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Look beyond the politics – Britain's healthcare really is in crisis Look beyond the politics – Britain's healthcare really is in crisis
(2 months later)
There was only one message that mattered this week when the government published its report into the poor care and the culture of mediocrity in 14 NHS trusts. We can dismiss Jeremy Hunt's ludicrous attempt to blame Labour for all that had gone wrong in the hospitals. We can ignore the government's initial spin, that bad care resulted in 13,000 deaths: the statisticians immediately stamped on that one. The important conclusion was simple and revelatory: the health service doesn't know when it's making mistakes because it consistently refuses to listen to its patients or its staff. And that, the Keogh report says, is what must change.There was only one message that mattered this week when the government published its report into the poor care and the culture of mediocrity in 14 NHS trusts. We can dismiss Jeremy Hunt's ludicrous attempt to blame Labour for all that had gone wrong in the hospitals. We can ignore the government's initial spin, that bad care resulted in 13,000 deaths: the statisticians immediately stamped on that one. The important conclusion was simple and revelatory: the health service doesn't know when it's making mistakes because it consistently refuses to listen to its patients or its staff. And that, the Keogh report says, is what must change.
I couldn't agree more. During the last four years I have been a tiresomely regular user of the hospital system, being treated for various serious conditions, including cancer and its side-effects. Nothing in my life has made me feel as helpless and uncared-for as the week I spent in an NHS hospital as an emergency admission two summers ago.I couldn't agree more. During the last four years I have been a tiresomely regular user of the hospital system, being treated for various serious conditions, including cancer and its side-effects. Nothing in my life has made me feel as helpless and uncared-for as the week I spent in an NHS hospital as an emergency admission two summers ago.
Everything around me went wrong, consistently, so that having gone into hospital with a sense of tremendous relief – thank God, somebody is going to look after me now – I spent my days in a state of frightened hyper-vigilance, frequently in tears, as one muddle followed another.Everything around me went wrong, consistently, so that having gone into hospital with a sense of tremendous relief – thank God, somebody is going to look after me now – I spent my days in a state of frightened hyper-vigilance, frequently in tears, as one muddle followed another.
The worst of it was that it was not just me who felt impotent in the face of an incompetent system. The hospital staff, many of them very well-meaning, told me they felt the same. None of them, from nurses to sisters to consultants to managers, had the authority or understanding to cut through the errors and make the organisation work.The worst of it was that it was not just me who felt impotent in the face of an incompetent system. The hospital staff, many of them very well-meaning, told me they felt the same. None of them, from nurses to sisters to consultants to managers, had the authority or understanding to cut through the errors and make the organisation work.
The chaos began in A&E, where I had to be admitted into the hospital even though the ward was expecting me. My illness meant I was dangerously weak and malnourished, but it took seven hours of waiting in a crowded basement on a hot day to get up to a bed. There was no mobile phone reception, nothing to eat but chocolate and crisps, and water could only be accessed from behind a door locked to the public. An old lady in a wheelchair wilted next to me for five hours, her need for reassurance or food or water none of the business of the overworked A&E staff.The chaos began in A&E, where I had to be admitted into the hospital even though the ward was expecting me. My illness meant I was dangerously weak and malnourished, but it took seven hours of waiting in a crowded basement on a hot day to get up to a bed. There was no mobile phone reception, nothing to eat but chocolate and crisps, and water could only be accessed from behind a door locked to the public. An old lady in a wheelchair wilted next to me for five hours, her need for reassurance or food or water none of the business of the overworked A&E staff.
When a registrar finally admitted me, there weren't enough nurses available to do blood tests or put in a drip, and not enough porters to run the samples to the blood room, so the highly paid doctor did it all himself. On the ward, where I was put into an isolation room until the test results came back, things were no better. Of the four drugs I urgently needed to take twice a day, only three had come up from pharmacy, and that was now closed. I explained how necessary the drugs were. The nurses looked at me as if I was a whining child demanding an ice cream. They could do nothing. That was the pharmacy's business.When a registrar finally admitted me, there weren't enough nurses available to do blood tests or put in a drip, and not enough porters to run the samples to the blood room, so the highly paid doctor did it all himself. On the ward, where I was put into an isolation room until the test results came back, things were no better. Of the four drugs I urgently needed to take twice a day, only three had come up from pharmacy, and that was now closed. I explained how necessary the drugs were. The nurses looked at me as if I was a whining child demanding an ice cream. They could do nothing. That was the pharmacy's business.
