Oct 16 2007
Dirty hospitals
The Health Secretary’s reluctant Statement about the deaths in the Kentish Health Service yesterday, prized out of him by an Oppositon Urgent Question, was alarming in its content.
The Health boss told us that standards were quite unacceptable in the affected area, and that the lack of cleanliness caused the problem. He implied that this was a problem unique to this Health Authority, and implied that now the Chief Executive and the Chairman had gone things would get better.
He did not tackle why patients were told to soil their beds instead of being taken to the bathrooms. He glossed over the fact that Maidstone was not the worst performing Trust in the figures for hospital acquired infecitons, and did not discuss at all the 6000 deaths in 2005 where hospital acquired infections were mentioned on the death certificates.
There is still no great sense of urgency, or apology for the enormity of the infection problem in our hospitals. The Health Secretary says the right things - that he wants zero tolerance of dirt and infection and expects better of the NHS. He then at the same time sets a target to cut some infections by 30%, which implies he does not mean what he says about zero tolerance.
How many deaths in hospital will it take before this government wakes up to the need to change the way it runs the NHS to stamp out this dangerous state of affairs? If this were a large private sector company or institution presiding over so many deaths this government would have taken much stronger action to stop it.
John Redwood has been the Member of Parliament for Wokingham since 1987. First attending Kent College, Canterbury, he graduated from Magdalen College...
“If this were a large private sector company or institution presiding over so many deaths this government would have taken much stronger action to stop it.”
Not quite.
If this were a private company it would have been closed down and the entire management would be facing criminal charges carrying very long prison sentences.
It has been evident for a long time that this government is quite staggeringly incompetent at everything it attempts to do. (Even the much-vaunted ‘independence’ of the Bank of England can now clearly be seen as yet another botched reform.)
And now there is also proof that this government is also criminally negligent and its policies are resulting in the deaths of thousands of people. Never has it been more important to harry this government from office as quickly as possible.
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This is indeed a crisis but not just for the senior management. Although they carry responsibility for the effective and efficient management of the hospital trust questions have to be asked about the professional attitudes of the clinical and nursing staff. Telling a patient to just soil the bed and leaving them in a soiled bed should be grounds for instant dismissal, allowing used cups to litter treatment rooms should also carry consequencies.
What really should be condemed is the complete lack of supervision and standard setting. Although the predicted cry is “bring back matron” a ward sister should carry all the authority necessaryfor the proper running and functioning of her ward. This calls into question both the management structures of the organisation and the effectiveness and quality of nurse training. The move from a hospital based school of nursing to the university bases curriculum has not been a complete success particularly in a profession based upon practical abilities.
The final point worth future consideration is that the practice of health care takes place in an environment which is dynamic. Change is everywhere from diagnosis techniques, treatment regimes, capabilities and new understandings. Flexibility, the ability to meet and react to change ,to think outside the box are, all essential attributes for the delivery of effective health care. These qualities cannot be delivered by a bureaucracy. The health service is full of experts from many, many disciplines and they need an organisatonal structure which allows them to interact effectively. A bureaucracy fails in this objective also. The present NHS needs to be broken up into smaller, more autonomous units, as a first step on the road to complete restructuring. Where did the myth of economies of scale come from? I have yet to see this be effective.
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It is a pity that Patricia Hewitt is not still around to resign, but Alan Johnson should resign and the Government should take action, not spin, on this matter.
Johnson was asked about this matter by Ann Widdecombe in January (hat tip: Conservative Home) and no one has done anything about it.
Meanwhile, the numbers of nurses have been cut by Trusts like this one, whilst the number of administrators and bureaucrats remains static.
The Government’s target culture, and mismanagement of the public finances, is behind these deaths. The Chief Exec and Chairman of the Trust have resigned - the Health Secretary should do the decent thing and go too.
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Targets set by the NHS’s central planners probably also played their part. Every time the govt sets new targets for the NHS, John should remind them that the Soviet Union met all its targets, right up to the day of its collapse. Hayek & Goodhart’s Law explain it.
