Mid Staffordshire: The Modern Witch Hunt

The Mid Staffordshire report came out today

February 24, 2010

Jobbing Doctor:

This is a disaster directly lying inside Number 10 Downing Street. It was they that created Foundation Hospital trusts (plus the spineless MPs). They that created the purchaser-provider split. They that founded Monitor who were only interested in financial success.

No, Messrs Brown, Blair, Burnham and all the others: this is not a local problem. It is being replicated at a hospital trust near you.

The fault lies with policy and the labour Government. It is people at the top that need to resign. Except that they won't, of course.

Times: Mid Staffordshire NHS Trust 'routinely neglected' patients says inquiry

Patients were “routinely neglected” at an NHS hospital where hundreds of deaths resulted from appalling care, an independent inquiry found today.

Mid Staffordshire NHS Foundation Trust lost sight of its responsibility to provide safe care because it was preoccupied with cost-cutting and meeting Government targets, a report said.

The inquiry, by Robert Francis, QC, made 18 recommendations for the trust and the wider NHS after hearing evidence from more than 900 patients and families.

Regulators revealed last year that between 400 and 1,200 more people had died at Mid Staffordshire Trust than would be expected between 2005 and 2008, in one of the worst examples of poor care in the history of the NHS.

The trust said that it would consider whether individual nurses or doctors should face further disciplinary action.

He said evidence gathered during the inquiry into events at the trust between January 2005 and March 2009 had shown clearly that for many patients the most basic elements of care were neglected.

Patients were left unwashed, at times for up to a month, and food and drinks were left out of reach of patients.

“We understand both the sadness and sorrow of the relatives who lost their loved ones,” he said. “It was a management failure and completely unacceptable.”

He added that the Government was taking steps to better regulate hospitals and would introduce the power to “strike off” managers who were unfit to work in the NHS.

BBC: Hospital left patients 'sobbing and humiliated'

The report criticised the "ineffective" management which was too often concerned with hitting targets, particularly in A&E, as well as the "lack of compassion" and "uncaring attitude" of staff.

But staffing levels were also said to be too low because the trust was trying to slash costs by £10m.

Related:

BMJ: Changing the face of whistleblowing

Concerning Mid-Staffordshire NHS Trust, the chairman of the Healthcare Commission indicated that warnings existed about some of its problems for years before the problems became publicly known.¹¹ Why should staff accept the risks of whistleblowing if warnings are ignored?

The chairman of the Care Quality Commission has criticised staff at Mid-Staffordshire NHS Trust and elsewhere for operating in a "culture of silence."⁹But the commission’s plan to assess progress at Stafford does not mention whistleblowers. The secretary of state for health has stated: "I do not understand why clinicians whose primary role is the safety of their patients are somehow concerned about whistleblowing."¹²

Hansard

T8. [265644] Michael Fabricant (Lichfield) (Con): Two constituents came to my surgery a few weeks ago to talk to me about a hospital in the west midlands— not Mid-Staffordshire hospital. They showed me photographs of mouse holes, mouse droppings in the operating theatre and blood smeared in wards. One is a consultant surgeon and both were frightened of being whistleblowers and feared for their jobs. What sort of ethos exists in the health service if people like that can be afraid of revealing the truth?

Alan Johnson: I know about that case, because the hon. Gentleman dropped me a note about it after the debate last week, and I am looking into it. As he did not mention the hospital, neither will I, but the fact that he has now placed the matter on record allows me to respond to him more formally than I would otherwise have done.

I do not understand why clinicians whose primary role is the safety of their patients are somehow concerned about whistleblowing. Indeed, knowing the number of people in various occupations who are not slow to make people aware of such difficulties, it amazes me that that did not happen at Stafford. The hon. Gentleman has taken a great interest in the matter, and I shall make absolutely sure that the issue that he has raised with me is thoroughly examined. Incidentally, I would also like to talk to the consultant concerned to find out why they were so frightened to raise the matter.

The Daily Telegraph:

The General Medical Council (GMC) said several doctors involved in Mid Staffs had been referred to it for investigation but would not disclose how many.