It took another 24 hours and a meltdown in front of the director of nursing services for the drugs to appear. The nurses were wrong. They did have access to emergency drug supplies, yet none of them knew it.It took another 24 hours and a meltdown in front of the director of nursing services for the drugs to appear. The nurses were wrong. They did have access to emergency drug supplies, yet none of them knew it.
Meanwhile I wasn't being fed. I could digest so little that the hospital nutritionists prescribed me a diet: cooked fish, meat and vegetables. No food arrived at lunch or supper. Eventually a kind nurse rang to find out why. The dieticians had ordered the special menu to start the next day, but because I was now under their orders, the caterers were not permitted to give me any food at all without permission – and the dieticians had all gone home.Meanwhile I wasn't being fed. I could digest so little that the hospital nutritionists prescribed me a diet: cooked fish, meat and vegetables. No food arrived at lunch or supper. Eventually a kind nurse rang to find out why. The dieticians had ordered the special menu to start the next day, but because I was now under their orders, the caterers were not permitted to give me any food at all without permission – and the dieticians had all gone home.
It was nobody's business that a skinny, undernourished patient was now frantic with hunger. I took my drip down to the canteen and bought a stew I hoped I could eat: I was wrong, and was promptly sick. At 10 o'clock at night, desperate, I tracked down the hospital's night manager to ask if she could do something. Her response? "It's not my fault. I've only just come on shift."It was nobody's business that a skinny, undernourished patient was now frantic with hunger. I took my drip down to the canteen and bought a stew I hoped I could eat: I was wrong, and was promptly sick. At 10 o'clock at night, desperate, I tracked down the hospital's night manager to ask if she could do something. Her response? "It's not my fault. I've only just come on shift."
She was the most senior manager on duty, and yet she felt just as unable to deal with systemic issues as everyone else I encountered while I was there.She was the most senior manager on duty, and yet she felt just as unable to deal with systemic issues as everyone else I encountered while I was there.
No one seemed to be in charge and no one wanted to take responsibility for any problems. The hospital departments all operated according to their own hierarchies, and someone from one section could do nothing to influence the actions of another.No one seemed to be in charge and no one wanted to take responsibility for any problems. The hospital departments all operated according to their own hierarchies, and someone from one section could do nothing to influence the actions of another.
Even the doctors felt powerless. When my blood tests went missing, and when another person's blood was labelled as mine – causing panic as the results came through – they told me, sadly, that even though they reported mistakes like these several times a week, no action was ever taken and the protocols never changed.Even the doctors felt powerless. When my blood tests went missing, and when another person's blood was labelled as mine – causing panic as the results came through – they told me, sadly, that even though they reported mistakes like these several times a week, no action was ever taken and the protocols never changed.
It's this refusal to hear, investigate, or learn lessons from failings that Bruce Keogh is determined to reform. He wants every hospital, not just those targeted this week, to seek out complaints and use them to transform their services, just as the best customer-focused organisations do. He wants the whole process to be public and transparent, and to be positive rather than punitive, so that people have the confidence to report concerns.It's this refusal to hear, investigate, or learn lessons from failings that Bruce Keogh is determined to reform. He wants every hospital, not just those targeted this week, to seek out complaints and use them to transform their services, just as the best customer-focused organisations do. He wants the whole process to be public and transparent, and to be positive rather than punitive, so that people have the confidence to report concerns.
Quality, rather than just statistics, must be at the heart of what hospitals do. It's a revolution in behaviour and attitudes he's calling for. He believes there will be major changes within two years. We all have to hope he succeeds.Quality, rather than just statistics, must be at the heart of what hospitals do. It's a revolution in behaviour and attitudes he's calling for. He believes there will be major changes within two years. We all have to hope he succeeds.
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