Story. I think that the general consensus is no one. I believe 40 doctors were brought before the general medical council but not one was censured same sort of thing with nursing regulatory bodies and obviously no one within the management structure is ever at fault, or rather not enough at fault to take responsibility. So we have appalling care,appalling management resulting in many unnecessary deaths yet I have heard very few apologies from those directly involved or responsible, in fact I believe promotions and pay rises or retiring rather quickly with a handsome payout are the order of the day. As with banks there seems to be a point where responsibility for your actions or responsibility for the actions of those underneath you cease to matter and integrity becomes non existent. Through bad and painful personal experiences with my local health trust I will not, if conscious, attend at least 2 hospitals within the trust,in fact I travel to Leeds from Edinburgh for anything that involves invasive treatment for my condition so terrified am I of being treated by certain aspects of my trust, where you are seen as little more than a condition and a tick on some target or other. Should you complain then the NHS will use all and every means to silence or at least discredit you. Are the NHS hospital service likely to get better or even change, no danger,no matter what politicians have been spouting. The NHS Hospital service is broken, it is now become overly corporate where vast sums are spent on PR consultants, corporate entertainment,flash offices, yet nurses are stretched so thin that it is extremely difficult for them to function in a way that they should. Fortunately I have a terrific GP practice without whom it is unlikely that I could post this.
Blame government. They wanted privatisation and a cost-and-profit target driven business model. How well did that work for the railways again? Remember how the UK opted out of the EU working hours directive for doctors? How does sleep deprivation and exhaustion affect clinical performance? Aside from that, health care is a hierarchy. Nurses and nursing assistants do not have the same power and status as registrars, who do not have the same power and status as consultants. And management is a law unto itself, because they have the unenviable task of making an overstretched service run on increasingly tight resources. There is a bit of a cultural disconnect there, with clinicians in one camp and managers in another and neither feeling that the other understands their pressures. What we are seeing at Hospitals like Mid-Staffs is what we call 'burn-out'. Health care is a tough job: you deal with a never-ending flow of human pain and suffering. Some is self-inflicted by drunken idiots on a weekend night (there's a drain on resources right there, that the public could take some responsibility for), some is just harrowing to even witness. Health care professionals try, but managing patients' needs while dealing with anxiously demanding family and anxiously demanding management and bureaucracy and lack of staff and resources and your own vicarious traumatisation can get a bit hard. And only recently has there started to emerge an understanding that the staff need psychological support, let alone patients and family. Take child care. Recently it was decided that it is too expensive so what does the government propose? An increase of child-to-carer ratio. But it's OK: caters will be better trained: they'll all have better academic qualifications because that makes them better carers, of course... Plus ça change...
I don't think the government is entirely to blame. I would suggest that some consultants, junior doctors and other medical staff within the NHS should never have had the opportunity to be in their professions. There have been several cases where health professionals have demonstrated neglectful, lazy attitudes in their roles, and it's the patient who suffers. Sure, the mis-management of the NHS is a contributory factor in large scale cases such as this, but those involved must also take some responsibility too. Mis-management is not, and never should be an excuse for laziness, cutting corners or downright neglect. I would be willing to bet that there are some Mid-Staffs who should have been struck off, and just as many management staff who should have been sacked. Blaming every wrong within the NHS on the government just isn't realistic. I worked within the NHS myself, and I saw lazy belligerence from some staff myself in the hospital I worked at, so I'm sure other hospitals suffer the same too. As with any other profession, health care suffers from the bad staff syndrome too. I do think that morale within the NHS is a pressing issue though, and needs addressing. We need people managing our health services who come from health professions, and understand the unique challenges and demands that come with the profession. As a side note: Nexxo, you say that being in health care is tough, and I agree. That is something that anyone coming into to profession is aware of though, or they should be. Much like a soldier should be aware that they may get shot at. If one has made the choice to enter into the profession, despite the knowledge that there will be hardship ahead, then they cannot use that hardship as an excuse for wilful neglect.
I think the NHS gets more stick than it deserves - Although, on the other hand, it does deserve a reasonable volume of stick in its current form. As far as I'm concerned, the NHS shouldn't have a "budget" for valid medical treatments. Level the pay grades, stop paying what basically amounts to contractors so bloody much money compared to a "regular" staff member. Abide by sensible working hours (It'd make doctors and nurses much happier I expect), and for the love of god stop letting people into the NHS who are only there because they're told to be there. Medical professionals should want to help people, not only do it because they're required to. The NHS is a great idea, but it's become some bloated money obsessed carcass of what it was meant to be.
