The Mid Staffs nightmare goes on

As a commentator, it is very easy to be judgemental and idealistic – I’ve often thought it must be much more fun to be in opposition than government. But surely anyone who has heard about the recent horror at Mid Staffordshire Foundation Trust has a right to judge.

A tiny, premature 4 month old baby suffering from breathing problems was found in a hospital ward with a dummy taped to his mouth.  Taping a dummy to a baby’s mouth is unacceptable, stupid, dangerous and cruel from whichever standpoint it is viewed. It doesn’t take a consultant paediatrician to work out that if the baby’s nose became blocked or if he regurgitated some milk he could choke or suffocate. If social services found such a situation in the community – the family would be placed on an ‘at risk’ register. And yet this baby was in a place where he should have been safest of all – in hospital.

I’m not sure which is most worrying – the fact that this happened at all or the fact that the Director of Nursing, Colin Ovington stated that he was ‘proud that our staff now feel confident to report any incidents that happen’. I am jumping straight off the fence and hope that Mr Ovington’s tenure in his role is soon finished. This isn’t about whistle-blowing – it’s about appalling treatment of a vulnerable baby. And please, no-one blame staff shortages or lack of training. It has to be either an imbecile or a bully to do this to a baby. It’s hard not to get emotional and I feel sick to the stomach of how I would have felt if that had been done to my daughter when she was tiny.

But let’s try to put emotions to one side for a moment. An official inquiry into failings at the hospital estimate that between 400 and 1200 patients have died needlessly. There is an excellent piece in The Telegraph by Professor Sir Brian Jarman, from Imperial College London:

http://www.telegraph.co.uk/health/heal-our-hospitals/9828966/Stafford-scandal-hindsight-is-a-luxury-we-can-ill-afford.html

Professor Jarman points out the danger of ignoring safety data and that hindsight is only of value if it is heeded. He notes that by 2007, the Trust had received 4 alerts regarding higher than average death rates.  He finishes ‘If the NHS is to honour the lives which were lost, so many needlessly, we must surely learn that when it comes to matters of life and death, hindsight is a luxury we can ill afford’

Bad care isn’t about hindsight, history, or staff shortages. It is about the here and now. It’s about hospital and ward culture, discipline, standards and careful recruitment. Is there such a thing as bad care? If it’s bad it’s not care. Although the background to this incident isn’t yet clear, the treatment of this baby amounts to cruel abuse taking place in an environment which has already been shown to be flawed and dangerous.

Julie Bailey – a fantastic patient advocate from Cure the NHS calls for the ‘Hospital to be closed and wards re-opened one by one after checks have been made on every member of staff’

This a tempting idea, but maybe the best place to start – and I make no apologies for repeating myself, is with the leadership team of any hospital where the data spells danger.

 

Football, Bullying, Leadership, Role models

An incident in last night’s football match between Chelsea and Swansea City touched on my favourite topics – Leadership, Bullying, Role Models in the Workplace and Football.

The incident involved a Chelsea player, Eden Hazard who kicked a ball boy as he lay on the ground. The 17 year old son of the Swansea City Director annoyed both home fans and players by holding on to the ball too long as he attempted to wind down the clock for his team. Viewing the replay, Hazard delivered quite a hard kick and the boy’s body was squarely between the Chelsea player’s boot and the ball, so the outcome of the kick could never have been in doubt. Hazard defended his actions saying that he had not intended to kick the boy ‘…I was just trying to kick the ball’. Mmm -  a bit like a wife beater saying his prey’s face got in the way of his fist.

The spectacle was bad enough but the mixed reactions from those involved with the sport are even more shocking with several ex-premier league players saying that they would have done the same in similar circumstances. Yes the lad was trying to cheat by time wasting, but does that justify physical violence? I think not.

Alas, not only does this sad story demonstrates how far our national sport can fall from ‘the beautiful game’ to an ugly spectacle. It is also a depressing example of how an organisation’s leadership and culture spills down throughout the ranks.

Football is now spattered with undisputed cheating, poor behaviour, bullying and dodgy practice. Maybe this young lad felt that time wasting and exaggerating his pain is acceptable as he watches his heroes regularly dive to win penalties, feign injury as they clutch their undamaged faces and abuse match officials. My love affair with football, which has spanned four decades, is now seriously compromised as players and their clubs continue to disappoint. 

As I have written before – a professional football club is an employer, and the pitch is the workplace. If a junior clerk in a shipping company skives off and comes back late from lunch or messes up an order is it acceptable to clip him round the ear? Of course not. Positive workplace behaviour is bred from strong leadership and positive role models. Strong leadership is not the same as bullying and a good role model should be more than just talented at their job.

The power of football isn’t only about the vast sums of money involved – it is also based on the millions of fans who can be influenced by the sporting heroes on, and off, the pitch.

Strong leadership? Let me think – how many managers has Chelsea Football club had over the recent past? 8 different managers in five and a half years. Does that make the owner of Chelsea FC, Roman Abramovich a strong leader or a bully? Does that type of leadership generate good behaviours on and off the pitch?

Of course Chelsea aren’t the only culprits so I make a plea (yes I know this may be a little naïve) to all employers – lead well, behave with fairness and honour, and you may be pleasantly surprised with the results.

 

Caremakers – the NHS must make sure this isn’t an opportunity missed.

I fear for the future of nursing. Angels or devils, nurses are the front line staff who define the patient experience. The Royal College of Nursing’s new 6 C’s initiative spells out the danger signs in patient care. Anyone interested in care will have already heard of  the 6 ‘values and behaviours’ defined by the RCN - Care, Compassion, Commitment, Courage, Communication and Competence. One could argue that these should all be a given, not some new idea. What nursing needs is clear leadership at ward or unit level, not more sound bites and jargon.