The Nursing and Midwifery Council (NMC) has also opened a case file and is investigating at least one nurse. It is also considering whether other nurses should be investigated.

It has indeed started!!!

Other related posts:

Mid-Staffordshire: Media Media Media.
Mid-Staffordshire: Unbelievable! Unbelievable! Unbelievable! 

Mid-Staffordshire: Where Are The Doctors? 
Humber Mental Health Teaching NHS Trust: Learning From The Past.

Mid-Staffordshire? Not Just Mid-Staffordshire!

Blogs:

Jobbing Doctor: Poor bloody infantry.

Hospital Dr: Mid Staffs was driven by targets and cost-cutting

Ward 87: The Silence of Robert Francis QC. Mid Staffordshire NHS Trust Inquiry

The Report:

Download Inquiry Report - Vol 1

Download Inquiry Report - Vol 2

Anorexia Nervosa: Eating Disorder Awareness Week

A Brief History of Time: Anorexia Nervosa

First published March 1, 2008

 

Il faut manger pour vivre et non pas vivre pour manger.
(One should eat to live and not live to eat.)
- Moliere (1622 – 1673): L'Avare (The Miser)

Some hae(have) meat and cannot eat,
Some cannot eat that want it:
But we hae meat and we can eat,
Sae let the Lord be thankit.
- Robert Burns (1759 – 1796): The Kirkcudbright Grace

This is not about Stephen Hawking’s famous book that sold over 9m copies world-wide, but a collection of material that relates to Anorexia Nervosa in a chronological order. You see, I believe in free sharing of knowledge.

First introduction of the term Anorexia

Sir William Withey Gull (1816 – 1890) first used the term:

“In… 1868, I referred to a peculiar form of disease occurring mostly in young women, and characterized by extreme emaciation…. At present our diagnosis of this affection is negative, so far as determining any positive cause from which it springs…. The subjects…are…chiefly between the ages of sixteen and twenty-three…. My experience supplies at least one instance of a fatal termination…. Death apparently followed from the starvation alone…. The want of appetite is, I believe, due to a morbid mental state…. We might call the state hysterical.”

Source: Anorexia Nervosa (apepsia hysterica, anorexia hysterica).
Transactions of the Clinical Society of London, 1874, 7: 22-28.
Classic description of Anorexia Nervosa.

Earliest published accounts

Richard Morton (1637-98), a London physician: The Treaty in his book Phthisiologia, or a Treatise of Consumptions, first published in Latin in 1694.

Ernest-Charles Lasègue (1816 - 1883), a professor of clinical medicine in Paris: “De l’Anorexie Hysterique” containing descriptions of eight patients.

More recent views

Girl in a Chemise circa 1905 Pablo Picasso (1881-1973)
Tate Collection

Anna Freud’s psychoanalytic view (1958):

• Adolescent emotional upheavals are inevitable
• Anorexia Nervosa is the outward manifestation of the battle between the ego and eating, with the former struggling for it’s very survival

Bruch (1966): relentless pursuit of thinness

Crisp (1967): weight phobia

Russell (1970 ): a morbid fear of becoming

Crisp (1967 - 1980):

• Anorexia nervosa serves to protect the individual from adolescent turmoil.
• Anorexia nervosa reflects a phobic avoidance of sexual maturation.
• Unsettling effects of sexual maturation at puberty may drive the female adolescent to a pursuit of thinness leading to greater acceptance, self-control and self-esteem.
• Anorexia nervosa tends to appear in families with buried, but unresolved, parental conflicts.

Palazzoli (1978) on women’s role (not just Anorexia Nervosa)

• Women are expected to be beautiful, smart and well-groomed.
• They are expected to have a career and yet be romantic, tender and sweet.
• They are expected to devote a great deal of time to their personal appearance even while competing in business and professions.
• In marriage, they are expected to play the part of the ideal wife cum mistress cum mother.
• They are expected to put away her hard-earned diplomas to wash nappies and perform other menial chores.
• The modern woman is therefore exposed to a terrible social ordeal, and the conflicting demands and dual image of the female body as sex symbol and as commodity.
• An adolescent girl may develop feelings of insecurity and alienation toward her changing body.

