Today the Patients Association published a report ‘Patient Stories’ (PDF). It focuses on thirteen different stories. These are stories directly about the experiences of patients through hospital systems and discharges. Some are told by family members when the person involved and some are told directly. Some are anonymised and one is from a doctor who received treatment herself.
The format of ‘telling stories’ is a good one because it makes for interesting reporting. It personalises tales that we know about poorly managed hospital discharges which take place before they should because we hear the voices of those directly affected and it is easy to see the lack of humanity in some of the systems that exist in acute health care.
Sometimes what is remembered is a single comment which may have been made by a busy member of staff in an offhand manner, for example, in relation to Margaret Allen, her sister writes
‘my (other) sister called the hospital to enquire after Margaret’s health before her death. The answering nurse replied that Margaret was ‘screaming away nicely’ and held the phone out for my sister to hear her cries’.
There are some shocking details in some of the stories of miscommunication, arrogance and rudeness of staff, basic care not being given but sometimes it is these snippets of language which are telling in terms of respect and attitudes of professionals towards staff.
While it may be possible to write these off as ‘individual stories’, I think that would be an massive error because there is an enormous amount of learning and themes which can be traced – not just through these stories but through the similar ones that have emerged over many years.
There is a consistent lack of flexibility and a lack of listening in these processes.
An example would be in the story of George Robertshaw who was admitted to hospital and was discharged in a way that his GP felt was ‘unsafe’ due to it being so rapid and was discharged in thin pyjamas in the winter – so that when carers did arrive to him he was cold, hungry, very thirsty and still not well.
His daughter writes
‘Following my father’s death, I again spoke to someone to inform them of my father’s demise and that I would be making a formal complaint re procedures. She told me directly that she would ask a nursing director to phone me back in a day or two, This never happened. No call, no communication, no nothing. I again rang and I was told that they had informed whoever it would be and that they would remind them. I got the impression that the relevant person was present but did not wish to speak to me and was telling the person on the phone what to say
Again, this could be claimed to be an isolated incident but as a rule of thumb and as someone who takes quite a lot of verbal complaints about the services that I provide, I tend to assume for everyone one person who complains or whose family complains, there are far more who will not have the confidence, strength or understanding to do so. It is important that systematic errors are challenged and improved but it is also important that clarity of information and respect are given to those who use services.
I wonder if that same Nursing Director would have been so slow to respond to her own manager? No? Then treat the people who use the services, particularly if they have a complaint with at least enough respect to contact them in the same time frames – even if it’s a matter of updating them with no additional information.
An organisation which is not willing to take or deal with complaints, cannot be a ‘learning organisation’ which is willing to improve.
I don’t have time to identify the issues in all the stories but it is worth reading as a snapshot of some of the care which is being given in hospitals in this country.
Of course there are good stories, and there are fantastic staff. The very first section of the report is based on positive feedback but we cannot ever become defensive about the systems as they exist and must treat each of these experiences as areas of learning. Sometimes it isn’t always about resources, it’s about respect and it’s about listening and responding.
Yes the NHS is wonderful and many of us have personal stories of gratitude, I have many myself, but if there is anything that can be done by any one of us to make things better, we absolutely must.
The main lesson I will take from these stories is to make sure that every interaction is bounded in dignity and respect. Mistakes happen but they can be resolved by listening and learning from those who experience them.
Defensive organisations that won’t encourage criticism are dangerous organisations. These lessons are just as important in all social care organisations as it is in health care.
The saddest thing about these stories is that we have heard similar before. There have been commitments between increasing ‘compassion’ in nursing and care staff but the systems need to become more compassionate too and far more responsive and flexible.
This is a series of awful stories and experiences but they must be learning experiences so that some positive may come amid the extreme pain and grief caused.
I am a nurse who started nursing forty nine and half years ago.I am shocked be the patient and families experiences.
I have seen many changes, I have moved with the times and furthered my education in concepts of caring.I am grateful for the initial rote learned concepts of general nursing care and the more modern cousins of care plans and holistic care concepts and now the self directed care concepts. I employ unconditional positive regard and aim to provide patient centred care. I still make mistakes , but also consider the present environment of reporting mistakes and learning from them is so much more conducive to admitting fault.We must foster the attitude of recognising the need for reporting failures and look at the culture of blame which is the result of many factors.
I don’t think old nurses were better than new nurses, there are fantastic young people in the profession. We must keep them valued. There is a lot of good and bad in us all.
A nurse is now a carer and a technological wizard, her knowledge base is unrecognisable to that of the girl I was in frilly cap,, leg of mutton sleeves , black stockings and starched apron- the epitome of a Victorian maid. Yet we are expected to embrace unbelievable bureaucracy, each new development And hang on to the dedication of the past. On the whole , we do it despite the fact that in common with every other service we are expected to do more with fewer staff.
Every report of cruelty , thoughtlessness, failure of service and neglect reflects on us all, shames us all and sadly taints us all. Success stories do not have any effect on our image or those amongst us who are unable to care for what ever personal or extraneous reason.
We should all take heed of these stories , for our own loved ones sakes, for the sake of those affected and for the effect on the long term outcome of the profession. These stories are grist for the mill of politicians who want to reduce the collective expense of maintaining this fantastic profession.
Oh, yes, and please put ward sisters back in real charge of the organisation ,coordination of services and management of wards, departments and districts.They were good at creating a ward ethos and cohesive approach by multidisciplinary team members even if they were scay. Everyone knew where the buck stopped then
With a elderly loved one currently in the same hospital / department for a third time for a similar/ related health issue on each occasion I have found myself needing to foramlly complain each time about the same matters. The sheer number of different staff involved in ‘care’ on a ward is a real issue for consistent care.
The fact that loved one ended up with something that was not present when admitted because of failure, as in the past, to take on board information repeatedly given to numerous people is the scandal that besets the whole system. I wish on all those in the system one day to experience the same- if they do not accept blame that is what they deserve. Someone is always to blame- not just the system
So staff in the system, all too ready to make unfounded false safeguarding alerts about family carers, fail repeatedly to safeguard anyone on their own patch of work. A farce.
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