Tuesday, 17 July 2012

Good care doesn't have to be complicated.

The tragic case of Kane Gorny is a dramatic example of what can and does, go wrong in a hospital ward. Kane was just 22 when he of dehydration in a London hospital. He was so desperate for fluids and so upset that the hospital staff ignored his pleas that he dialled 999 and called the police who took his call seriously enough to come to the hospital ward to find out what was going on. They were sent away by the staff and Kane later died, for lack of water.

The case isn’t as straightforward as it would first seem, that patients were dying in the NHS simply for the want of a drink of water. This unfortunate young man was suffering from a medical condition which meant that he needed regular medication and constant top up of fluids to ensure that his organs received the hydration they needed. Add into the mix that Kane had suffered a brain tumour a year earlier which meant he could be prone to bouts of aggression. None of this was unmanageable and his post-surgery care after a hip operation should have been routine as long as the staff responsible for his care understood his medical history and specific needs.

The coroner investigating Kane’s death ruled that he was ‘undoubtedly let down by incompetence of staff, poor communication, lack of leadership, both medical and nursing, …a culture of assumption’

It is truly shocking that the many clinical and support staff who came into contact with Kane failed to ascertain the exact needs of their patient. Why was this? Because they didn’t care? I hope not. Because they were too busy? Maybe. Or because there was insufficient ownership and unclear responsibilities? More likely.  They all made assumptions regarding his condition and behaviour. Not one person ‘owned’ the wellbeing of this vulnerable young man. The highly desirable side effect of ownership and responsibility is communication, and good communication between clinical staff would have probably have saved his life.

I have just read a synopsis of the 37 page mandate for commissioning laid down as a result of the
Health and Social Care Bill. It talks about ‘improving recovery of illness’ and that the commissioning board will have a role in ‘maintaining or improving performance’. The government is ‘committed to extending the range of choices at every stage of patient care’. Would any one sentence in the 37 page mandate change the outcome for Kane Gorny? I doubt it. I suspect that he wasn’t so much worried about choice. His needs, and the needs of most patients, are pretty basic. Give me the right treatment at the right time with as much kindness and compassion as is humanly possible.

How can we ensure that quality of treatment and care in our hospitals? Through strong management at ward level. Through clearly defined responsibilities. If one person in that ward had personal responsibility for Kane, then hopefully they would have read his notes and made sure that they understood what was needed. And if they didn’t understand any element of his care there would have been other clinicians on hand to answer their questions.

When I worked in hospitals three decades ago there was a system where at the beginning of each shift the ward sister would allocate a number of patients to each nurse. Those patients would be their responsibility for the duration of the shift and the handover to the next shift was also their responsibility. They ‘owned’ those patients. I hope I’m not being na├»ve in believing that this simple method could still work today as long as you have enough qualified nurses on duty at any one time.

Why change basic principles. Good care is cost-effective care. Strong leadership, performance management and sufficient hands-on qualified staff create good care.  It doesn’t need 37 pages to explain that simple fact.

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