Comment: The NHS needs a culture change

I hope the ten cases reported by Ann Abraham, the Public and Health Service Ombudsman (PHSO), this week, make an impact on the national conscience and help our society as a whole to refocus its picture of the NHS. Our beloved health service is broken and it needs fixing.

By Julie Bailey

However, watching and listening to the responses in the media earlier this week, it felt as though the Stafford Hospital disaster had never happened. By the following day, there was already very little coverage of those ten tragic stories. Let’s hope we get some good in-depth coverage in the Sunday newspapers.

The image that our society holds of the NHS is completely wrong. Nursing “angels” are long gone. People say, “Bring back matrons! That will fix it.” Their modern day equivalents, directors of nursing, are everywhere. Nursing is just a job now, done, alarmingly, all too often by uncaring people. The nursing profession has lost its way and the leadership is politicised. “Too posh to wash” they say; recently someone asked a nurse for help with his mother, the response: “No, I’m pills and paperwork”. Ridiculous; he took his mother out of the hospital, the University Hospital of North Staffordshire.

What the ombudsman’s report will hopefully spark is a debate about whether our “acute” hospitals as they are currently organised are the right places to be treating our elderly sick. All of the geriatric hospitals have gone, it was decided they were no longer what was required, but have we got it right now?

In fact the ombudsman’s introduction to the report is an excellent description of the NHS that chimes to a great extent with ours. We must not think however that this kind of appalling care is limited to the elderly; some of the very worst cases at Stafford Hospital concerned patients still in the prime of their lives. Please do make sure you read the whole report, and then act on it.

When I took my mother’s complaint to the PHSO I was treated as a nuisance. “What more do you want? They have apologised and have put an action plan in place,” I was told. My complaint wasn’t upheld for these reasons, the following week we heard of another death; same ward, same drug error. But this was two years after my mother’s tragic death, more pain for another family to have to live with. This was one of many drug errors at the hospital following my mother’s death and they continue to this day. Lessons learned? Well the hospital told the PHSO they had and that was enough for the PHSO to not uphold my complaint.

Our hearts go out to these families involved, our sympathies, and our condolences, and of course to the loved ones of everyone who has complained. The last thing you want to do when a love one is sick is to have to complain because the hospital staff do not care and then to undertake a battle over many years with the hospital management and the ombudsman is just torture. The word among campaigners across the country is that the NHS complaints system is designed so that even the complainants with the greatest stamina and fortitude will surrender after seven years.

This is all too little and too late from the ombudsman; not even an annual report on NHS complaints until October 2011. ‘Cure the NHS’ believe Ann Abraham should bring her retirement forward, or at least leave the NHS complaints part of the job to someone new.

What is so strange about Ann Abraham’s approach is that her team investigated only 2.5% of the complaints “properly made” to her. The last annual figures were 9,000 “properly made”, 226 investigated. An explanation for this tiny percentage and the criteria for rejection should be published very soon. In fact it would be very helpful if all of those 9,000, of course suitably anonymised, could be put online and the public allowed to comment on them and score the hospitals involved. This would achieve two goals; first, it would help to show the public the extent of the failings in the NHS and the truly awful standards and, second, it would focus the minds of NHS staff on change.

Really we shouldn’t be focusing on complaints and complaint systems at all. The most important thing for the NHS is to start delivering all care with zero harm, right first time. Similar concepts have been common across so many sectors of society for so long it is deeply saddening that our NHS has not adopted them. Isn’t “first do no harm” an axiom of medical care that goes back not hundreds but thousands of years? Has the NHS forgotten it?

To achieve this the NHS needs to take ideas from civil aviation and many other safety-critical sectors to assist staff in delivering with zero harm, right first time but most of all a revolution is desperately needed in attitudes and behaviours by all frontline staff, a change of culture. This revolution can be led and delivered only by the hundreds of thousands of doctors of all grades, all seniorities, and all specialities. By nurses, by all of the other professions involved in frontline care, by healthcare assistants, by porters, by medical secretaries, by every single person with direct involvement in patient care. There are plenty of “managers” in that definition too, but the current NHS hospital, dominated by teams of executives – with non-executive directors drawn from the local ‘great and good’ – and board meetings discussing everything but the reality of the awful experience of patients on the wards, is not delivering what our society wants and needs.

The frontline must take a lead, they must change their behaviour with patients and their loved ones. Every individual staff member must renew his or her own professional commitment, that’s what can make the difference. No amount of legislation, no amount of exhortation by Andrew Lansley, David Nicholson, or anyone else will do it. I believe they can do it. They must, for all our sakes.

Julie Bailey is the founder of Cure the NHS. She campaigned for three years for a public enquiry into conditions at Stafford Hospital after her mother, Bella, died following a routine hernia operation.

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