Fox (n): carnivore of genus vulpes; crafty person; scavenger; (vb) to confuse; -ed (adj): to be drunk.
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Thursday 7 February 2013

Reflect (vb.): Throw back without absorbing.

NOBODY washed Joan Morris, 83, for the entire month she was in hospital.

Deb Hazeldine had to clean faeces off her mum Ellen Linstead's hands when she visited her on the ward.

Arthur Peacham, 68, went in with a bad back and died after catching a severe diarrhoea bug from other patients staff had not bothered to isolate.

Yesterday the man in charge of the whole thing - and who at the time was in charge of the local NHS administration - said: "I am not ashamed of being in my job today.

"Clearly it was a whole system failure and we need to reflect ... the whole of the NHS - myself, leaders in the NHS, doctors and nurses - need to reflect on what we can learn from that to make sure it never happens again."

Righto. Let's reflect.

Let's reflect upon the fact that, first off, hospitals have always killed people. People go in with a dicky hip and once paperwork and rubbish food and sitting in bed all day take hold, the patients can be inclined to give up just as easily as doctors who decide they're too ill or old to save.

Some people hate hospitals, simply because those that go in don't always come out. They're a good thing to avoid, wherever possible.

But that sort of thing is normal. A hospital is a Last Chance Saloon where some are saved, some are lost, and some just fade away. No matter how perfect the NHS could be, you couldn't do much about that.

Next let's reflect upon the fact that there are more of us than ever before, that medical advances mean we are saving more people than ever before, and that the business of doing it costs more than ever before. Then let's wonder if that's worth doing, or if we'd rather people die because things are cheaper that way.

It's cheaper not to wash patients. It's cheaper to leave them lying in their own urine. It's cheaper to just let clostridium difficile run rampant, and it's cheaper to say 'well, they have to die some time'.

It's cheaper not to sack anybody, complain, discipline, train. It's cheaper to shut the A&E, and worry more about the interest on your PFI deal than how much fun it is to spend your final days on Hyacinth Ward covered in your own crap.

And let's reflect upon the fact you can do all those things while still meeting targets.

You can do it while not replacing nurses, and making midwives struggle on with more babies and less staff. You can do it by changing your surgeons' shift patterns, stretching the anaesthetists out a bit, and making paediatricians stay longer. You can do it by paying your receptionists less, 'incentivising' porters and cleaners with the threat of the sack, giving line managers more paperwork and making medical record staff redundant.

You can do those things while politicians of all parties say you're doing marvellously, and even make you a foundation trust in recognition of your 'excellence'. You can get promoted afterwards to be the person in charge of the entire National Health Service, and you will not feel ashamed.

After the fifth investigation into the high death rates at Stafford Hospital, and the first public inquiry, there have been 290 recommendations for change, fury as to why no-one has been sacked or struck off, and calls for someone to take the blame.

Sir David Nicholson, the unashamed man who was head of the regional health authority when the problems began and is now chief executive of the NHS, is under most attack. The hospital's chief executive at the time, Martin Yeates, claims to have post-traumatic stress, refused to give evidence, and has just resigned from the charity he has been working for to save it from negative publicity.

And do you know what? There is no one person to blame.

The nurse that was overworked and too busy to make sure every patient ate their food - it's not her fault. The junior doctor who wasn't properly trained and in a rush who gave the wrong pain relief - it's an understandable mistake. The agency cleaner employed on the cheapest possible wage, who can't read the directions too well and has two more jobs to do today - she shouldn't carry the can.

The receptionist who's not medically trained but is forced to prioritise patients, the clerical staff who keep the whole thing ticking over, the people who set targets in the first place - they're all doing the best they can. You need to have paperwork and targets, just as you do bandages and X-ray machines.

But the fact remains that at Stafford 1,200 people died early. Hundreds or thousands more suffered unnecessarily. There will be a small number of rotten apples among the doctors and nurses who could be struck off in the months to come, but that won't stop Stafford happening again. Five other hospitals are now under investigation for similarly high death rates, so it might be happening already.

The basic problem at Stafford was the same as at every other hospital, and in every single bit of the NHS. And that is that the people making the decisions, right up there at the top of the tree, have absolutely no reason to use it.

In 2011 the average NHS trust chief executive earned £158,800. Members of trust boards had an average pay rise of 4.5 per cent. The heads of strategic and regional health authorities, and NHS quangos, usually pocket £250,000 or more.

The average midwife earns £31,000. Nurses, with experience, slightly more. An A&E receptionist - which is a fairly frontline, if untrained, job - earns between £14,000 and £17,000. A consultant would earn between £74,000 and £100,000 once qualified, but just £22,000 when they start out.

If any of them get sick they need the NHS - the people who make the decisions don't.

Sir David Nicholson and Martin Yeates didn't set out to kill 1,200 people. They didn't personally remove pain relief, or pour excrement upon elderly and disoriented patients.

But what hope could either of them have - or any of our Health Secretaries, for that matter - to improve a service they do not rely on? How can people skilled at reading budget breakdowns have a  scooby doo about the best way to nurse a dementia patient?

The NHS is packed solid with people who care enough to do a difficult job for little recompense. It is topped off by people in a different world, with a different outlook, who think the bottom line is more important than cleaning someone's bottom.

You need both types in the NHS, but you have to spread them about more evenly.

Get the accountants on to the wards once a week to see where the waste really happens, the gear that goes missing and the time that is wasted. Let them see where they're over staffed and under staffed, up close.

And get the doctors and nurses on to the boards, so that big decisions about bank loans, new equipment and ward closures are made with the help of people who know that wiping someone's backside is sometimes the most important thing you do all day.

It won't happen, because the men in charge of the men in charge have even less need to rely upon what is swiftly becoming the Poor Health Service.

But it should.

I've love to see him in hospital.