The quality of care

 

         The Care Quality Commission Report yesterday was shocking.  I would be interested to hear comments on other experiences of the quality of care in hospitals, especially for the elderly. Why have there been such serious lapses in nursing standards?

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70 Comments

  1. Antisthenes
    Posted October 14, 2011 at 6:48 am | Permalink

    We know the answer and Andrew Lansley is attempting to address it but will fail because his reforms do not go far enough and vested interest and wrong thinking that are resisting reform will prevail.

  2. Mick Anderson
    Posted October 14, 2011 at 7:06 am | Permalink

    My mother broke her ankle a few years go and was admitted to hospital. So far, so ordinary. The problem was that once the “given a bed” box had been ticked, she was left for most of the week. There was never any operating theatre time to pin the break because scheduled surgery took up all the slots.

    Because of the delay, when some time finally emerged, the leg had swollen to the extent that the operation had to be postponed for several more days until it went down. If the first delay hadn’t happened, nor would the second. She should have been out in two days, not ten, and the recovery time and all the associated pain would have been substantially reduced. However, the box had been ticked and that was all that mattered.

    However, on the day she was due for discharge there was a massive snowfall, making both local and main roads impassable to anything without four wheel drive and ground clearance. The hospital wanted every possible bed empty in anticipation of people slipping over on ice. Everyone who knew someone with suitable transport rallied round (literally!) and the fifteen mile drive home was made in a privately owned Range Rover.

    The normal routine was a clinical disaster because the target had been met. When the rule book went out of the window due to circumstances, all the staff rose to the occasion.

  3. Mike Stallard
    Posted October 14, 2011 at 7:45 am | Permalink

    I am 72 and that is my qualification for answering this.

    Three of my four children are now living far, far away. One lives in the North of England, while I live in the Fens.

    If anything happens then what? I shall have to depend on highly skilled, university trained nurses who are far, far too qualified to wipe my bottom or change by bedding.

    I am scared! What a lonely, disgusting and humiliatingly boring way to die!

  4. Tim
    Posted October 14, 2011 at 7:54 am | Permalink

    Although the answer will be multi-factorial and the quality of new entrants to nursing is an issue, fundamentally I think the problem is the apathy born of not being being listened to or to be able to make anything improve. Every small concern that is raised and ignored leads to the staff member learning that it is not worth doing it. Culture trumps policy.

    At Toyota UK the most lowly employee can stop the production line with a safety worry, and the the big boss in Japan will get a full report a couple of days later (and he wants to have it). The employee is given praise for bringing this to his attention and action is taken instantly and across the world. The impact of this on their production standards is stunning.

    Does the SoS want these sort of reports? Does he/she set a culture that demands them? Sadly the opposite is true.

    • Electro-Kevin
      Posted October 14, 2011 at 9:15 am | Permalink

      Tim – under the Health and Safety at Work Act it is not only the lowliest employee at Toyota who has a right to stop the job on grounds of safety – it’s the duty of every worker in the country and this can be on pain of imprisonment if an omission is bad enough.

    • Richard
      Posted October 14, 2011 at 11:17 am | Permalink

      Imagine how efficiently Toyota would operate if they always had a waiting room full of customers who could not easily go elsewhere and who have also pre paid.
      How motivated would Toyotas staff be if they felt their jobs were safe and their pay was not dependent on total quality focus and customer satisfaction?

      • Bob
        Posted October 14, 2011 at 2:28 pm | Permalink

        You’ve hit the nail on the head Richard!

  5. lifelogic
    Posted October 14, 2011 at 8:12 am | Permalink

    The report does not surprise me at all having see the way the NHS and in particularly care of the elderly works.

    I was particularly amused by the BBC coverage and the nurses groups claiming that “better training” was needed. How much training and “degrees” does on need to feed water and wash someone. At one hospital I remember the Filipino cleaner being rather more use than the nurses for feeding the elderly patients.

    I tend to think the degrees and training are more of the problem than the answer. The attitude is “I am a graduate nurse and that is below me – the patient are such an irritation and inconvenience to my day of paper work”.

    What is the point in all the specialist treatments & such expertise if you are not even feeding, watering and washing the patients?

    • uanime5
      Posted October 14, 2011 at 4:43 pm | Permalink

      The main problem is that under the last Government Labour decided that to save money they would have the nurses perform some of the tasks that junior doctors performed. To give nurses the skills they’d require the training they received was changed from a vocational course to an academic one. The result of this was that fewer junior doctors were needed and it created nurses who considered many of the duties nurses used to perform as beneath them.

      So the Government has 2 choices:

      1) Use healthcare assistants to perform the tasks nurses used to perform (current strategy).

      2) Have nurses perform the role they used to perform and train more junior doctors.

      The Government cannot continue train nurses to be junior doctors then expect them to do tasks that junior doctors would refuse to do.

