to hope that the report on mid Staffs hospital will shake up the NHS?

[grovel]

It was just awful and everyone from the then government through management to clinicians and nurses come out of it badly.

I don't for one moment think it reflects all (or even much) of the NHS but it does suggest a direction of travel which needs to be reversed - from caring service to self-obsessed bureaucracy.

[mumzy]

I listened to the interviews with mid staffordshire trust staff on Today this morning and what they're saying rang very true. However we have to remember these cases happened between 2005-2009 when the NHS was flooded with money and couldn't fill one post in three so money as not the issue but the chasing by the trust for foundation status. I work for the NHS in London and feel we are losing our compassion and our ideal of always putting patients first. Our first priority nowadays is meeting targets for number of patients seen, waiting times, first contacts etc etc in fact the patient is almost seen as a nuisnce in some instance if they can't be made to fit into a criteria by which a box can be ticked. Whose to blame? Ultimately its the politicians who issue these diktats to NHS chief execs and they are passed down via managers to the practioners on the coalface. All the political parties have used the NHS to win themselves votes and change after change have left patients getting poorer care and demoralised staff. Why are staff demoralised? Its because we are not valued by our managers and ultimately politicians who refuse to recognise the pressure that the NHS is under ( increasing population and ageing population) and don't support us when we say we cannot provide the level of care to our patients that we want to because there simply are not enough of us. The NHS managers are also incapable of tackling staff who are incompetent and whistle blowers are bullied or hounded out of their posts. PFI hospital projects have left many trusts almost to the point of bankrupcies and cutting staff numbers further is now the most common way of making savings. I could go on and on but how can we learn from this ? Well i think the british public need to appreciate how expensive it is to run a decent national health service then when politicians say they willl deliver a world class service then we will know they are talking rubbish. We also need to realise the NHS cannot treat everything so we need to decide on our priorities maybe families need to help care for relatives in hospitals as in other countries or we start charging for anything other than basic treatment on a sliding scale system or maybe we need more of a nanny state to make the population to take more care of heir own health. But we need to be honest about what the NHS can provide and what it can/ should not provide. The NHS should also be independent of politicians and run by a multidiscplinary team of medical and business experts. The best thing about working in the NHS is when you feel you have made a difference and some one's quality of life has improved as a result. Rant over !

[meddie]

There have been e petitions runnign for years trying to get staff ratios addressed, they dont get signed, people cant be bothered or just fail to understand how important this is. Yet someone starts a campaign to save a local woods and the papers jump on it and suddenly its a major issue and something is done.
I dont know why the media are unwilling to take on the cause of nurse to patient ratios.

[grovel]

ChestyNut, Cameron may or may not be a twunt but Staffs happened on Labour's watch. I started this thread and profoundly hope (though it's not my business) that it will not become party political.

At the last election the Labour party criticised the Tories for committing not to cut NHS funds. The Tories committed not to re-organise the NHS. None of this is helpful.

[MyDarlingClementine]

Claig its dreadful, there really is an all pervading ignorance whereever you turn and a lack of wanting to improve things and move forward.

Instead a feeling of hopelessness and constraint.

Where is the QCC in all of this?

[meddie]

I wish it wasnt political as well, but the NHS has been used for political point scoring for years. It needs to be divorced from politics and get back to what its meant to be about and this is providing good quality health care.
My heart sinks after every general election when you know that whatever party is in power, the first thing they do is start re organising the NHS, usually to its detriment. Then 4 years later, before the changes ahve even been had time to be fully put in place or evaluated the next shower of incompetents comes along and reorganises it again.

[70isaLimitNotaTarget]

Honestly Clementine you wouldn't. The number of complaints would sky rocket.

I'll give you an example.
If I said "Thank You" to the RAC man who came to my rescue, and he said "Just doing my job madam" I'd think "ooh, nice"
If a patient said "Thank You" to me and I gave the same reply it implies "I'm doing my job.No more.Bare minimum. Because I get paid for this not because I want to help you"

I used to love The Royal -Wendy Craig as the ward sister chastising the patients. The nurse who was a Nun threatening to send a snorer to have his nostrils sewn up.

I know it's drama/fiction. Lots of my patients trot out the Bring Back Matron line.
But would they really want that?
In this work climate it would be bullying/harassment

[poppypebble]

I don't think it is just staffing ratios though. Basics were missing when I was on the ward of doom. Nurses talking about which doctor they were hoping to shag whilst administering the medication, deliberately putting the call button out of reach etc. In fact, the best care anyone got on the ward was when the student nurse was on duty. She did all of the things the actual trained nurses couldn't be bothered to do. I'm sure they were busy, but to be honest they also didn't seem to give a shit about any of us.

