Yesterday, QC Robert Francis published his report into the failings of care at Mid Staffordshire NHS Foundation Trust, making 290 recommendations for improvement. David Cameron apologised for the negligence: he labelled the Trust’s performance as “truly dreadful”. What is to be noted, however, is that he admitted that the evidence seems to suggest that the failings of care are not necessarily limited to just this one hospital. Failings of care are perhaps occurring across the country – the issues that the QC has identified are not unique to this particular Trust. Just as this piece is being written, the Telegraph have reported a further 3,000 unnecessary deaths now being looked into. The concern that these terrible medical practices, fatal to so many patients, could exist across the board and in other hospitals doesn’t bear thinking about: 1200 is already a number too large, and it may well get bigger in time.
Cameron’s acknowledgement of more wide-scale malpractice is an interesting development from the general rhetoric of the Government, usually keen to praise the NHS in every comment it makes of it, including the criticisms. Nobody doubts that the NHS contains a host of nurses, doctors, surgeons and specialists who truly care about their patients, are competent, with a good work ethic, and the respect required for fellow human beings to treat them with dignity when they may be feeling their most humiliated. When a grown person has to ask a nurse to assist them with using the bathroom, it’s the medical staff’s job to do their best to make that patient more comfortable with what is happening to them. Many do. Many others don’t. Whilst good doctors and nurses enter the NHS system, a number of young adults with degrees but not necessarily the skills to put these to use in these hospitals also enter the public sector. Medical staff come in three strains: the first type, are those that are just utterly abysmal at their job, they may, or may not, have sufficient medical knowledge, but they don’t understand what it’s like to be a patient and they don’t know how to be good caregivers. The second are those who would be very good, but feel that the system they work in is so flawed and so incapable of producing good care (i.e. because there aren’t enough nurses for the number of patients) and therefore don’t aspire to do well because they truly believe that there is no point. Then thirdly, are those nurses that are wonderful, that try so hard to bridge the gaps left by the preceeding two types, that work all hours and develop a rapport and consideration for patients that truly enhances the patient experience. These nurses may work themselves to the bone to make up for all the other deficiencies – but it cannot reverse the underlying trend and attitude adopted by so many. Once these people are employed there, it’s very hard to remove them. Consequently, the system is flooded with medical staff that don’t treat their colleagues or their patients in a way conducive to good practices. The good staff are let down; the patients suffer most. It’s no wonder then, that a Trust can rack up 1200 unnecessary deaths simply from medical negligence. It’s almost a wonder it wasn’t more.
The Government wants you to think these incidents are one-off events. They want you to think that most of the time the NHS does well and that these ‘blunders’ are not significant, not meaningful, not representative of the system as a whole. But they’re also keen to brush the many significant failings the NHS is guilty of under the carpet. Negligence claims tell a sad story.
In the 2011-2012 financial year, the amount that the NHS owed in clinical negligence compensation claims was a total of £1.2 billion. A further £52 million was due in non-medical claims. South London Healthcare NHS Trust had a bill of £16.6 million in negligence payouts, and went into administration because of the huge debts it had managed to accrue. Barking, Havering and Redbridge University Hospitals NHS Trust paid out to the tune of £14.9 million, with Kings College London not far behind on £13.8 million.
The NHS is struggling: money is tight, and only set to get tighter. The population is living longer, and treatment for some illnesses is becoming more expensive than the NHS can truly afford. The best will in the world would find it difficult to reconcile this with good care. However, as long as we act as though these “failings of care” are single-events with few learning curves for the sector as a whole, we do a huge injustice to present and future patients.
One of the main problems with the NHS is the disassociation between action and consequence. By fully funding all medical health treatments without concern for how they came about, we do not encourage people to live healthier lives; essentially we offer people free rein over how to live their lives whilst promising them that the taxpayer will foot the bill for whatever they decide to do. This isn’t healthy for the NHS, or for future generations who will be saddled with the debt of paying for what the present NHS can’t afford, without any guarantee of a standard of care for themselves. The concept of a universal NHS is out-dated, belonging to a time when we lived well, died young, and had an attitude of self-reliance. None of these factors still hold. It’s time to face up to reality: a universal, fully public NHS can’t work. We need market forces, we need market-generated efficiencies (like, for example, saving £1.6 million in how paper is ordered) and we need to start giving people a vested interest in how the NHS functions, by connecting them directly with the medical provision and getting the government out of it. Paternalism and social provision helps nobody – when you take the time to look up the statistics, and don’t accept the Government’s hard and fast line on how wonderful the NHS is, it couldn’t be clearer that we may as well be flogging a dead horse.
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