Finally, it is appropriate to close with two quotes:

L'appetit vient en mangeant.
(The appetite grows by eating.)
- Rabelais (1494 - 1553): Gargantua

One hath no better thing under the sun than to eat, and to drink, and to be merry ...
- Ecclesiastes 8.15

Other Posts:
Anorexia Nervosa: Olanzapine (Zyprexa)-Veganism
Anorexia Nervosa: Bach
Anorexia Nervosa: What If!
Anorexia Nervosa: a cult?

Anorexia Nervosa: Chirac & Faustian Pact

Did You Catch These: Anorexia Nervosa

The Cockroach Catcher: A Chapter on Anorexia Nervosa,  

Readers' views.

Diabetes & Dolphins: What If?

When I was in Hong Kong recently I had dinner with a doctor friend who had Type 2 diabetes. He told me that he now uses insulin. He finds he could think and function better.


Imagine my surprise when I read:


The New York Times:

Research Ties Diabetes Drug to Heart Woes

By GARDINER HARRIS
Published: February 19, 2010
Hundreds of people taking Avandia, a controversial diabetes medicine, needlessly suffer heart attacks and heart failure each month, according to confidential government reports that recommend the drug be removed from the market.

Avandia, intended to treat Type 2 diabetes, is known as rosiglitazone and was linked to 304 deaths during the third quarter of 2009.

Then on the same day in the National Geographic News:
Dolphins Turn Diabetes Off and On -- Hope for Humans?
Victoria Jaggard in San Diego/Published February 19, 2010

Bottlenose dolphins have what could be called type 2 diabetes, but unlike humans, the animals are able to turn it off and on—perhaps an evolutionary adaptation to maintain their big brains, new research suggests.

Bottlenose Dolphin. NOAA image

Diabetes may have arisen in Ice Age humans for similar reasons, so the newfound dolphin on-off switch may be a key to curing type 2 diabetes in people.

Like humans, dolphins have relatively large brains compared to their body sizes—in fact, dolphins are second only to humans in the ratio between body and brain size. 

Scientists know that humans need plenty of a sugar called glucose to keep their .brains functioning. Some researchers think  the same might be true for dolphins, since both species send high amounts of glucose through their bloodstreams.

Dolphins, however, primarily eat fish, which are high in protein and low in sugar. To get enough glucose from this diet, dolphins have evolved a mostly harmless form of insulin resistance, according to Stephanie Venn-Watson, director of clinical research for the U.S. nonprofit  National Marine Mammal Foundation(Press Release).

Is it indeed possible that we try to feed our brain at the cost of other organs? Has evolution done away with our ability to switch?

Could further studies on the dolphin throw more light on humans?

In the mean time, it may be best to do what the doctors do, not what they tell you!!! Just like my doctor friend.

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Related: 

Diabetes: More than just sugar overload?

Avandia 2007: NY Times, Guardian

Avandia Latest: A Face-Off on the Safety of a Drug for Diabetes,

Cleveland Clinic.

Related: Tasmania: Whales & Dolphins-Mother & Baby

Anorexia Nervosa: Chirac & Faustian Pact

Reading a new book sometimes brings you the unexpected.

In Ahead of the Curves, the author told of the story he heard of Jacques Chirac and his pact with West African marabouts, witch doctors. He was told to sacrifice one of his daughters if he wanted his presidency. Soon after his younger daughter, began suffering from anorexia nervosa.

So, I Googled Chirac’s daughter:

Chirac's wife tells of anorexic daughter's death wish

Telegraph: By Colin Randall

Published: 07 Dec 2004

President Jacques Chirac's wife has broken a 30-year silence to talk publicly about the anorexia that drove their elder daughter to try repeatedly to kill herself.

"A mother who fails with a child, who cannot bring a sick child back to health, always feels guilty," Bernadette Chirac said on French television. "And a father, too."

Laurence Chirac, now 46, was a promising medical student and worked for a short time after her studies with Samu, the emergency medical service, in Paris.

