I’m moving a little outside my ‘social care’ remit because I came across a link on Twitter from @shaunlintern (Health Correspondent for the Express and Star – the local newspaper covering the West Midlands, including Staffordshire) which linked to some of the evidence given at the The Mid Staffordshire NHS Foundation Trust Public Inquiry (pdf) – in particular to the evidence of one of the nurses who worked there.
The document makes quite frightening reading and coming on the back of the report from the Care Quality Commission that nearly half of the staff in NHS hospitals are not able to manage the nutritional needs of older patients and 40% fail to deliver ‘dignified’ care (from The Guardian) it raises more than a few questions.
Having spent some time in my working life, dealing with hospital discharges, particularly for older people, I don’t think that this is remotely related to ‘uncaring’ staff or as a perception of ‘university educated’ nurses that the tabloids like to raise up from time to time. I have come across some of the most professional, thoughtful and hardworking nurses.
Indeed, if you look at the first link to the evidence of the nurse, Helene Donnelly, who gave evidence in the inquiry, you will see that what she describes is a management and systemic failure in the process of providing health care to patients. It is a top down malaise rather than bottom up ‘laziness’.
She tells of a culture of fear and bullying that took place at management levels and was covered up by falsifying processes to meet targets that had been set. The flight towards Foundation status cost lives and all those involved were complicit in the associated poor care, distress and yes, even deaths.
In paragraph 13 of the evidence she (Helene Donnelly) states that
‘’falsifying records seemed insane; if the department was seen to be meeting the targets, we would never be allowed to recruit more staff or buy additional equipment. If I ever raised this as an issue, I was told in no uncertain terms that, if we didn’t meet the targets, heads would roll and A&E would be closed, with all of us losing our jobs. I understood this point but I was equally concerned about the terrible effect that our actions were having on patient care. I did raise this with Sisters (names redacted) however their response was extremely aggresive, basically telling me that they were in charge and accusing me, and anyone else who agreed with me, of not being team players. Anyone who made trouble, as they saw it, was ostracised from the team and had to endure constant bitchy comments’.
Donnelly goes on to explain how visits by Monitor to regulate the services were ‘explained away’ by telling them that there were ‘fed a line’ about it being a temporary situation and that when the coveted Foundation Status was acquired, there would be more money for more staff.
Of course that comes as little consolation to those who have passed through the doors and passed away within the hospital during the drive towards Foundation status but I think that paragraph illuminates the management push within the hospital and the reign of terror affected on nurses and patients by their seniors. This is not about ‘ground level’ nursing support. It is about systemic and institutional abuse of both staff and patients by a use of power to mask real failings.
Donnelly went on to explain how she did make a statement in 2007 when she felt she had to ‘whistleblow’ and was told that a number of junior doctors told her it was ‘about time’ (paragraph 21).
‘I responded by suggesting that they speak out too, however I understood and respected the fact that they were worried about their jobs. At one point, a band of doctors.. wrote a joint statement. However they were later persuaded to retract this when a superior told them that it would not look good on their record, being junior doctors’.
So again, this a top-down abuse of power in respect to the ethical and moral codes of caring for patients rather than a grass roots problem.
As Donnelly’s evidence (and it is worth reading in full) she continues to recount what happens until an inquiry was requested.
She sums up her evidence with ‘learning points’ and for me, some of the most crucial parts of the evidence come when she talks about targets
In paragraph 53 she says
‘In principle, I agree with the government targets.. but the system is being completely abused. Patients are still lying on trolleys for twelve hours, they are just doing it in a different room; a room not classed as A&E… having a fine as a deterrent means that the Hospital loses out financially, so has even less money for staff and also increases the fear factor for the staff. Managers are frightened of the people above them in Government and they put that fear factor onto departmental managers which then trickles all the way down’.
For me, that sums up the problem that has been perpetuated in the health and social care systems. The targets and outcome measures in themselves are not problematic (in most cases!) but the push towards them that makes managers forget the small matters of personal care and attention to the experience of the hospital of the patient really do.
Papers that blame frontline nurses for not spending time feeding patients need to look at the ways the wards are managed and the ways the hospital is managed as a whole.
For me, though the questions remain:-
Have we stopped caring about those older people (as those were the group who primarily died disproportionately in Stafford Hospital) so an increased death rate wasn’t noticed?
Would it have been a different case had the patient affected been younger and more vocal and more mindful of their own rights to receive good care?
Would more independent advocacy in general hospitals help?
On the basis that the so-called ‘buck’ stops at the top, how on earth was Cynthia Bower. who was the Chief Executive of NHS West Midlands (which includes the Mid Staffordshire NHS Foundation Trust in its remit) ever promoted to be Chief Executive of the Care Quality Commission – the organisation responsible for regulating care delivery in health and social care settings?