unkind staff, who are poorly trained and receive no oversight. The best nurses and doctors show that it is possible to be good in the NHS - but you need to be a good person first and foremost. A good culture is created from the top-down, and good managers should select good staff and monitor their work and the views of patients closely.

The state in the UK simply cares about its own needs, not those of the people who pay for its existence. In other countries they seem to manage small states which is accountable and truly provide a service to its citizens. Clearly, and sadly, in the UK it seems we are incapable of managing this. Therefore, only a closely regulated market in private provision of health care can possibly help patients to get a decent service - as the best run private companies (Apple, John Lewis, Amazon) care about their customers first and foremost, as they know that they will profit from a loyal customer base. The state would just be needed to ensure these private providers were monitored and regulated to ensure patient needs and tax payer value for money came before profit. In Germany they manage very well with non-profit as well as for profit companies providing health care, which is paid for by the state and available universally.

Please sign the petition asking the government to look at this for the UK.

John Moloney said...

I'll sign the petition. But like Bruce Willis, I think we'll find that the dream that is the NHS will die hard.

To see any real change the opinion formers will have to change their minds and there is almost no sign of that happening yet.

david brown said...

How does our NHS hospital system compeare with those in other Western EU states,such as Spain, France, Germany? I think they have private hospital's with that state paying the patients bills.
Ours are run by so called trusts, who skim off money. Built by PIF a scam for private investors so labour could hid real state debt. The NHS, as europe's biggest single employe has far to many none medical staff

Stillgettingoutmybedforpatients said...

I agree with all you say.I have been a GP since 1982.Have you considered the effect of the working time directive on younger doctors than me?.The end of a medical session was when all patients were stable, all investigations organized,all treatments administered all ops arranged.This was unremarkable behaviour and the norm..Now it is stethoscopes down at and the law says so.Some other team can pick up the mess.Young doctors have graduated from schools where they have learned what their rights are and have no idea of their responsibilities,so carrying on this behaviour as senior med students and young doctors could be understandable.Also, would you give up your livelihood and your family's future to whistlebow.Honest answer please.Politicians are not capable of running an NHS,it needs to follow the fate of the BoE.

Anonymous said...

@anon 'Maloney's ranting clearly shows a lack of understanding in relation to constantly changing roles within large institutions...'

My grandmother died in the Good Hope in Birmingham with oral thrush and bedsores caused by neglect. The nurses sat around and read Heat and OK! While she died of thirst.

Not sure how 'constantly changing roles' prevent you from giving an 86-year-old woman a drink of water.

John Moloney said...

Part of the problem is obviously that society has changed.

Even if the political will was there, the idea of duty and even the willingness to sacrifice for others is looked upon with amused disdain.

technorebel said...

John, you are correct about that. I'm a retired nurse in the USA. When I was working, I thought of my job as my ministry. It was my privilege and duty to care for the sick. Most nurses in my class felt the same way--nursing was a calling for us.

I don't know why the attitude changed. I wouldn't go to the hospital these days without bringing a family member to take care of me. The willingness to serve just isn't there anymore, and you will receive lackadaisical care if, indeed, you are cared for at all.