      • Bob
        Posted October 14, 2011 at 7:30 pm | Permalink

        Option 2 please. Doctors can doctor and nurses can nurse.

    • Bazman
      Posted October 15, 2011 at 10:20 am | Permalink

      So they need to be less educated and this in some way will improve the situation. As if less education was the answer to anything. Maybe they should be paid less too?

      • lifelogic
        Posted October 16, 2011 at 9:44 am | Permalink

        The need to learn to give liquids, food and clean the patients. Until they can do that well, and ensure that is has been done, is their much point in teaching them any more?

  6. stred
    Posted October 14, 2011 at 8:14 am | Permalink

    Three years ago we visited an elderly friend in a hospital in Essex. She was undergoing treatment for a life threatening condition and in a general ward awaiting an operation. My wife is highly qualified in medical matters and was trying to find out what had been happening with regard to the diagnosis and treatment. The nurses were from Africa and did not seem to understand what we were asking about. Then we found the record board on the bed was for another patient!

    Fortunately for our friend, my wife was able to insist on contacting the registrar and obtaining some tightening up of procedures. The shambles was a result of paperwork which appeared satisfactory to staff, who were only following instructions. However, there was no nurse or ward manager who was interested in talking to the patients and, as a result, they had confused the surname and our friend might have been sent for the wrong operation.

  7. Robert K
    Posted October 14, 2011 at 8:21 am | Permalink

    My mother, aged 77, received excellent outpatient care from our local community hospital when suffering from sciatica. She felt she received particular empathy for her age.

    • scottspeig
      Posted October 18, 2011 at 12:34 pm | Permalink

      Community hospitals (I’ve found) tend to be better care than others. I believe they have a better level of empathic staff.

  8. Nick
    Posted October 14, 2011 at 8:34 am | Permalink

    It’s been going on for ages. I’ve seen one doctor kill off a patient that he injured so badly they were going to die.

    I’ve had one friend where they intubated his stomach and didn’t monitor his O2 levels. Brain dead and then died.

    Another friend died one week after giving birth because of errors of doctors. In this case the compensation bill will hit 7 figures and could hit 8.

    That’s just two that I have had personal knowledge of.

    It’s rampant. With the NHS’s own figures of 20-80,000 a year where the NHS contributes to deaths of patients seeming huge, its not. We have the TPA with figures of 12,000 for the excess deaths. That is, if they NHS was a good health system, you might expect 8,000, instead the lower limit is 12,000.

    So what’s gone wrong?

    First compare airline pilots with doctors. Why do pilots report errors and not doctors? Very simply. The consequences. For a pilot, they have a strong personal interest. Doctors don’t. So chronic under reporting. No lessons are learned.

    Just think about those hospitals in Staffordshire, Kent and Essex that have each killed hundreds. Where are the prosecutions? Where is the offers of compensation?

    The NHS didn’t even detect Shipman, where the unofficial figure is over 600 killed, the official 215

    Next is that its a structural issue with the NHS. The NHS is both insurer, supplier and regulator. It’s not in its interest to solve these problems. The NHS’s approach is that victim has to suffer and take the costs, because it would detract from their spending (and doing the same to others).

    So the NHS needs to be broken up. The three legs need to be separated. The only bit that should remain as a national service, is A&E.

    What is needed is universal health coverage. Everyone gets to get insured, even the bad risks. The approach to take here is the Swiss model. Standard costs for insurance. If you elect to pay the first 250 pounds of any treatment in the year you can get discounts. Insurers can refuse to insure. However, if you get refusals, the government will pick an insurers name out of a hat, pro rata to market share, and that insurer has to insure you. This is a very simple mechanism that is fair on both patient and insurer. Insurers know they will get a market share of bad risks, and won’t get all the expensive to treat patients. Patients know they get insured at the standard costs.

    The regulator is then split off. For example, in the UK last year there were over 20 cases of the wrong limb being amputated. No doctors were struck off. Do that in Switzerland, and you aren’t a doctor any more.

    There also a load of rot talked about private supply. I regularly here that private companies will profit by doing operations cheaper than the NHS and that this is bad. How can it be bad? The NHS is wasting money. They get the reduced costs, and that money saved can be put to other uses.

    So given the regulator is split off, the insurers are split off (they don’t have to be for profit), how does that leave the supply?

    Well, I think the NHS should just be A&E. The rest can be private, not for profit, Unison could start a hospital or run one. Charities could run them as they did in the past. You get a mix. Works far better than the NHS. Patients get better treatment.

    • Mike Stallard
      Posted October 14, 2011 at 4:13 pm | Permalink

      In the 1960s I emigrated to Australia which was then operating a similar policy to the one you describe.
      I met a fellow immigrant (lady) wandering round the streets with a temperature of 104, and without insurance, she could not see the doctor. I checked with my wife – the disease was not infectious…..

