Sunday, 21 October 2012

Science vs. religion? – sounds a bit like the politics of healthcare

I should be heartened by the recent statement from the new Secretary of State for Health that he will be guided by science. Jeremy Hunt is on record as saying that his decisions would be ‘evidence based’. I fail to be convinced as one of his most publicised statements endorses abortion at 12 weeks and another supports the efficacy of homeopathy – neither of which preferences are ratified by the accepted wisdom of current scientific research.

His predecessor, Andrew Lansley seemed to be oblivious of much evidence based research and designed his reforms not based on science but his own form of religion – strongly held beliefs but little evidential back up.

And so it is with the politics of health. Good medicine is based on current scientific evidence balanced with the needs of the patients and available funds. I cannot exclude money from this definition as in the real world, cost benefit analysis will always be key. The politics of health, I believe, has a different definition. It is the balance (often unequal) of science and religion. The religion in health politics is the beliefs and possible bias of the decision makers, moved even further off-kilter by the colour of the party politics involved.

But one must have sympathy for the holder of the heavy and potentially poisoned chalice of the health ministry. I carefully included ‘current’ science in my definition of good medicine. I still shudder when I consider that 26 years ago I used to settle my precious baby on her front to sleep – luckily without ill effect. That was the advice at the time, even though now there is irrefutable evidence that cot death has significantly reduced since parents have been advised to lay their babies on their backs.

We are constantly bombarded with new pearls of wisdom from health researchers, especially when it comes to lifestyle and surgical options.  Working in both the public and private sectors, I am familiar with the anger experienced by patients when a treatment they believe to be essential is not offered by their NHS trust or approved by their particular medical insurer. Hysterectomies used to be ‘ten a penny’  but now there are other, less invasive and more cost effective ways of treating the symptoms that sent women in their droves to the surgeon’s knife.

Times change, health knowledge changes, scientific evidence changes. But all that any medical practitioner, and for that matter health minister can do – is to work within the accepted scientific guidelines of the time, study evidence not hypothesis, and make a decision based on here and now and not hearsay.

And please, whatever you do – leave religion and politics out of it.

Ah well – a girl can dream…

Thursday, 11 October 2012

The cost of silence – a high price to pay

The fallout from the sound of silence is being demonstrated with dramatic effect either side of the Atlantic right now. Two very high profile cases have shocked the health, sporting and corporate establishments where a catalogue of wrong doing is finally being exposed.

The world of cycling is finally accepting (or should I say admitting) that the iconic American cyclist, Lance Armstrong was probably at the head of a global doping cartel, cheating his way to world dominance of his chosen sport.

Here in the UK, the late Jimmy Saville, the legendary presenter, DJ and benefactor is being exposed as the predator of the worst kind, abusing the privilege of his status and taking advantage of vulnerable young girls. This abuse took place on BBC premises, at schools and within hospitals possibly over 5 decades. Truly shocking. I’m not sure which is most shocking, the multiple acts of abuse or the conspiracy of silence.

Like the first tentative spray of water fighting its way through the flawed concrete of a failing dam producing an unstoppable and highly destructive torrent, so the victims and silent enablers have started to come out in the open.

Of course, the highest priority for the authorities here in the UK is to provide appropriate support to the victims of Saville’s excesses, and finally help them heal.  Putting the human tragedy of these individuals aside for a moment – what about the corporate conspiracy of silence? What about those who shunned the victims who turned to them for support? The BBC, a highly respected organisation which appeared to support the culture of a blind eye. The teachers who chose to disbelieve a troubled teenager. So many observers, complicit through their silence, must take some responsibility for not speaking up. Or should they? Is it organisational culture that is the real culprit here?

The victims of abuse were not just failed by the TV personality, they were let down by those they trusted to know better.

In the corporate or organisational environment, people tend to stay quiet about bullying, abuse, inappropriate behaviour, bad practice or fraud for one of two reasons. Fear or gain.  I suspect that currently in the workplace it is fear that is the driver to silence.

I am aware of no figures available to quantify the number of excellent employees who leave an organisation because of the conspiracy of silence.  Not speaking up because you know your concerns would be ignored is a damning indictment of any employer. What is the point of exposing bad behaviour if you know that at best you will be ignored, at worst your career prospects will be damaged or you could lose your job.

When I was much younger, I learnt the hard way that speaking up must be carefully managed. I discovered that my immediate superior was using company funds to pay for furniture for his family home. Even worse, I discovered that some of the ‘patients’ on the clinical trials we were setting up were in fact this doctor’s relatives, enrolled for juicy fees and results were being fabricated. Horrified, I challenged the perpetrator and was summarily fired (you could in those days). Our paymasters were in the US and when I called them to warn them of the irregularities, my comments were understandably viewed with some suspicion as an aggrieved ex-employee. Luckily, they trusted my word enough to embark on an investigation which proved my allegations. Had there been a suitable whistleblowing policy in place, the human and economic cost of my discovery would have been significantly lower.