What makes a good care experience? A well run ward. What makes a well run ward? A good leader. What does a leader need? Teams with clearly defined roles.

A family member recently experienced NHS care and felt that there were plenty of nurses on duty, but care was not great. He was left bleeding profusely and choking on the blood while the A & E nurse handed him some paper towels and then went back to reception to chat. It's easy to blame staff numbers for poor care but nursing shortages are not always the cause when standards slip.  

As I have blogged often, for every bad care experience there are multiple stories of all 6C’s way above and beyond the call of duty. But how can we bring this back to be the norm and not judge basic care as a luxury?

One suggestion is that 1000 ‘caremakers’ posts are created. ‘Great’ - I thought until I read that this role would be extended to experienced nurses. Ahem – isn’t this a bit like saying from now on we are going to make sure that all our bus drivers can drive a bus?

Just because nurses are now highly qualified and hold expert medical knowledge doesn’t mean they no longer give care. The same should apply to doctors and therapists – we are all in the business of care.

I thought that the fantastic games makers from the 2012 Olympics were going to be the inspiration for a new breed of volunteer within the NHS. People who could take care of the little things that mean so much while the clinically qualified spend more time on medical care and treatment. An example of this would be a cheery person at the ward reception who could answer relative’s questions such as ‘when will the doctor do his round or where is the hospital shop?’ Someone who can quickly find a nurse if one was needed. How often have you visited someone in hospital and no single qualified person can be found? At least a well-trained volunteer could go behind the scenes and ferret out anyone who was needed. We have heard of stories where the elderly are left with their meals out of reach or unaided even though they can’t pick up a fork. How lovely to have the equivalent of a meals on wheels type kindly soul to make sure patients eat and drink sufficiently and their personal needs are catered for.

 Caremakers? Great idea for carefully trained volunteers. Very different from Caregivers - all medically qualified people should be caregivers as a matter of routine.

 

Why do hospitals fail ?

 The Care Quality Commission (CGQ) have just announced that 17 NHS hospitals are included in a list of 26 providers failing to operate with safe staffing levels. London Ambulance Service is also included in the roll of shame.

http://www.bbc.co.uk/news/health-21002205
 

How do you define safe staffing levels? I have witnessed wards with plenty of staff but still failing to provide adequate care. Even more importantly – how do you define a failing hospital and why do hospitals ‘fail’? The Mid Staffs inquiry is still an open wound, reminding all concerned with healthcare of just how catastrophic the outcome of poor management and poor care can be.

The CQC has indicated that the facilities and services named in the list must ‘comply with its standards, and show how they were going to achieve this’

I must be among many who continue to be more than a little confused about to which tune a hospital must dance. The Health and Social Care Bill of 2012 strengthened Monitor’s role, defining the regulatory body’s main duty as ‘protect and promote the interests of people who use health care services by promoting the provision of services which is economic, efficient and effective, and maintains or improves the quality of services’. A classic sound bite that says everything and nothing. The document entitled ‘Introduction to Monitor’s future role’ continues… ‘our job as sector regulator will be to work with other bodies, notably the NHS Commissioning board, the Care quality Commission and NICE…’

There is an old saying which goes ‘he who pays the piper calls the tune’. But who is calling the tune for NHS hospitals? According to the House of Commons select committee, the CQC has ‘failed to grasp its primary role to ensure patient safety’

Everyone of course has their view of how care can be improved and the lack of clarity is further exacerbated by organisations such as the Royal College of Nursing. Last month Jane Cummings, Chief Nursing Officer ‘helpfully’ (in my opinion, not, actually) defined the 6 ‘values and behaviours’ to ensure good patient care– Care, Compassion, Commitment, Courage, Communication and Competence. A worthy and attractive list – but how can the six c’s be implemented and measured? Ms Cummings went on to say that patients are ‘more complex’ these days. No! Patients are not more complex! They are vulnerable human beings who need to put their trust in the clinicians and support staff who are treating them. Yes – healthcare is more complex, technology more advanced and expectations (quite rightly) higher. But patients are still just the same as they were in 1948 when the NHS started.

Back to failing hospitals. It is an uncomfortable truth that Hospitals need to be run like businesses – not necessarily from the profit perspective but certainly from a position of good management, good financial planning, positive culture and meeting the customer’s needs in a cost effective way. Why do businesses fail? Apart from start–ups where the initial idea and execution is flawed, there are four main reasons businesses go under.

1)   The financial modelling is wrong so it will always operate at a deficit. Poor cash flow will finally catch up with the business and bring it down. This can apply to Hospital Trusts

2)   The customer base dries up – either due to better or cheaper competitors or because there is no longer a requirement for the product or service (such as the recent demise of the photography retailer – Jessops. Online sales and good camera phones have changed the marketplace). I don’t think there is a danger of any hospital running out of patients although of course a facility can be over-bedded or the emphasis of services may not reflect local needs.

3)   Overtrading. The business supplies more services and products than they can profitably handle – back to cash flow. This is the equivalent of unsafe staffing levels – hospitals providing too many services with inadequate resources.

4)   Poor Leadership. Where the basics of the business are sound, but staff are underperforming, they are poorly managed and fail to deliver the required level and quality of service.

Do these all sound familiar? Of course they do. And talking about poor leadership and failure to deliver service – it is poor financial management, poor clinical leadership or poor operational leadership that can generate damaging lapses in care, quality and efficiency.

So whoever is paying, or monitoring, the piper – the tune must be the same. Strong leadership, measurable targets and tangible feedback (from patients and clinicians) is the best hope for the future of NHS hospitals.

Am I sounding a bit like a broken record?