[edam]

David Nicholson, the current chief exec of the NHS, was ultimately responsible for mid-Staffs, as the then chief exec of the Strategic Health Authority. He has been promoted by both Labour and Tory. With him in charge, how can patients and the public have any confidence that the kind of top-down management by dictat, silencing any questioning or concerns, demonising whistleblowing, will be reversed?

Mid-Staffs may have happened when NHS budgets were under less pressure, but the hospital itself was desperately trying to cut costs in a misguided but politically demanded attempt to chase Foundation Trust status. That's why they cut nursing numbers to the bone - it didn't matter if patients were ignored as long as the bosses hit their targets. That attitude came from the very top, from the Dept of Health and the SHA trying to please their masters. With current demands from the govt. that the NHS cut £20bn over five years, can anyone really believe it will get better, not worse?

[Flambemoi]

I an a consultant in the 52 bedded admissions area of a large English hospital.
Today, on my ward, we had 1 trained nurse for every 6 patients. We had 3 additional clinical support workers, 3 additional HCAs, one ward administrator, one volunteer, three ward waitresses, two cleaners (working all day), two receptionists, a discharge co-ordinator, 8 doctors, and two porters. The ward is bright, clean, cheery in atmosphere. Things happen in a timely fashion, the staff are without exception caring and polite, they are all excellent practitioners in their fields and standards of care are high.

I would have no hesitation in recommending my ward to any friends or family and would be treated there myself.

I am just trying to balance the general doomery and criticism that seems to be the background sentiment here. Yes of course there are problems in some places and the Mid Staffs lessons must be learnt - but please don't think that every hospital is like this.

What is needed are clinical leaders who are entirely committed to and focused on care quality and who are supported by managers that realise that investing in safe efficient well-resourced front line care is cost efficient.

And busy working multi-tasking Mums to run these units

[claig]

'they also didn't seem to give a shit about any of us'

The problem is none of them are afraid, from the bottom to the top. They can all blame something other than themselves - cuts, staffing levels etc.
There is no accountability, accountability is evaded and no one os punished. No one will probably be jailed. Many of teh culprits have been moved to other trusts and still receive their pensions etc. There are no consequences, they can get away with it. That is why they don't give a shit.

Put criminal sanctions in, make them afriad of negligence and ma;practice and they will change their attitude and the culture from the top to the bottom will change. After that we can fix the staffing level problems, once we have reinstated core values.

[fiventhree]

Hurray for illiketea!

Having worked in plenty of bits of the NHS and in all sorts of change projects over many years, I know one thing for sure-

The NHS is like any other organisation in that everyone takes a lead from their own manager. The culture travels down.

Also, you can have a good ward next to a bad ward if the management style is different in each.

Also look at your experience with schools- if you have a head with poor leadership skills and a bad attitude to parent involvement, regardless of any rhetoric they may spout, then the school secretary is highly likely to be a snooty worsit- learned by copying the boss.

What matters is good leadership at every level.

[Pandera]

Flambemoi - that is really heartening, your ward sounds fantastic, perhaps they could employ you in Mid Staffs or at least listen to your advice

[LurkingBeagle]

But Flambemoi - an awful lot of hospitals are like Staffs. I have never met a clinical leader who I believed was focused on quality above all else. There is simply no other explanation for the shambolic care I have seen and received. The focus seems to be on the staff's convenience more than the patient's comfort. It stinks.

And while we're at it, prompted by your post, why the hell is the UK alone is still having Wards anyway? They went out with the ark in most countries and surely increase infection risk.

[SocialClimber]

I am so torn on this.

I am having a hard time saying it's not the nurses at fault. Of course they are stressed and overworked, they have targets and they are put under pressure, but so are so many in other industries. I work in the rail industry. We have targets, we get frustrated and stressed that managers feel it's more important to fill reams of paperwork in rather than get out onto the railway and fix what's wrong. However, not ONE of the workers who goes out (on my patch anyway) lets standards slip or doesn't do their job properly. If we don't inspect or maintain the railway, people would die. Simple. People aren't doing their jobs properly in the NHS and people are dying. So for that, I think some blame has to lie with the doctors and nurses, after all, if they had compassion they would stand and fight.