@ StingLikeABee: But if that soldier (to take a contemporary example) gets killed in action because he was not supplied with adequate armour, or weapons or other equipment; if he has to worry about friendly fire or gets sent on missions with bad intelligence or impossible objectives, then he will get demoralised. And after a while he gets burned out, and after another while he may find himself doing horrible things to the local population that he was sent to protect and serve; things that he would have found abhorrent in his right-thinking mind when he signed up for the service. As I said above (probably not clearly; I was in a rush): the problem is partly governmental, partly organisational and partly cultural; but also about how those systems fail to acknowledge how people behave when they are suffering or confronted with suffering (which is partly a consequence of how people behave when confronted with suffering in itself). Fact is, like the clergy, health care professionals are often not psychologically equipped for the job. Some people have a natural caring streak and human insight that underpins such equippedness, so they learn and cope, but it is not a characteristic that is selected for at interviews for either clergy or health care professionals. It is not nurtured and promoted. No-one ever got to be Archbishop or Consultant Medic by being a warm, caring human being. It's not how these institutions roll. They should roll like that, of course, but that is incompatible with the cost/profit, target-driven business model that the government has chosen to embrace for the NHS. But then, politicians are not psychologists. They still think economics is about numbers, not human behaviour. And when the government does consult behavioural experts to inform policy it is greeted with a lot of tabloid-stoked Orwellian paranoia by a public that thinks it is going to be manipulated (the irony of that accusation completely being lost on them, of course). It is also in part a problem of the public's expectations of the NHS. Smoking, drinking and obese, it takes little responsibility for its own health, but expects doctors and nurses to treat them like precious babies when things go wrong. The problem with blame is that it doesn't fix the problem, it just substitutes the person. Like changing a broken part on a mechanical design that is fundamentally flawed and will just cause that part to break again. We want health care professionals who care about people, but we want them to work in conditions where they can care about people. Otherwise you just end up with a bunch of frustrated, burnt-out and bitter professionals, who care about nothing anymore.
From where I sit, the issue is the government - both past and present - who measure the NHS on ridiculous targets, such as a 4 hour A&E wait, or bed occupancy or any number of petty things. This then, over time, leads towards a target orientated environment, where, if you're not careful, actual caring and doing a good job falls by the wayside. I've stood next to an SHO who is getting a bollocking from their registrar because their patient breached the 4 hour wait "limit" - despite the fact that the reason for the breach was actually simply doing their job and not just dumping the patient, half-cared for, on the Acute Assessment Unit. That SHO stood and took it, defending themselves by declaring their actions to be in the patient's best interest, whereas the reg, more concerned with targets, didn't see this. Does this mean that registrar didn't deserve to be a doctor? Or that they don't care? No. It more likely means that they've simply had their willpower, compassion and willingness to bend the rules beaten out of them by an inflexible system dictated from high - by which I mean the consultant, the hospital and ultimately the government. The same goes for nurses. Nearly every single nurse I know wants to do their job, and do the best for patients. They're stopped in doing so by a sheer lack of numbers, which is a government funding issue, and the same relentless pursuit of targets. David Cameron had the gall to stand up in the Commons and state that NHS funding has gone up under his leadership. Why then is the NHS running on fewer nurses than ever? Why are hospitals allowed to go "bust" when there was a multi-billion NHS surplus returned to the Treasury last year? To be blunt, he's a lying ******* and wants nothing more than to reduce the NHS to ashes. Mid-Staffs is unfortunately going to become the public method by which this process is furthered, under the guise of progress. As for the EWTD and doctors, whilst it's nice that I'll be forced to go home after working too many hours it has a massive impact on training. Surgeons can't fit enough operations to learn properly in to the time, and medics walk out of hospital leaving patients in somebody else's hands. EDIT: You'll always get the occasional bad-egg. That doctor who actually just wants to murder old ladies, or the nurse who just wants access to the drug cabinet, or the manager who just wants his £80k a year, or somebody who is simply utterly incompetent at that job and who will never improve. They can be dealt with via existing systems - the GMC, RCN or the courts - although some may need teeth sharpening or more funding to deal with cases faster. It's also bad that Mid-Staff's reputation has been ruined. I know nobody who would, or will, go work there. In turn, this means they're not going to get job applications from the best of the medical school output, and the same goes for nursing and all other professions.
