Tuesday, 5 March 2013

Not Just Wrong - Truly Dreadful

The failings in the Mid-Staffordshire hospitals are well documented and according to the public inquiry what happened was ' "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency'. It is probably the biggest NHS scandal in recent years and the chief executive at the time was Sir David Nicholson. Now he happens to be the chief executive of the whole of the NHS in England. This morning he was questioned as part of the Mid-Staffs investigation.  He cannot remember whether he was in charge of 54 or 56 organisations at the time. This is not a good basis for questioning him on any specific matter. He was also asked about mortality rates at his hospitals but he hadn't received any information. He didn't see any mortality rates.

How do you measure whether a hospital is doing well? Well perhaps, most importantly you could ask the patients and Sir David tells us he has done that even though he can't remember getting to all of his hospitals. You could ask the staff and both of these measures would give you some indication of what is happening. Sir David did this too. However if you gather this information together in a scientific way it gains even more importance but still Sir David did not get to know about the years of abuse and neglect.

Morbidity rates relate to illness and are quite complicated to decipher because we are complex creatures. However it is fairly easy to know whether someone is alive or dead. Nobody is going to argue about this diagnosis and mortality rates are fairly easy to understand. I knew about them in the 80s as a student of physiotherapy. They are a fairly easy method of monitoring standards within hospitals even if you have 54 or 56 hospitals under your care and this would be one of the first places where I would look if I were a chief executive but not Sir David.

The big problem in the NHS is lack of responsibility. There are no characters left like James Robertson Justice in Doctor at Large or Hattie Jacques in Carry on Doctor. There are many hard working and caring people who work in the NHS but they don't have the authority that they need. They go to work and do their job as part of a team. If something is going wrong then they may report this in the appropriate way but that would then put the responsibility on managers. Between 2004 and 2008 one nurse working in the A&E in Mid-Staffs reported more than 50 times about the risks to patients. She got no feedback. 

The person who delivers the service is not responsible for the service as a whole. Financial directives drive the NHS. Whether you have a local A&E, whether you have any hospital service and the quality and quantity of that service will depend on management decisions which are very often directed nationally. They use terms like best practice, but this means that responsibility is centralised and those with local authority become less authoritative.

Now we know that the national decision makers can, at least in some cases, get to be where they are by presiding over a "truly dreadful" service while being apparently oblivious to that dreadfulness. Something is broken, and needs to be fixed. This chief executive had no grasp of detail, and then he got promoted.

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