That said, it goes a lot higher than that. There are processes in place in our industry that ensure that we HAVE to do our jobs properly. If we don't, we lose our jobs, or we are severely reprimanded or have to retrain.

The whole NHS system needs shaking up, and I hope this is a step in the right direction.

[ginmakesitallok]

The report is horrific. I agree with those who have said that NHS governance procedures are too driven by finance and targets, forgetting that patients are the priority. Whatever the reasons, the doctors, nurses and managers involved should be bloody ashamed of themselves, they should all be sacked.

[claig]

'If we don't inspect or maintain the railway, people would die.'

The reason that standards cannot be allowed to slip in your industry is because the people who let them slip would be held criminally liable. It is not an option to let them slip, the consequences for teh individuals are far too serious.

But in hospitals, a nurse can remove the alrm bell out of a ptient's reach and there will be npo consequences, because the whole system covers for it, right from the top down. The form filling and box ticking and target reaching is the system from the top and people are not afraid of consequences.

What happened in Staffs happened years ago and now finally after mnany years we have the report and recommendations are made, but what happened in the intervening years? Why did teh wheels turn so slowly when people's lives were involved. Will tough penalties be enacted or will it just be more calls for "training" and will the words responsibility and accountability be downplayed?

Without urgency, without penalties, without sanctions, without public examples being made of negligence and mistreatment, the whole decline will be allowed to continue.

Let's hope there is a revolution, let's hope sanctions are implemented, let's hope accountability and responsibility are instilled.

[AppleOgies]

Where can we get the report?

[ChestyNut]

Im largely not interested in politics grovel but am interested in our failing NHS and don't agree with lots of his statements and plans for the NHS.

I really think the front line staff who are on the wards need to be given a voice as to why such terrible issues are arising.

I in no way condone anything that happened but it's sad that nurses are often all tarred with the same brush

[utterlyscared1]

Flambemoi

Yes I accept that there are good wards, hospitals, GPs etc, but there are others that are not. I do wholly believe that your ward is run as you say and understand the pressures that probably come from above.

In cases of mistakes, however, there appears to be more attempt at cover-up than treating complications and ,if this involves a child, then the mother put on an fii allegation to prevent a complaint/medical negligence action (even where there is no suggestion of instigating such and the health of your child is all that you care about). Medical records go missing and previous medical history denied at the mere question of diagnosis or the realisation of a mistake is made.

I have never complained despite several hospital mishaps, have always been curteous and never argumentative with doctors, have always put my child's needs above my own etc, but none of this matters!

From personal experience, this is the most awful and frightening experience that will live with me forever. Having spent years fighting for diagnosis/treatment and grieving for the difficulties that my child does and will continue to endure, this is the result.

Please be assured that this is not a personal attack on you, but merely a statement as to how it is (or rather how it has been for me).

[claig]

They can let people lie in their own faeces for days, drink from vases and beg their families not to let them die in those hospitals, and they feel no fear at all. They can say they are overworked and nobody does anything. It must have been an open secret and yet where were teh regulators, why didn't they speak to the patients who begged their loved ones not to let them die there, why didn't they put the fear of God into the staff who let people lie in their faeces for day?

They are all liable, and the ones at the top who turned a blind eye are the most liable of all.

[AppleOgies]

Right I've found it...

summary.pdf Executive Summary here.

[AppleOgies]

Bugger..

summary.pdf

[AppleOgies]

cdn.midstaffspublicinquiry.com/sites/default/files/report/Executive summary.pdf

It's here if you copy and paste!

[SocialClimber]

"The reason that standards cannot be allowed to slip in your industry is because the people who let them slip would be held criminally liable. It is not an option to let them slip, the consequences for teh individuals are far too serious."

I agree, and that's correct. Which is why things need to change at the top and I agree 100% with your last paragraph.

But although you're right, the consequences would be serious for the frontline men (manslaughter charges etc) the threat of this is not the only reason we go out and do our jobs properly. We are trained from day one to have a deep rooted idea of safety and what needs doing to keep it safe, ie keeping people from harm. This is where nurses must be lacking, IMO. It's not that they're overworked or stressed all of the time, so are we and we are working to ridiculous targets and pressure from above, we would never leave something unsafe. Not because of the threat of liability, but because we would never want death or an accident on our conscience.

[SocialClimber]

Maybe that's what the NHS needs. Direct culpability for malpractice.