Thursday, February 28, 2013

NHS & Francis Report: Who gets promoted?

Did things just happen or was there a master plan?

The NHS has been subjected to reform, re-reform and re-re-reform over a number of years with little actual improvement in clinical care to patients. Yet the bonus culture has led to side effects that were normally the domain of bankers and financiers.

We have to remember that those high up were carrying out the Government’s Master Plan. That was why they were not sacked but promoted.

The Telegraph: Mid Staffs NHS trust: Why is nobody being punished for this disaster?

Between January 2005 and March 2009, the Mid Staffordshire hospital was a terrible place, where patients were left lying for hours in their urine and faeces. Those who tried to get out of bed and help themselves often fell, and their injuries went unrecorded. You see, old people drinking out of flower vases because nurse won’t bring water are of no concern. Not if you want to hit your targets and achieve the holy grail of Foundation Trust, which Mid Staffordshire most definitely did.

The Telegraph:
This is the central question that the Francis inquiry addressed. Why did a hospital – and, to a dismaying extent, other parts of the NHS – stop being sensitive to patients’ distress? What about consultants doing their ward rounds at Stafford every day? Did none of them hear the cries and smell the smells? What about Dr Helen Moss, the hospital’s director of nursing from 2006 to 2009, the worst period of neglect? Did she listen to Helene Donnelly, the shocked junior nurse who outlined her fears about lack of care? Or did Dr Moss believe, as most NHS managers seem to, that airing the hospital’s dirty linen in public was far worse than not bothering to change the dirty linen your patients were lying on?

Warning! You may want a gulp of gas and air before you read on. Yesterday, Dr Moss was cleared by her professional regulator. The Nursing and Midwifery Council (NMC) said that Dr Moss had “no case to answer”. The NMC refused to say how it had reached this remarkable conclusion, since all details of the case are “private”.

So a public servant who was in charge of nursing at a hospital that was complicit in the deaths of 1,200 people is not accountable to the people who paid her wages. If the buck doesn’t stop with Dr Moss, who the hell does it stop with? Certainly not Stafford’s former chief executive, Martin Yeates, who cut 150 jobs to save £10 million at a time when there were already serious safety concerns. An external report recommended that there was a case for disciplinary action against Mr Yeates, but the hospital board decided on “pragmatic and commercial grounds” to negotiate terms for an agreed departure. Therefore, unlike many of his former patients, Mr Yeates left Stafford hospital not in a wooden box, but with a £400,000 payoff.

Mr Yeates, who resigned with a pay-off of more than £400,000 and a £1 million pension pot from Mid Staffordshire Foundation Trust, which runs the hospital, told the inquiry he was too ill to appear in person.
Bereaved families said they were appalled to learn that Mr Yeates has now taken a job as chief executive of a health charity, Impact Alcohol and Addiction Services, which hold contracts with the NHS.<<<<

Do you need more proof that those involved were part of a master plan? Here they are in the Telegraph:

Cynthia Bower, who was head of the West Midlands strategic health authority at the height of Stafford’s inhumanity, dismissed the hospital’s alarmingly high death rates as “a statistical blip”. Satire lay down and died the day Ms Bower was appointed chief executive of the Care Quality Commission. If you wanted to stop a tragedy like Mid Staffordshire happening ever again, would you really choose a woman who failed to notice the abuse at Mid Staffordshire?
Just for good measure, Sir David Nicholson, who also ran the West Midlands strategic health authority, is now chief executive of the entire National Health Service. Small world, isn’t it? A former Communist, Sir David is said by critics to be the perfect man to ensure that Stalinist central targets are met, whatever the cost may be.

……What about the midwife who told the Today programme on Tuesday that “you are penalised for taking time to care”.

First Class Clinical Care:

I think that the wonderfully clear language of the NHS’s founders, expressing a profound moral good, has been replaced by management jargon of providers and drivers. That change is not cosmetic. Ugly language has created ugly thinking, with behaviour to match. Too many people going into a British hospital will encounter first-class clinical care in third-world conditions.

But really:
Dr Chris Turner told the Francis inquiry that when he started work at Stafford A&E in 2007, the place was “an absolute disaster”. It was so bad that no one could remember what good looked like. The overworked staff were constantly threatened with losing their jobs if they didn’t get patients through the department within the four-hour target. So when John Moore-Robinson was admitted after a cycling accident, he was swiftly diagnosed with bruised ribs and sent away with some painkillers. John died a few hours later from a ruptured spleen, which doctors could have spotted if they’d given the 20-year-old the tests he needed.

So there you have it, master plan or not, patients died unnecessary and those that comply with the Governments plan cuts and targets get promoted.

Medicine as I know no longer exists in many complying hospitals.

Please don’t cry!
© Am Ang Zhang 2012

The answers are complex and they are many, says Francis, but at their heart is a profound crisis of culture at every level of the NHS. The inquiry found a deep rooted, pernicious cult of management, obsessed with achieving ill-conceived targets yet isolated and wilfully oblivious to day-to-day operational reality, and fixated on image management and cultivating positive publicity while demonstrating little or no interest in acknowledging or addressing problems. Throughout the period considered by the inquiry, from 2005 to 2008, the executive management of the Mid Staffordshire Trust was blinded to the appalling care given to patients at their hospitals by their excessive focus on securing Foundation Trust status. An oppressive atmosphere in which intimidation and bullying were rife prevented staff from raising concerns, and, when they did, swept them under the carpet.
In parallel, the multiplicity of bodies with regulatory and oversight responsibilities in the NHS seemed to be asleep at the wheel. From health-care systems regulators and performance managers like Monitor, the Care Quality Commission, and the HCC, to professional bodies and regulators like the General Medical Council, the Royal College of Nursing, and the Nursing and Midwifery Council, “all such organisations have the responsibility to detect and redress deficiencies in local management and performance where these occur”, says Francis. “It does not need a public inquiry to recognise that this elaborate system failed dramatically in the case of Stafford. As a result, it is clear that not just the Trust's Board but the system as a whole failed in its most essential duty—to protect patients from unacceptable risks of harm and from unacceptable, and in some cases inhumane, treatment that should never be tolerated in any hospital.” Not a single person has yet been held accountable for what happened at the Mid Staffordshire Trust. Yet the systemic failures that the case has brought to light suggest that although atypical, Mid Staffordshire is unlikely to be unique.


hyperCRYPTICal said...

Sad, bad stuff CC - and its reading makes me wonder if I really want to save the NHS...

but yes I do - I want the NHS of old - before internal markets, before tick box medicine, before reaching (often dangerous) targets became the be all and end all and the plethora of other constraints resulting in the loss of autonomy of the medical profession - leaving them near impotent; before nurses were so burned out they ceased to care, were afraid to complain; before all who work in health (not management) were afraid…before bad apples were allowed to set the rot.

The Francis Inquiry will soon be forgotten and hospital life will continue as is- a NHS without a heart.

Scapegoats may be found on the bottom rung of the ladder and no-one will care – and those in the higher echelons will continue to reap the benefits of promotion…

The media will continue with reporting important issues of horse DNA and the NHS will die…

Anna :o[

Alina said...

Hmm, good job! This is really something!