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Archive - Month: December 2009

December 20, 2009

Dr Phil’s Private Eye Column, Issue 1252, December 20, 2009
Filed under: Private Eye — Tags: — Dr. Phil @ 10:11 am

NHS Choices Feedback

 

The health service has ended the year with a health secretary out of his depth, two headless regulators and the threat of crippling financial cuts.  However, it does at least now have a facility for patients to feedback their experiences in NHS and private hospitals to enable others to make better choices about where they’re treated. Eye reader Alison Wilson recently posted feedback on the NHS Choices website about the care she received at North Staffordshire Nuffield at Newcastle-under-Lyme. Her message was:
Liked …
The staff in outpatients were kind and understanding, as were one or two of the staff on the ward.
The catering staff were very cheerful, kind and helpful.
My surgeon was excellent.

Disliked …
Attitude of most of the staff was offhand
Drug safety (prescribed a drug to which I am allergic, drugs missed, staff not knowing how the morphine syringe worked)
Poor cleanliness of facilities – and of me (as a patient who was unable to do much for myself)
General neglect, including neglect of some essential instructions from my consultant.
Found crying in bed by a visitor, where I had been for more than an hour, no-one on the staff had noticed as no-one had been in my room for hours despite me fainting the day before.
Staff failed on a number of basic tasks, leading me to unnecessary discomfort and suffering which I could have done without.
I needed some advice on aftercare at home, (I had had abdominal surgery) but was given none at all despite asking two members of staff for it.
When I rang up as I was bleeding at home, I got the brush off twice on the phone before being called back to the hospital.
Left hospital after five days in great distress with bedsores, a dressing which had to be removed and changed at home because it had been put on incorrectly, sore hands due to errors with a cannula, and a wound infection (wound still needed treatment a year later)

Anything Else …

Under pressure from my insurer, I did make a formal complaint about my care a year ago. Since that time I have received (late) one sarcastic letter from the hospital, which I found very distressing, but despite me writing to them to say so, they have never replied.

The response from NHS Choices was decisive. ‘Thank you for your contribution to the  website. We have removed your contribution because it is a serious complaint about a specific hospital, service and/or clinician which should first be addressed by the relevant hospital. We suggest in the first instance you contact the Patient Advice and Liaison Service (PALS).  They offer: – confidential advice and support to families and their carers, – information on the NHS and health-related matters, – confidential assistance in resolving problems and concerns quickly, – explanations of complaints procedures and how to get in touch with someone who can help, and – information on how you can get more involved in your own healthcare. To find your PALS office, search for your hospital on www.nhs.uk and go to the Facilities and Patient Support tab. If you want to make a complaint, please see: http://www.nhs.uk/aboutNHSChoices/Pages/Howtocomplaincompliment.aspx

So, not only are NHS Choices censoring critical comments from patients but are not bothering to read submissions either. Ms Wilson had already made a formal complaint and isn’t entitled to the NHS support they suggest. Also, you are not supposed to post comments on the website about care you received if it is more than 18 months ago. But if critical comments are censored and redirected through the complaints procedure, possibly ending up with the ombudsman or legal action, this generally tales longer than 18 months. A neat way of ensuring all the ‘independent patient feedback’ is overwhelmingly positive.





December 12, 2009

Dr Phil’s Private Eye Column, Issue 1251, December 11, 2009
Filed under: Private Eye — Dr. Phil @ 6:20 pm

The Confusing Hospital Guide
 

What’s behind the spat between the government’s healthcare regulators and data analysts Dr Foster? In October, the Care Quality Commission (CQC) rated Basildon and Thurrock NHS Foundation Trust as ‘good’, before highlighting a catalogue of safety failures at the end of last month.  It alerted Monitor, the Foundation Trust regulator, who surprised everyone by sacking the chief executive…. of Colchester Hospital.  Then up pops Dr Foster claiming that, from its safety assessments, there are fifty hospitals worse than Colchester, including eleven very poor performers that neither the CQC nor Monitor have highlighted. Meanwhile, the Royal Cornwall NHS Trust, which has been graded poor by the CQC for four years in a row, received a very impressive safety rating from Dr Foster.  And although both the CQC and Dr Foster agreed that Basildon and Thurrock was in dire need of improvement, Monitor was very impressed with the Trust’s management plans.

 

Hospitals are complex organisations and the political imperative to reduce everyone to a single band, star rating or adjective has always been ridiculous. How do you rate a hospital with excellent maternity services, an average intensive care unit and a dysfunctional accident department? Some hospitals have good clinical services and poor financial management, and vice versa. To stamp them as ‘good’, ‘average’ or ‘poor’ is meaningless. Dr Foster has been churning out the Good Hospital Guide since 2001, but has upped its game in recent years by concentrating on patient safety. This year, it got into bed with the National Patient Safety Agency (NPSA) and developed a forthright scoring system that focuses on how likely a hospital is to harm you.  The government and CQC were unprepared for this embarrassment, not least because Dr Foster has been the recipient of sweetheart deals from the Department of Health (Eyes passim). However, it lost the NHS Choices contract in 2008 and now seems intent on proving its independence.

 

The CQC is currently hamstrung with an old inspection regime, and its legal powers to register (and deregister) all providers of health and social care don’t come into play until April 1 2010. However, the defensiveness with which is faced down media allegations of incompetence was pitiful, particularly the attempt to pass the buck onto its predecessor, the Healthcare Commission, which itself was limited in its powers by government.  The CQC will probably survive a Tory bonfire of the qangos, and the NPSA has improved its chances by teaming up with Dr Foster to embarrass Labour.

 

The highlight of the Dr Foster Guide is that it praises best practice, something the CQC would do well to learn. A year ago, the Eye highlighted how staff at Wrightington, Wigan and Leigh NHS Trust managed to turn around a very high mortality rate by cutting out extraneous bureaucratic targets and focusing on patient safety. This year, Mid Staffordshire is managing the same dramatic improvement and Trafford Healthcare NHS Trust won ‘Medium Trust of the Year’ by doing a succession of obvious things well: Bringing back matrons to audit, inspire and observe individual wards, fostering healthy competition between wards, rigorous hand hygiene, ward-employed cleaners, putting clinicians in charge of clinical services, having an early warning system to detect patients who are deteriorating rapidly and a critical care outreach team to sort them out quickly. And they also share information and best practice with neighbouring trusts.

 

Anyone can massage a paper assessment, but it’s much harder to hide blood under the mattress.  However, it’s often patients and relatives who spot it first, and the one factor missing form health regulation is the use of their experience to spot unsafe care quickly. In every health scandal the Eye has exposed, the red flag was raised by those on the receiving end long before the NHS saw fit to act. We have the technology to collect and analyse feedback from the frontline but not quite the willpower to use it. Patients and relatives are fobbed off, whistleblowers are still being shot on sight. What the NHS needs above all is a culture that encourages speaking up and a system to enable it, so that anyone at the sharp end can raise a concern and know that it will be acted on. The NHS is the only health system in the world attempting comparative scrutiny in such detail, and NHS Choices has made some progress in publishing patient feedback. But there’s a way to go before people feel safe to speak up without harming their care or career.





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