MID STAFFORDSHIRE NHS TRUST - WHAT HAPPENED TO VOCATION AND COMPASSION?

Mid Staffordshire NHS Trust - Bring back the compassion?

The shocking revelations about the Mid Staffordshire NHS Trust put us all to shame - the founding fathers of the NHS will be turning in their graves at what has happened. Conditions within the Trust between 2005 and 2009 were dreadful and there was little at the time that seemed to be done about it, apart from the efforts of one pioneering woman this could have been missed and not addressed. This is doubly shocking because health care professionals are always viewed as people who are not just motivated by money but who do care for the health and well being of the patients they are responsible for. Working for the NHS, the public and the not for profit sector should at least be a partial vocation --- no, we will never get the stellar salaries that some bankers get but yes we will be reasonably well paid and yes we can make a difference to our communities and to our fellow citizens. The latter opportunity to make a difference to our fellow men and women should motivate all of us who work in the public and not for profit sectors. Where was this sentiment in Mid Staffordshire between 2005 and 2009 for the patients?

 

The other element that appeared to be missing in this equation was compassion - defined as pity inclining one to be helpful or merciful to the people under one's care.Some of the conditions that were tolerated included the following; food and water were unavailable, patients were left unattended, bead pans were not emptied, patients and their relatives were treated disrespectfully - the catalogue goes on and on.It was also estimated that some 1,200 lives were lost as a result of the hospital's treatment failures.The report on the Trust by the barrister Robert Francis issued 290 recommendations on how this can be avoided in the future. This seems like an awful lot of recommendations to me. Let's hope they are prioritised and turned into a properly resourced action plan to make things better.

 

Let's also not pretend this is an isolated incident. When my  eighty six year old father in law was terminally ill we experienced some indifference to his plight in the NHS hospital where he was initially treated, an over provision of a pain killer could have  had much worse consequences if we had not been as robust in our stance and questioning as we were. It is good to see that there will be greater training for nurses on compassion although a nurse without compassion is the same as a soldier without any courage - so that is very surprising to me. Nursing = compassion - that should be without question. Poorly paid health care assistants can be a problem -- but that needs to be  addressed -- The Marie Curie helpers and nurses who cared for my father in law when he was at home were excellent and I'm sure they were not better paid than their NHS counterparts.

 

NHS patients will need clearer service standards and the proposed "duty of candour" where medical mistakes on patient treatment will have to be revealed  - both could make a difference but it will be difficult to see how the duty of candour will work in practice - without committing these trusts to huge legal and compensation bills if something does go wrong. Everyone thinks whistle blowing is a good idea in principle, but in practice few people do it because they do not wish to suffer the personal consequences. Whether it will work as a recommendation of the Francis enquiry remains to be seen. I  personally have my doubts.

 

Apparently the tension between local and central control in the NHS played its part in this, as local managers appeared to cut service delivery standards to cut corners to achieve foundation trust status, which ironically would have given them more autonomy  -- but to do what?  Clearly poor performance was tolerated by some managers,supposedly for the greater good to achieve this status. This reminds me of my own experiences where poor performance in parts of organisations i have worked in has been justified as being for the greater good of the organisation in that people had to be kept "on side" and the proverbial "boat could not be rocked." In my experience ignoring current performance problems just stores up much bigger performance problems in the medium to long term for the organisation and they just become more challenging to resolve than if action had been taken straight away - A lesson for us all perhaps?

 

We need an NHS which is effective,efficient and equitable. This is a tall challenge but not an insurmountable one. Privatisation with lower cost targets is not in itself a solution to this. We need an NHS where patient outcomes are improved -- According to the Economist the % of patients experiencing avoidable harms in the NHS varies from 9% per hospital to 20% per hospital. An avoidable harm is something like; bedsores, infections, falls and missed drug doses. We should be aiming at much closer to zero % in these areas.

 

Let's reset things to bring back vocation and compassion and let's focus on how we can improve patient outcomes over time - That is the priority -- not the precise service model by which these improved patient outcomes are delivered by\through.

 

The future of NHS work lies in these value-based structures giving it a chance to align its budgets within the confines of tighter fiscal realities.  It should now be thinking about value-based provision that is patient outcome-centric not a race to the bottom in terms of the costs of health provision.

Please look at the links to the Francis Report here:

http://www.midstaffsinquiry.com/pressrelease.html