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Archive - Tag: Mid Staffordshire inquiry

October 18, 2010

Dr Phil’s Private Eye Column, Issue 1273 October 13
Filed under: Private Eye — Tags: , , , , — Dr. Phil @ 10:23 am

Preventing another Mid Staffs?

Who can say with any confidence that a similar disaster to Mid Staffs isn’t happening now in the NHS? When MD asked for a show of hands at a Tory Fringe meeting that included the Health Secretary, the president of the Royal College of Surgeons, the chief execs of the GMC and the NMC and a host of senior NHS managers and clinicians, not one arm was raised. A decade after the Bristol Inquiry and with thirty bodies supposedly scrutinising the quality and safety of NHS care, we still can’t spot and stop avoidable, repeated harm to patients occurring over a prolonged period.

Anyone doubting the scale of harm to patients at Mid Staffs between January 2005 and March 2009 needs to read the Francis Inquiry report. The debate about how useful and accurate Hospital Standardised Mortality Ratios continues, but the fact is that just about every early warning light flashed brightly in Mid Staffs for months, and yet nothing was done. The Inquiry has thus far has looked at failures within the hospital but now sets its sights on the plethora of regulatory and commissioning bodies that also failed to act. It’s likely to embarrass senior managers at the PCT and SHA, and may even finger several Labour health secretaries and the chief executive of the NHS and the Care Quality Commission. But will it prevent another disaster?

When MD gave evidence to the Bristol heart inquiry in 1999, the NHS had no proper quality control mechanisms and the questions were relatively simple. What did you know, when did you know it and what did you do? As a result of that Inquiry’s 198 recommendations, we are now supposed to have revalidation for individual clinical staff to guarantee their competence (still hasn’t happened), clear whistle-blowing policies backed by legislation to protect those who speak out (ha, ha), regulation of managers (no action taken), a national reporting system for unexplained death and serious physical or psychological injury (voluntary), effective local and national monitoring of performance and very clear guidance on involving the trust board, purchasers and regulators when things go wrong. So Robert Francis, QC, can now ask: what should you have known, when should you have known it, what should you have done?

We already know the answers. The current Bristol Pathology Inquiry suggests that NHS management in the city is still deeply dysfunctional and regulators are unable or unwilling to step in, the Oxford Heart Inquiry has shown how we have failed to safely reorganise child heart surgery eighteen years after the Eye blew the whistle, and the Bristol Inquiry chair Ian Kennnedy has just reported on the continued widespread failures in the treatment of children in the NHS.

As the NHS is now facing £20 billion cuts, it’s hard to see how systemic failures of care can be stopped. Most participants at the fringe meeting accepted that some hospitals and units may need to be merged or closed to keep them safe, but ‘asset-stripping’ hospitals is complex and can have knock on effects on other services. The seeds of Mid Staffs were sewn by Labour’s earlier boom and bust in the NHS – John Reid as health secretary spent all the money, leaving Patricia Hewitt to pick up the debt and some hospitals felt obliged to balance the books irrespective of the effects on patient care.

Lansley hopes that getting rid of SHAs and PCTs will at least remove a lot of the top down bullying and suppression of whistleblowers in the NHS, but it remains to be seen whether the alpha GPs who take up the mantle of commissioning have the balls and skills to act on the poor care they discover both in hospitals and GP practices on their patch. For the White Paper to work, doctors have to stop whingeing about management, and start doing it. Clinicians should manage clinical services, but it might be an idea to train them for the task. If we simply transfer the ‘see one, do one, teach one’ mentality of medical training to NHS management, we’ll be courting more avoidable harm.

March 4, 2010

Dr Phil’s Private Eye Column, Issue 1257, March 3, 2010
Filed under: Private Eye — Tags: , — Dr. Phil @ 8:56 am

Medicine Balls: A Tale of Two Scandals

What goes around, comes around. The Bristol heart scandal of 1984-1995 occurred under the Tories’ watch but it was the incoming Labour government that ordered a Public Inquiry and used the results to impose sweeping, centrist health reforms. Now the Mid Staffs scandal – which in many ways is worse than Bristol – has occurred under Labour’s watch and it’s the Tories lobbying hard for a Public Inquiry, the results of which – if they get in – will doubtless be used to force their own ideology on the NHS.

The Bristol heart surgeons at least cared deeply about their work and were trying their best, even when their results for complex heart surgery were demonstrably poor. The Francis Inquiry into Mid Staffs, held behind closed doors but published last week, is more troubling: “It was striking how many accounts related to basic nursing care as opposed to clinical errors leading to injury or death”.

The Kennedy Inquiry found that from 1991 to 1995, between 30 and 35 more children under one died after open heart surgery in Bristol compared to a typical NHS child heart surgery centre at that time. 198 recommendations were made to prevent avoidable deaths happening on such a scale again.  The largest ever increase in NHS funding was coupled with the largest and most complex regime of targets and scrutiny. But in March 2009, the Healthcare Commission uncovered ‘appalling standards of care’ at Mid Staffs, and estimated that from 2005 to 2008, between 400 and 1,200 excess deaths occurred compared to comparable NHS trusts. And in these years, the Commission itself had judged the hospital to be performing well and Monitor awarded it Foundation status for its managerial excellence.

Labour’s centralised monitoring of quality and safety just doesn’t protect patients.  It’s expensive, retrospective data collection is slow, insensitive, inaccurate and misleading. Hospitals can game their mortality rates by fiddling with the coding system and unsurprisingly, the crude results and rating scores aren’t believed by NHS staff, politicians or the public. Health secretary Andy Burnham caused insult of Hewitt proportions, describing Mid Staffs as ‘ultimately a local failure’ and claiming the NHS has had its ‘best year ever’. Five separate panic reviews have been ordered that are unlikely to see the light of day this side of an election, if ever.

The take home message at Bristol came from Steve Bolsin, the anaesthetist who first raised concerns and paid for them with his NHS career. ‘If you want to avoid another Bristol, never lose sight of the patient.’ This is strikingly similar to the conclusion of Robert Francis QC in the Mid Staffs report: “If there is one lesson to be learnt, I suggest it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented”.

The difference now is that we have the technology for patients and relatives  to provide valid and timely feedback on their care that will spot problems in the NHS years ahead of any quango. What’s needed is a cultural change that invites constructive scrutiny and has zero tolerance of avoidable harm to patients. Most NHS staff would love to work in such an environment, free from the tosh of political control and focusing entirely on the needs of the patients in front of them. That ‘new’ Labour could contrive a culture where £105 billion goes into the NHS and it’s still no safer then bungee jumping, with widespread staff shortages, over-crowded emergency departments, disillusionment and patient harm, suggests that much of our increased funding hasn’t gone where it’s needed. Oh, and we’re desperately short of inspirational managers who’ll stick two fingers up to Whitehall (when necessary) and focus on helping their staff to serve their patients.

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