Employee engagement is a much vaunted corporate value – and this should include the knowledge that your voice will be heard. Easier said than done. Which is where a whistleblowing policy comes in.  

As the Chartered Institute for Personnel Development (CIPD) states:
'A clear procedure for raising issues will help to reduce the risk of serious concerns being mishandled, whether by the employee or by the organisation. It is also important for workers to understand that there will be no adverse repercussions for raising cases with their employer.’

 Legislation is in place to protect whistleblowers – the CIPD summarises:
‘Employees and workers who make a ‘protected disclosure’ are protected from being treated badly or being dismissed. The key piece of whistleblowing legislation is the Public Interest Disclosure Act 1998 (PIDA) which applies to almost all workers and employees who ordinarily work in Great Britain. The situations covered include criminal offences, risks to health and safety, failure to comply with a legal obligation, a miscarriage of justice and environmental damage’
Whistleblowing is particularly vital in protecting the vulnerable such as those in care homes and hospital patients and the government funded Whistleblowing Helpline, offering ‘free advice to the NHS and social care’ has been created to enable staff to report ‘malpractice, wrongdoing and fraud’ (tel: 08000 724 725)

A similar helpline for all public and private sector employees is  a must- have to support health and wellbeing in the workplace, whatever your job entails – whether you are a bean counter or brain surgeon. To speak out is best for you, your mental and physical wellbeing and ultimately for the good of the organisation that employs you. Sporting bodies could clearly benefit by offering a safe environment to report drug abuse.

All NHS hospitals and care homes now have access to the whistleblowing helpline. I hope the BBC now has a similar facility at their disposal and strongly recommend that all organisations get cracking to introduce and implement an appropriate whistleblowing policy for the common good.

This should help make these scandals a thing of the past.

Friday, 5 October 2012

Ward rounds are all about leadership, responsibility and team work

‘Make ward rounds the cornerstone of care’ is the title of a recent press release issued jointly by the Royal College of Physicians and royal College of Nursing. The statement goes on to call for ‘a concerted culture change with clinical staff, managers and hospital executives engaging with, and focusing on, improving the quality of ward rounds’

Hear Hear!

Why are ward rounds so important? They are a tangible representation of responsibility, communication and team work. They are a classic example of an entity equalling more than the sum of its separate parts. Sometimes the old way is actually the best way. Routine may be the enemy of creativity but it is the lifeblood of consistent care. In a traditional hospital setting the ward round really was the heartbeat of ward life.

Progress into the 21st Century and shifts in hospital hierarchy at least means that the consultant is no longer (at least not usually) the pompous omnipotent demigod portrayed as Sir Lancelot Spratt in the comedy films in the 1950’s. A vast improvement in cross disciplinary respect, a growing understanding of nursing, paramedic, therapy and support roles and hopefully a regular dose of good manners means that each professional along the patient pathway has a valued part to play in patient care.

An uncomfortable thread that runs through iatrogenic (literal translation – ‘physician-induced’) tragedies is poor communication and blurred lines of responsibility among the medical staff. In the same way that team meetings keep commercial departments on track, so patients can benefit from regular contact and review with their medical team. Switched on patients and their relatives can also gain additional insight and feel more in control of their destiny if they can see and speak to their medical team as one entity.

The press release offers recommendations for a well-run ward round which make remarkably good sense. Such good sense in fact, that it seems shocking that many hospital wards do not currently follow this good advice:

·        Preparation for the ward round should include a pre-round briefing.

·        Consultant-led ward rounds should be conducted in the morning to facilitate timely completion of tasks during the working day.

·        A nurse should be present at every bedside as part of the ward round.

·        Patients, carers and relatives should be provided with a ‘summary sheet’ clearly presenting information discussed in the ward round.

·        Patients with dementia and learning disabilities should be supported as far as possible to make decisions about their care.

·        Patients’ records should be kept centrally to promote effective communication and team working.

·        Ward-round teams should utilise locally adapted checklists to reduce omissions, improve patient safety and strengthen multidisciplinary communication.

As our previous Secretary of State now famously said of the health reforms ‘the patient should be at the heart of everything we do’ and ‘nothing about me without me’. Worthy sentiments even if you are not a fan of a top down reorganisation.  It’s at the coal face of care where improvements are most important.

Regular ward rounds are a very good place to start.