But she had suffered from an acute form of the eating disorder since she was 15, leading to several stays in hospitals and clinics.

Sixteen years ago, during her father's second presidential campaign, she was taken to hospital amid widespread rumours that she had died.

"Being famous can be harmful when one is faced with illness," Mrs Chirac said. "Confronting this kind of difficulty, you just want to hide from the gaze of others."

Laurence, whose younger sister Claude is a key member of the president's team at the Elysée, continued to suffer from the condition. In 1990 she tried to commit suicide by jumping out of the window of her fourth-floor flat.

A nurse assigned to her round-the-clock care was unable to stop Miss Chirac, who survived with a broken pelvis and head injuries.

Little has been heard of her since and Mrs Chirac said merely that she always kept the hope "pinned to my heart" that her daughter would recover.

Mrs Chirac has been the president since 1994 of a charity seeking to create better conditions for children and teenagers in hospital, enabling them to listen to or play music and play sports. She agreed to talk about her daughter on a France 3 discussion programme, “You Cannot Please Everyone”, to help publicise a new clinic for adolescents, La Maison de Solenn, funded by her charity.

"These children need some gaiety in their lives, to be able to see the sun," said Mrs Chirac,

She contrasted this ideal with the conditions in which her daughter was sometimes treated, "enclosed behind brick walls in a bedroom with a small window". She added: "That is why this mother wants to create a facility specific to adolescents' needs.

French Health Care as experienced by the President’s daughter.

We did not do too badly with our own Adolescent Psychiatric Units.

Related:

A Brief History of Time: Anorexia Nervosa

Anorexia Nervosa: What If!

The Cockroach Catcher: A Chapter on Anorexia Nervosa, 

Reader’s views.

NHS: Business Model? Spare Us Please!!!

As many in our government is bent on changing the NHS, should we not take a step back after the apocalyptic disaster in the financial world of 2008 and ask the simple question: Can we continue to trust and pay financiers and consultants to run our banks and other institutions and even our NHS?

Ahead of the Curve/Philip Delves Broughton

I was reading a book by Philip Delves Broughton on Harvard Business School (HBS): Ahead of the Curve.

He may not be the first to observe that HBS loves Marines, Mormons and Mckinsey. Kim Clark  must indeed be the most famous sons of The Church of Latter Day Saints and PDB’s article in The Sunday Times: “Harvard’s masters of the apocalypse” may indeed be aptly titled.

He opened with:

If his fellow Harvard MBAs are all so clever, how come so many are now in disgrace?

From Royal Bank of Scotland to Merrill Lynch, from HBOS to Lehman Brothers, the Masters of Disaster have their fingerprints on every recent financial fiasco.

We MBAs are haunted by the thought that the tag really stands for: Mediocre But Arrogant, Mighty Big Attitude, Me Before Anyone and Management By Accident. For today’s purposes, perhaps it should be Masters of the Business Apocalypse.

Harvard Business School alumni include Stan O’Neal and John Thain, the last two heads of Merrill Lynch, plus Andy Hornby, former chief executive of HBOS, who graduated top of his class. And then of course, there’s George W Bush, Hank Paulson, the former US Treasury secretary, and Christopher Cox, the former chairman of the Securities and Exchange Commission (SEC), a remarkable trinity who more than fulfilled the mission of their alma mater: “To educate leaders who make a difference in the world.”

It just wasn’t the difference the school had hoped for.

Business schools have shown a remarkable ability to miss the economic catastrophes unfolding before their eyes.

In the late 1990s, their faculties rushed to write paeans to Enron, the firm of the future, the new economic paradigm. The admiration was mutual: Enron was stuffed with Harvard Business School alumni, from Jeff Skilling, the chief executive, down. When Enron, rotten to the core, collapsed, the old case studies were thrust in a closet and removed from the syllabus, and new ones were promptly written about the ethical and accounting issues posed by Enron’s misadventures.

Let us stay with the UK:

Much the same appears to have happened with Royal Bank of Scotland.