Regards blame and replacing one person for another, if it's suspected that certain individuals are to blame, then these individuals should be dealt with in accordance with disciplinary procedures, and the process should be both fair and transparent. Any health care professional who has wilfully neglected their duties should be removed from their profession. There must have been an element of wilful neglect on the part of some of the staff at Mid Staffs. In the same vein though, those who make working conditions so unnecessarily demanding on health care staff should be made accountable too (politicians, political parties and bureaucrats take note). If we are going to make the NHS great, then we need to separate the chaff from the wheat, remove those who have no place in such an organisation and ensure that those managing the organisation actually understand the work that is done by the NHS. Leave the management of our health care services to those who are experienced in working within these services. Stop fast tracking graduates into management positions, stop bringing management in from the commercial sectors with no NHS experience, and stop making changes without fully understanding or appreciating the implications of those changes!
That's like saying that the atrocities committed by Allied soldiers in Iraq and Afghanistan (or by UN soldiers in various places in Africa) are down to "a few bad eggs". Prof. Zimbardo would argue differently, and in fact has done so in US court as expert witness for the defence of soldiers thus accused. What you, the general public, government officials and most certainly the families involved are experiencing is grief: the emotional shock of losing a sense of attachment. For the families, loss of attachment to NHS caregivers who they thought they could trust. For the rest of us, loss of attachment to the idea that when we're sick, in pain, frightened, that there are trusted competent and caring professionals out there who will look after us, and that surely, good people could never go evil just like that? First we are in Shock and Denial: "Surely this cannot be? This must be a horrible mistake!" Then there is Anger: "Why could such a thing happen? Who could let such a thing happen? Someone's to blame! The guilty must be found and punished! Someone's got to pay!". Next up is Bargaining: "If we punish the wrongdoers, raise standards, have a no-tolerance policy, increase checks and controls, increase governance and monitoring, change management/doctors/political party, then maybe it will all be OK...". I'm waiting for Depression ("It's no use, it's hopeless. The NHS is ****ed"). Burnt-out health care professionals are already there, waiting for the rest of humanity to catch up. So are politicians who'd rather just can the whole institution and start again with privatised health care (because that is working out so well in the US). What we need to work towards is Acceptance: that good health care costs; that in the business of health care, profit is not measured in money but in quality of life, that a moral centre and an altruistic, caring nature are as important as academic qualifications and technical skill, that patients need to take responsibility for their own health too, that performance is improved not by demand and threat but encouragement and reward (Control, Mastery and Purpose, remember?), and that people are not angels or gods, but fallible humans and that systems need to take account of and compensate for that. Psychology: it matters. In everything. There is a nice little scene in Terry Pratchet's Maskerade, where an opera director is trying to explain the business of opera to its new owner, a millionaire who made his money in cheese. He doesn't get it. Why is opera not making any profit? Where does the money go? The opera director explains: Money goes in, opera comes out. The business of opera is not to make money, but to make opera. Why does the new owner not get that? The owner tries to argue that opera is a business: it needs to make money to have money to turn into opera. Why does the director not understand that? It all comes down to what you consider more important, of course: money or art. NHS clinicians have a similar conversation with the Commissioners, and by extention, the government. Money goes in, health care comes out. Arnold Relman, former Editor in Chief of the New England Journal of Medicine argued the same. Health care is not a commercial business. It cannot be, essentially, because profit does not come before human lives. The business of health care is not to make money, but to make people healthy and keep them that way for as long as possible. Some politicians don't like that idea. They read some books on economics and probably invest in, if not outright own a few profitable companies somewhere in their spare time. They understand that for something to be profitable, it must make money. For something to be more efficient, it must be cheaper. It all comes down to what you consider more important. Healthy humans, or money. The true economist realises that one equals the other, of course. Healthy humans make more money, but one also needs money to make healthy humans. Clinicians and commisioners need to both understand these pressures and balance them on a daily basis. Clinicians at the coalface similarly need to constantly balance the ideals of care with the hard practicalities of how many resources you have --both material and emotional-- and how far you can stretch them.
