Tuesday, 16 July 2013

How do we stop the bad news coming from the NHS?

Regular followers of this blog may have noticed that it has been a few weeks since I last posted any commentary. I could use the excuse that a heavenly week in Devon and Cornwall, followed by some speaking engagements intervened, but the truth is that I have been at a loss for words.

Bad news and the NHS are now synonymous. Horrific stories of poor care, failing hospitals, commissioning teams in panic mode, financial meltdown of Trusts and most frightening of all, unexplained high death rates make for very upsetting reading. I don’t want to be another purveyor of doom adding to the cacophony of despair but it is hard to find some positive insight into the disarray of our state funded healthcare system.

Most distasteful of all is the political interference, name-calling and finger pointing, not forgetting a hefty dose of arse-covering into the bargain.

In my opinion, the recent review of the Liverpool Care Pathway epitomises the current crisis. Medicine, and many related functions, is an inexact science. Clinical decisions have to be made on the best advice available at the time, backed up by robust evidence and those decisions monitored through clinical governance which is best delivered by clinical peers. Sadly the human element can override good science and even worse, a culture of poor care totally undermines good medicine.

It is absolutely right that a review was instigated into the use of the pathway, originally created to ease suffering of those near death, but absolutely wrong that this review was needed in the first place. How dreadful to learn that this carefully designed set of guidelines was in many cases distorted and recreated by badly trained or badly managed staff with little or no consideration for patients or their loved ones. Yet again, we have been shocked to hear of staff displaying ignorance, callousness and in some cases, downright cruelty all in the name of ‘care’.

The review, led by Rabbi Baroness Neuberger, was originally set up to research the use of this pathway but en route uncovered significant shortcomings in the treatment of the dying, notably at weekends when senior clinicians were absent.

How on earth did we get to a state where a nurse felt it was acceptable to shout at a relative for trying to give a patient a drink? Is the stress of the job turning good people bad or are they just the wrong people for the job in the first place? And how do good managers, senior clinicians and medical leaders turn this mess around?

I have just been watching some news footage from the House of Commons with the current Secretary of State for Health Jeremy Hunt lobbing salvos a cross the House aimed at the previous Labour Health Minister, Andy Burnham who with equal vigour retaliated. The headline for an article by Sean Worth in the Telegraph today shouts ‘Labour must bear the blame for the shameful decline of the NHS’ and the BBC has reported that Professor Sir Brian Jarman,  ‘an independent expert on mortality rates has suggested that ministers have suppressed details of NHS failings to avoid losing votes’.

Maybe Professor Jarman has the key and maybe he’s right when he advises us that we should take heart that following Sir Bruce Keogh's report, 14 Hospital Trusts have been identified as failing and 11 will now be subject to closer scrutiny and urgent service improvement activity.

I also agree with his premise that ‘a "basic problem" with the NHS was that the government both provided health services and monitored them’

Maybe that’s the answer. Let independent and wise individuals such as Baroness Neuberger review specific areas of concern and let us find an independent, non-political means of monitoring quality of care. Let there be zero tolerance for cruelty or poor clinical practice. A cruel or incompetent nurse, doctor (and that should include GPs) or healthcare assistant should be suspended pending investigation and poor clinical practice should be offensive not just to patients but to staff with no exception. Let clinicians have the final say on clinical issues and most important of all, keep politics out of it.

Improve from within and then maybe the bad news will stop.


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