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My wife spent a couple of weeks in our local general hospital at the beginning of this year. It was an everyday commonplace experience to hear elderly patients saying that they needed to go to the toilet urgently, only to be told by the nurses that they’d have to wait because there was nobody available to help. The outcome was quite often a soiled patient and bed.
You would have thought that in the interests of efficiency - let alone something apparently so trivial as patient dignity - that an urgent toilet request would be dealt with straight away. After all, it must take a hell of a lot longer to clean a patient and remake a bed than it would to just handle the original request more promptly.
Part of the problem was undoubtedly due to patent/staff ratios, but this was exacerbated by the nurses having to serve the patient’s meals. To do this they had to put on clean overalls, and it would obviously be inappropriate for them to break-off from that job to tend to someone’s toilet needs. From the point of view of an observer, the whole approach just seemed completely daft.
Years ago, as I remember, serving food used to be carried out by a separate staff - not the nurses. But in those days there was also a single Matron who ran the entire nursing side of the hospital. She used to carry out a daily close inspection of every ward and would raise merry hell if there was anything that didn’t meet her standards. Even the patients were scared of her - believe me, I remember it well!
Another problem we noticed during my wife’s stay was the apparent demarcation of cleaning roles. Some staff were responsible for cleaning floors and wiping bedside cabinets, but they were not permitted to clean other areas around the patient. This demarcation of cleaning responsibilities resulted in some areas being missed altogether, or at least not being cleaned regularly.
There was an interesting ‘fly on the wall’ programme on the TV some months ago where Gerry Robinson spent a couple of weeks in a hospital working with all levels of staff in an attempt to bring about improvements. The thing that struck me the most was the lack of communication at all levels of the organisation. People had ideas about how to do things better in their individual areas, but there seemed to be a reluctance and an inability to turn the ideas into reality - usually because the proposed change would have an impact on another department or discipline and nobody had any idea how to initiate such a change - mainly because the necessary communication channels just didn’t exist.
One has to wonder what these highly-paid Chief Executives are supposed to be doing.
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I think the Gerry Robinson documentary demonstrated in absolutely stark terms that the highly-paid Chief Executives are being paid precisely not to manage.
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It does seem to me that nurses have to bear some responsibility for this. Failure to assist patients who need help using the toilet is appallingly callous, even immoral, however stretched they are. But it also comes down to modern nurse training as well.
Florence Nightingale wrote that cleanliness - and cleaning - was the greater part of nursing, and that nurses who declined to do such things as washing their patients and assisting them with bedpans should think again about being nurses. For her, nursing was about treating patients with dignity and respect.
But in the new politically correct world, nurses no longer learn in hospitals from the bottom up (no pun intended). Instead they go to university, away from real patients, and must be taught gender equality, good race relations, nondiscrimination on the basis of class. They learn about management and microbiology, but not about cleaning. They are tested on problem-solving and analytical skills and medical knowledge, but not about how to care for a sick person. Care doesn’t just mean changing a dressing or giving medication. Truly caring for a patient means treating them with kindness, respect and compassion, a concern for the whole person. It means treating people like other human beings, not reducing them to a set of sociological statistics and calling them “consumers”, as though we choose to get sick and go to hospital, like deciding on a new car.
I don’t want to damn all nurses with this. My brother is married to one and I have several friends who are nurses, and they, as many other nurses, are compassionate people who genuinely want to care for their patients. But they’ve all said that the culture in hospitals in the UK is one where targets and cost-cutting are the priorities, and actually looking after the patients comes a lot lower down the list.
Patients - sorry, consumers - are only seen as a set of numbers, and are dehumanised to the extent that a government minister can make statements like this about reducing infections by 30%. This is ludicrous. It means that in the next set of numbers for Maidstone hospitals, 60 people will have died through hospital negligence instead of 90. On what planet could that be conceived to be acceptable? Then again, killing people this way does have an advantage: it means death rates in cancer and heart disease can keep on falling.
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