This was 2005-2009 wasn't it? If you don't think the NHS is wasteful and doesn't use its resources properly, you're delusional. It needs some form of reform.
Thank you for editing my quote, but I know what I meant. I was thinking of 1992 when I started working in the NHS, and Conservatives were in charge then. If it makes you feel better, I blame both parties. Of course the NHS doesn't use its resources well, but neither do banks (see what I did there?). The trick is to know what to "reform", and how. So far I'm reading platitudes, not real proposals. Just as opening a tap further is no way to fix a leaky tub, neither is just closing the tap going to do it.
What public entity has ever used its resources properly though? I think the Conservatives have got it wrong (especially with the bond market) but no other party seems to know either not sure what I will do with my vote in 2015.
Are you suggesting then, that anyone who is found to be guilty of wilful negelect and/or abuse, or to be complicit in the act of wilful neglect and/or abuse should be excused of such action because the NHS is in a sorry state? Sorry, but there are more than health professionals who do jobs in tough environments, where the lives of others are affected, and they have to accept their responsibilities, and the consequences of their own action/inaction when the proverbial crap hits the fan. Why should those in the NHS who have done wrong be shielded, or have excuses made for them? The sad fact of the matter is that patients, and their immediate and pressing needs, were ignored by the staff that were paid to look after them. No amount of political preening and playing tag with the blame game will detract from the fact that there are individuals who deserve to lose their professions. Not out of playing the blame game, but to ensure that those who were responsible are never given the opportunity to deal with a patient again. It's that simple really. The families of those who suffered also deserve to see those involved being dealt with accordingly and fairly. I would save my sympathies for those who have lost and suffered, and waste none for the lazy and belligerent 'health care professionals'. I agree, but again none of this excuses the farce that has cost lives at Mid Staffs. You can blame the government all you want, and that's fine. Just don't expect everyone to fall in line. I personally accept that the government is one part of the problem, but in the case of Mid Staffs, I believe that there were individuals who should accept some responsibility. They have been shielded by their respective professional memberships though, as is the norm. There are too many bad egg clinicians in the NHS, and it's about time we gave them the same level of distaste as the bad managers and bad politicians. You want to clean up the NHS, then accept that this starts at ground zero and goes all the way up.
No, I'm suggesting that we need to avoid the trap of fundamental attribution error (this person did a bad thing because he is a bad person) and acknowledge that ordinary people like you and me can end up doing horrendous things because they are ground down by bad circumstances. We don't like to do that, because we don't want to identify with these people. They're bad, we're good, and we would never do stuff like that, right? Only that's ********. We're all capable of being monsters in the right (wrong) circumstances. I won't lie about this: when I've been dead on my feet in a hospital on a Friday evening at 7.00pm, visited the sixth young, dying patient (cancer is a bitch) and walked past a confused, dementing patient who, frightened and in pain, is calling for a nurse on an obviously busy and understaffed ward, I have felt the darkness whispering to me: that it's not my problem, to just ignore them, that there's nothing I can do anyway except risk the frustrated ire of an overworked nurse if I seek help for this patient. I choose not to give into it because, being a psychologist, I know more than anyone else where that road leads; instead I seek help, suffer the eye-roll and suppressed anger of an equally tired nurse. She'll try to drop what she is doing and help, but what can she do? We know what's needed but acute wards are not set up or staffed to deal with heavily dependent, disoriented elderly patients. In the end I just share my helplessness around so I don't have to feel so bad about myself for just walking past. Denial of grief, right there. And it's not as if we don't let management know about this; that a few sympathetic nursing assistants and access to a Psychologist could make a lot of difference. But I am spread over four (count 'em) Hospitals, a total of 80+ wards. I see 30% more patients than I saw last year, which was already 50% over the agreed target. It's why I am still there at 7.00pm, when my paid hours stopped at 5. The NHS gets an 10 extra hours of unpaid overtime peer week out of me, medics and nurses, for no other reason than that we think the work needs to be done. And most hospitals are currently losing about £1 million a month, so it's not as if they can afford to pay us for it, and managers know that too. They are some of the most stressed staff in the NHS. I'm not looking for sympathy: we all accept it's part of the job, we all know the realities of working in the NHS. We all just wish the general public did too. Sure, staff are still responsible for their actions and therefore need to be held to account. But unless you acknowledge and change the circumstances you are not really changing anything; you just replace them with other people to burn out and become monsters. In the late-night