    • uanime5
      Posted October 14, 2011 at 4:57 pm | Permalink

      “Why do pilots report errors and not doctors? Very simply. The consequences. For a pilot, they have a strong personal interest. Doctors don’t. So chronic under reporting. No lessons are learned.”

      While pilots are likely to report problems with the plane they’re unlikely to report the errors that they make because they’re very likely to be fired. The same is true of doctors who will report equipment failures but not their own errors.

      “So the NHS needs to be broken up. The three legs need to be separated. The only bit that should remain as a national service, is A&E.”

      Why should only A&E be state owned? The police and the IPCC are both state owned, and the IPCC is effectively able to investigate complains about the police.

      “However, if you get refusals, the government will pick an insurers name out of a hat, pro rata to market share, and that insurer has to insure you.”

      What happens in Switzerland when you can’t afford insurance, for example because you’re unemployed, does the Government force a company to insure you for free? Remember that Switzerland has far lower levels of unemployed than the UK and far higher salaries.

      “I regularly here that private companies will profit by doing operations cheaper than the NHS and that this is bad. How can it be bad?”

      There are two ways to save money; being more efficient and cutting corners. As the latter is much easier expect private companies to reduce their costs by endangering their patients.

      “Charities could run them as they did in the past.”

      So Oxfam would sell donated toys to pay for children’s operations? Guess they won’t do many operations each year.

    • lifelogic
      Posted October 14, 2011 at 5:10 pm | Permalink

      Much truth in the above we need proper reporting of mistakes, whistle blowers and lessons learnt and actions. How many more millions must die before someone sorts the mess out.

  9. Steve Cox
    Posted October 14, 2011 at 8:55 am | Permalink

    Over the last few years I have seen 2 elderly relatives and 1 old friend put into care. Both the relatives developed dementia just before they reached 90 years and so had to be kept in a secure care home. Before we could find a suitable home my auntie had to stay on the secure psychiatric ward at the local hospital. This is not a very pleasant place, and we were relieved when we found a suitable home for her final months (she passed away last March). The other relative has been placed in the same home, but now the owners have decided that they no longer wish to provide secure care for inmates, so we are looking for somewhere else, but there seems to be a great shortage of secure homes in our area and she may have to end up in the local hospital psychiatric ward. The old friend is still fairly cogent, but has suffered almost complete physical collapse, coincidentally also just when he reached 90 years. He’s simply on the geriatric care ward at the hospital and they seem to be looking after him well, though sadly he appears to be going downhill very fast. When he was hospitalised his wife, who is also very frail, initially went to stay with her son’s family. While they went on a holiday they had already booked, she went to stay in a council-run care home, and apparently she likes it there sufficiently that she has decided to stay instead of returning to her son’s home. This is all in the South Wales area around Bridgend, between Cardiff and Swansea. From my own limited experience I can’t say that I have any real complaints about the levels of care in both hospitals and homes, whether private or council run. The problems are the astonishing expense of keeping someone in a home, and the apparent acute shortage of secure care facilities. I suppose that if the owners find they can make more profit from running non-secure facilities, then that is what they will opt to do.

  10. alan jutson
    Posted October 14, 2011 at 9:07 am | Permalink

    Can only relate to the care of my mother (90 years old at the time) who had a series of strokes.

    Paramedic and ambulance service excellent, arriving within minutes of 999 call.

    Care at local Hospital which had a specialist stroke unit, poor.

    We are told that time is of the essence in determining recovery from a stroke, so a brain scan to determine cause, (bleed or blockage), and treatment should be undertaken within 4 hours. Her brain scan not completed until 2 days later, by which time damage done.

    They expected my mother to die, we were told that indeed she would, within days. She did not, that generation did not give up so easily without a fight.

    Result, in hospital for 10 months, paralised completly down one side, movement and strength restricted on the other side, swallowing reflex damaged (pureed food only), speech impared, brain damage, sight impared (could not read), double incontinent. head movement restricted. Result she could do asolutely nothing for herself.

    Once they knew she would survive, I fought medical assessments on her behalf, (I had Power of Attorney) I fought allocation into a nursing home of their choice, in a location of their choice.

    Eventually I won (a hollow victory really, given her condition) to have her in a nursing home of our choice, in a location close to her family, fully paid for by the NHS under the continuing care proceedure.

    My mother survived a further 4 years due to the excellent care given by the local nursing home (in Wokingham as it happens) until she passed away just before her 95th Birthday.

    Whilst Mum was in hospital I witnessed food being left on other Patients tables, out of their reach, then collected without a mouthful being eaten. I witnessed patients asking for bed pans, requests ignored (perhaps staff were too busy, perhaps they were not) so patients soiled themselves in bed.