When I was a student at Harvard Business School, between 2004 and 2006, I recall a distinguished professor of organisational behaviour, Joel Podolny, telling us proudly of his work with Fred Goodwin at RBS. At the time, RBS looked like a corporate supermodel and Podolny was keen to trumpet his role in its transformation. A Harvard Business School case study of the firm entitled The Royal Bank of Scotland: Masters of Integration, written in 2003, began with a quote from the man we now know as Fred the Shred or the World’s Worst Banker: “Hard work, focus, discipline and concentrating on what our customers need. It’s quite a simple formula really, but we’ve just been very, very consistent with it.”

The authors of the case, two Harvard Business School professors, described the “new architecture” formed by RBS after its acquisition of NatWest, the clusters of customer-facing units, the successful “buy-in” by employees. Goodwin came across as a management master, saying: “A leader’s job is to create the conditions that enable people to believe, in their hearts and minds, in the value of what they are doing.”

Then just last December, Harvard Business School revised and republished another homage to RBS – The Royal Bank of Scotland Group: The Human Capital Strategy.

It is tragic to read now of all the effort put in by those under Goodwin, from “pulse surveys” to track employee performance to “the big thank you”, a website where managers could recognise individual excellence in customer service.

Every trendy business school idea was being implemented, it seemed, while what really mattered – the bank’s risk assessment, cash flow and capital structure – was going to hell. To be fair, neither Podolny nor the authors of the case studies were finance professors, but it’s still pretty shocking that a school that purports to teach general management should fail to see the gaping problems at a firm they studied in such depth.

Last October, Harvard Business School celebrated its 100th birthday with a global summit in Boston. While Wall Street and Washington descended into an economic inferno, Jay Light, the dean of the school and a board member at the Black-stone private equity group, opened the festivities by shrugging off any responsibility.

“We all failed to understand how much [the financial system] had changed in the past 15 years or so, and how fragile it might be because of increased leverage, decreased transparency and decreased liquidity: three of the crucial things in the world of financial markets,” he said.

“We all failed to understand how that fragility could evidence itself in a frozen short-term credit system, something that hadn’t really happened since 1907. We also probably overestimated the ability of the political process to deal with the realities of what could happen if real trouble developed.

“What we have witnessed is a stunning and sobering failure of financial safeguards, of financial markets, of financial institutions and mostly of leadership at many levels. We will leave the talk of fixing the blame to others. That is not very interesting. But we must be involved in fact in fixing the problem.”

You would think after failing on so many levels, the school that provides more business leaders than any other might feel some remorse. Not in the least. It’s onwards and upwards, with the very people who blew apart the world’s financial plumbing now demanding to fix the leak.

Given the present chaos, shouldn’t we be asking if business education is not just a waste of time, but actually damaging to our economic health?

If doctors or lawyers wreaked such havoc in their own professions, we would certainly reconsider what is being taught at medical and law schools.

He said of Light’s statement:

He was like a drunk driver emerging from a wreck asking for the keys to the police car so he could drive home. Don’t worry about who’s to blame, let’s just all run along, shall we?

Light, told his audience in October: “The need for leadership in the world today is at least as great as it has ever been. The need for what we do is at least as great as it has ever been.”

A bold claim to which many might say:

“Please, spare us.”

A fairly straightforward book to read with real names and real people that one reads about in the business section of the major papers and often in the front pages too.

What is happening now in the US is very frightening: at the top some very rich CEOs and below them a highly dispensable workforce. The book talked about 30 million. No more job security for these.

If we are not careful, the NHS will move towards the same model of NHS Trusts and PCTs with highly paid CEOs and their management staff. Below them a number of highly dispensable doctors, nurses and other workers. Firing of staff is the norm to balance the books in the NHS.

Look at what happened to Out Of Hours service and hospital weekend and holiday manpower levels and you will know what I am talking about.

Unfortunately, it may be too late to try and bring back the good will that has kept the OLD NHS going for so many years. The good will that was slowly destroyed by modern management ways and silly Pavlovian bonus culture.  

“Please, spare us.”

Banks: Northern Rock, HBOS, RBS, Bonus at RBS

Out Of Hours service, bonus culture, Hospital Dr

Related:

To Intervene Or Not: A Colossal Failure Of Common Sense.