cathode-lit corridors of human suffering and dying, the whispering dark is there all the time. I listen because it's my job to; to know what it wants me to do so I don't do it, and to help staff do the same: reveal the dark and to acknowledge that it is just another part of ourselves. To neither listen to it nor deny it, but contain it as the frightened and angry child that it is, confronted with pain, disease and death, and to give it a name: Grief. Before you get to the satisfying part of condemning, you first have to go through the messy part of understanding. Lose the idea of "a few bad eggs". That's the denial of grief speaking. The problem lies with a government that favours finance industry over health care, a society that does not want to pay taxes and does not want to take responsibility for its own health, or its elderly, sick and dependent; a medical training that is hierarchical and dispassionate (more denial of grief), an NHS bureaucracy that is inefficient and does not compensate for human failings, and that does not take account of the psychological dynamics of health care (which are incredibly far-reaching and account for a lot of stress and inefficiency) --although it's starting to. My workload keeps going up... Most of all, the government, society, health professionals and individuals like yourself need to stop the denial of grief and acknowledge that illness, injury and dying are messy and scary stuff and that we cannot expect people to deal with that day in day out without it affecting them in some way. War is a messy business. You are going to get some soldiers losing it and doing bad things, because that's the nature of war and how it is waged. Health care is a messy business. You are going to get some health professionals losing it and doing bad things because that's the nature of health care and how it is run. Not an excuse, but an understanding necessary to effect change.
"mid staffs failures who is to blame?" That is the wrong question and is a huge issue for reform. The question should be how do we solve the problems.
I do know though that those in health care have to deal with a lot of stuff that those in other professions do not. I also understand the pressures placed on health care workers. I've worked in the NHS myself, something I've already mentioned, and I saw a lot of things I would rather not have and just processing what I saw often took a lot out of me as a person. I completely understand that the NHS requires major reforms, and a large part of those reforms should address staffing issues and staff morale issues. I also understand that we need to learn from events like Mid Staffs, so we can try to eliminate further occurrences. Having said that though, from my own personal experiences of working within the NHS, I know that there are some who treat the job as nothing more than a meal ticket, and care for their patients no more than the next man. I think it would be wrong to ignore the fact that there are people working in health care who should never have been given the opportunity to do so. Because the issue is so emotive though, few will dare to come out and address this very issue, and if they do they are often accused of not supporting the NHS. I've seen it and heard it myself. There is, and always has been, a "sweep it under the carpet" culture within the NHS, from grass roots level all the way up. Much the same with any other public facing organisation. It's something that can very often do much more damage to the NHS than people realise, and also happens a lot more than the average layman would realise. As I said, if we are going to clean up the NHS, then this needs to start at the bottom, and go all the way to the top.
True, and I'm saying that they rarely started out that way; something made them become that kind of health care professional. Sometimes it is the training, sometimes it is the job. I totally agree. Some people were damaged before they joined the NHS, and did it for all the wrong reasons. Happens in all services: army, police, fire brigade... The NHS is still learning how to do it and what to look for. No candidate presents as an uncaring doctor or nurse; in job interview everybody is on their best behaviour. I agree with that too. Part of the problem is that health care professionals have always operated from a somewhat charmed position of near-sainthood. Previous generations learned that you unconditionally trusted your GP, your nurse, your consultant, and never questioned them. At the same time they were expected to be like saints: caring, wise, patient and all-powerful in their ability to take our ills and pains away. The patient's relationship and expectations were childlike; that of the health care professionals paternalistic. I think it is good that is now changing. Scenarios like Beverly Allitt and Harold Shipman have taught us that nobody is above scrutiny; increased knowledge about health behaviours, better living circumstances and ubiquitous access to information have made it easier than ever before for a person to be empowered and take responsibility for their own health. The relationship between patient and health-care professional should be a co-operative one. Unfortunately the balance of power per definition is always in favour of the health professional and they have a professional responsibility to wield that wisely and ethically. Although my personal feeling is that if you can't stand the heat, you quit the job, that is always easier said than done. In the end we all need to make the next mortgage payment, pay the bills, feed the kids. It is with that fear in mind that most stupid mistakes are made.
