Why did management at the Morecambe Bay Trust attempt to silence concerns over infant mortality in their hospitals? Why did the Care Quality Commission (CQC – an organisation who apparently don’t Care very much, and for whom Quality is a foreign concept) delete a report revealing their incompetence? Why did it take so long for concerns over Stafford Hospital to surface?
In each case, the answer is the same – it’s the inevitable result of the marketisation of the health service, begun by Ken Clarke, but eagerly taken up, improbably, by Labour, and now more predictably reaching its apotheosis under a Tory-led government. If you impose the commercial ethos on to the NHS, you import the morality of the boardroom. You also, of course, begin to bring in people who have made their mark in the commercial world, in the entirely mistaken belief that their skills will be readily transferrable. This is why the deputy chief executive of the CQC, Jill Finney, who appears to have played a leading role in suppressing the critical report, turns out to have a background in PR for a company selling pasta. What was the CQC selling, that anyone believed she had the qualities required to run a health watchdog? – it certainly wasn’t their expertise.
The other thing you import is the culture of heavy-handed bullying which passes for management in many sectors of commerce. We know that this starts at the top, although people like Sir David Nicholson seem very reluctant to accept any responsibility for that. It’s worth noting the network of contacts that links the appointees to top posts in the NHS. Cynthia Bower, the Chief Executive of the CQC, responsible for it’s so-called ‘light touch’ approach to inspection, which seems to equate to doing no inspections at all, was Sir David’s protege, and was chief executive of the West Midlands Health Authority, supposedly responsible for monitoring performance at Stafford. And of course, it goes even higher than Sir David. We now know that Andrew Lansley threatened to sack Kay Sheldon rather than thank her when she blew the whistle on CQC incompetence, and the CQC’s chief executive, Dame Jo Williams (there really is nothing like a Dame, is there?) claimed that she was mentally ill. Lansley rolled over when threatened with legal action by the plucky Ms Sheldon, and Jones has now apologised. Well, that’s OK then.
This sort of attitude filters down. It results in the heavy-handed treatment of doctors who try to highlight failings in provision – they either accept cash for their silence, or risk having their careers ended. At ward level, it results in nurses and medical staff keeping their heads down even when they realise that understaffing is preventing them from doing their job properly. And this, of course, was the real issue at Stafford, as revealed by the Francis Report – chronic understaffing resulting from management efforts to cut costs and achieve Foundation Trust status, coupled to a reluctance of staff at the sharp end to draw attention to the results of this penny pinching.
Add to this the inability of the media and politicians to understand even simple statistics and you have a perfect storm, with the NHS being held up as an uncaring organisation that routinely causes ‘excess’ or ‘unnecessary’ deaths by its cruel incompetence. This organisation is not recognisable to the majority of NHS workers or, indeed, to most patients. The media continue to believe that upward variations in hospital standardised mortality ratios (HSMR) represent excess deaths which must indicate poor performance, despite clear evidence that this is not the case. They trumpet the ‘hundreds’ of deaths caused by poor care at Stafford, despite the lack of any supporting evidence. Yes, there was clearly unacceptably poor care – there may even have been some unnecessary deaths, but the only evidence we have suggests that there may have been one such incident. Even the Francis Report made it clear that ‘Taking account of the range of opinion offered to the Inquiry, including a report from two independent experts, it has been concluded that it would be unsafe to infer from the figures that there was any particular number or range of numbers of avoidable or unnecessary deaths at the trust’.
OK, I know I’ve covered this ground before, but it’s just so frustrating to see spurious figures accepted as the truth, particularly when it reflects so badly on a health care system that continues to offer a more efficient and effective service than most of its competitors. And now we have Jeremy Hunt jumping on the bandwagon, by claiming to be ‘the voice of the patient’ in their battle with the evil doctors and nurses who are out to get them. This from the man who continues to refuse to let patients see the risk register revealing the dangerous truth behind his government’s ‘reforms’, and who has openly called for the privatisation of the service.
Yes, I know there are some areas of the NHS that could be better, but the fact is that for most of the patients most of the time, it provides excellent care. So as patients in Stafford campaign to save their hospital, perhaps we could all stop buying in to the deliberately misleading political and media hype and celebrate the NHS a bit more? At least, that is, until it is finally dismantled by this increasingly incompetent government and given over to their friends in the private sector. Yes, that’s the same private sector that screwed up the out of hours GP service by employing too few staff to cover patient needs, and bussing in doctors from overseas with questionable competence and no knowledge of of UK medical practice.
Welcome to the post-HSCB future.