NHS & McKinsey: The Professor & 10%

BMJ Analysis: Allyson M Pollock

Dr Am Ang Zhang is the author of The Cockroach Catcher.

Grand Rounds: M D Whistleblower

Three Doctors & The NHS

Dr Grumble:

“It's a strange irony that it is managers who seem intent on trying to turn us from public servants with a genuine interest in patient care into the money grabbing people the HSJ likes to portray us as. Managers were the ones who essentially forced new contracts onto consultants resulting in our being paid for the very first time (on paper anyway) for all the work that we do. Doctors who were reluctant to move from a professional and vocational contract are now being paid more. Did our masters expect us to be paid less? Perhaps they really did. Perhaps managers just cannot grasp that doctors do whatever is necessary to meet the vital needs of our patients whether we are paid or not. And the same people made similar mistakes with GPs. For it was managers who forced GPs to jump through ever more hoops to be paid - which they promptly did. The BMA dutifully told the government that it would result in their being paid more. But the BMA was not believed. Yet the HSJ continues to distrust them.”

Jobbing Doctor: Dr Clive Peedell: Speaker of the truth

Every so often, one comes across someone who puts into the discussion the argument that needs to be put.

One such is Dr Clive Peedle:

Dr Clive Peedle

The BMA represents 70% of all doctors and the vast majority oppose a market based healthcare system (there are several surveys that prove this). As a member of BMA Council, I and my fellow Council members were mandated to mount a campaign against the market based reforms by several motions passed overwhelmingly at consecutive Annual Representative Meetings (ARM). I also happen to passionately believe that this was the right thing to do. Even Gordon Brown (SMF speech 2004) understands that markets don't work well in some situations and healthcare is one of the best examples of this.

As for big business profiting from the NHS, why not take a look at the Forbes website, Mr Vize:

US companies involved in the NHS (all FESC approved for example):
Humana.
Current CEO: Michael.B.Mccallister

Compensation 2009: $5 million and has $50 million stock options

UnitedHealth:
CEO: Stephen J Helmsley

Compensation $3 million and stock options worth $660 million
n.b previous CEO, Dr Bill McGuire was involved in $1.6 billion stock options scandal. Please see the US Securities and Exchange Commission (SEC) website for more details.

Aetna
CEO: Ronald A Williams

Compensation 2009: $24 million and stock options worth $170 million
n.b Former Aetna CEO John Rowe earned $175 million in 65 months ($225,000 per day!!)

Here are some further astonishing figures including other top execs (see further down page):  The Industry Radar

The HSJ should be investigating these characters instead of slagging off the BMA. These companies want to expand their markets into the UK and their number one priority is to their shareholders, not the English taxpayer and patients. That is why the BMA is fighting so hard against this.

As for GPs being small businesses, that may be the case, but they are a vitally important part of the communities they serve. Most GP partners work in their practices for their entire working lives and therefore have unprecedented knowledge about their patients and patients' families, which is vitally important for continuity of care. The vast majority are wedded to the ideal of the NHS and most are very innovative. Mr Vize's comments about GP's IT illiteracy are unfounded. In fact, GPs are miles ahead of the hospital sector in terms of successful use of IT.

Poor GP services do need sorting out, but Polyclinics are not the answer. The for-profit GP outfits will try to increase profits by employing cheaper staff on short term contracts. This will have dreadful consequences for continuity of care. It will be the poorest and most vulnerable patients with chronic long term illness who will lose out to the worried well who want to pop into clinic after work, who don't really mind who they see.

Related Posts:

NHS & the Repeal Of The Glass-Steagall Act

Mid-Staffordshire: Media Media Media.
Mid-Staffordshire: Unbelievable! Unbelievable! Unbelievable!
Mid-Staffordshire: Where Are The Doctors? 
House M.D. : 95% vs 5%
House M.D.: Modern Tyranny
Humber Mental Health Teaching NHS Trust: Learning From The Past.

Mid-Staffordshire? Not Just Mid-Staffordshire!

Public Enemies: Three Doctors, Patients Association & The NHS