    During the period of time my mother was in hospital I visited her at least 4 times a week, during her 10 month hospital stay I travelled 7,000 miles, I put over £800 into the car park machine.

    Why did my mother have a stroke, may be a co-incidence, but, probably due to a Locum Doctor at her practice making a mistake when looking at her medical records, and refusing her a repeat prescription which she had taken for years. I made numerous phone calls on her behalf, once I was aware of the situation, but her strokes happened within 24 hours of her medication running out.

    Not a rant against the NHS, we have friends who have had excellent treatment for Cancer and other problems, others where it has been perhaps questionable.

    • alan jutson
      Posted October 14, 2011 at 10:41 am | Permalink

      John

      If you are holding this in moderation for anything other than its length, I can say I have everything documented, copies of all correspondence, copies of all medical assessments, I even have a copy (the original hand written) of the Locums note to my mother.

      The paperwork file stands nearly 4 inches (100mm) high

      I have deliberately not mentioned any names, or any hospitals.

  11. John
    Posted October 14, 2011 at 9:08 am | Permalink

    John, which report please? I had a look at the Care Quality Commission website but the most recent report was published in July.

    Thanks

  12. Electro-Kevin
    Posted October 14, 2011 at 9:11 am | Permalink

    A return to single sex dormitories please.

    People hidden away in corridors and cubicles can be forgotten or ignored.

  13. backofanenvelope
    Posted October 14, 2011 at 9:24 am | Permalink

    We should break up and privatise the whole thing. The government’s job should be to ensure that everyone gets what treatment they are entitled to. This could be done by creating a powerful inspectorate, funded by closing down the DoH.

  14. NickW
    Posted October 14, 2011 at 9:31 am | Permalink

    The only way to address this problem is to make patient satisfaction the ONLY target for the NHS.

    In the private health industry patient satisfaction has to be a target or customers and revenue dry up.

    In the NHS, patient satisfaction is often incompatible with meeting all the other targets.

    Patients have become merely a number, management and nurses do not see them as individuals, and consequently their treatment is less than human.

    • NickW
      Posted October 14, 2011 at 10:23 am | Permalink

      The Private hospital only gets paid when it treats a patient.

      The NHS Hospital is given a lump sum from which patient treatment is deducted.

      The NHS financial model forces the Hospital to balance its books by delay, and the partial or complete denial of treatment.

      Combine that with my previous comment and one can see that callousness, cruelty and neglect are inevitable consequences.

      • uanime5
        Posted October 14, 2011 at 5:02 pm | Permalink

        Most private hospitals require payment before they treat the patient. They see their patients not as individuals but as cash cows.

        Also they don’t need to achieve patient satisfaction as long as none of their local rivals are better than them. Energy companies can make a lot of money because all their rivals offer a similar service at a price that’s just as high.

    • lifelogic
      Posted October 14, 2011 at 11:06 am | Permalink

      They have already paid, through taxes and so cannot go anywhere else. So it is tough for them. They just have to take whatever the NHS choose to deliver or usually not to deliver.

      Never pay up front for things – if at all possible – is a good rule for life.

  15. Posted October 14, 2011 at 9:41 am | Permalink

    Part of the problem is the requirement for nurses to have degrees, whereupon they expect to do clean office type jobs like their friends who studied other subjects.
    The old method of learning on the job meant that if someone was unsuited, they could easily drop out without great expense, now they have spent years qualifying, run up huge debts, and if they decide that they don’t like the job, hard luck, they have no choice but to continue. The best approach would be for all prospective nurses to do at least a year’s work as an assistant before beginning academic studies.
    Similar arguments can be applied to teaching; a friend of mine who has realised that he totally unsuited to the job would like to leave but simply can’t afford to do so

    • alan jutson
      Posted October 14, 2011 at 10:32 am | Permalink

      E P

      What a very sensible and logical post

    • lifelogic
      Posted October 14, 2011 at 5:22 pm | Permalink

      Often I find much of the professional education just feeds their heads with fashionable nonsense, delusions of grandeur, pretensions and a new, interesting, but largely meaningless language. A language usually used to try to sound clever and describe the blindingly obvious in an opaque manner to the uninitiated.

  16. Samuel
    Posted October 14, 2011 at 9:42 am | Permalink

    The reasons our health service is so bad compared to systems’ like Singapore or Germany are as follows:
    -it is a state monopoly; Monopolies tend to badly, state ones the worst of all.
    -because it is a state monopoly, you don’t have the pressure to be good like the healthcare in the private sector
    -The amount of money lavished upon it is excessive. It is the biggest and worst health system outside of Communist China
    -It is a mass killer. Because most people can’t go anywhere else, they are forced into an inferior hospital
    -It is or was a political project by the Labour Party. Because there was no system of healthcare controlled by government, they felt that power was slipping away. Labour are fascists really
    -You are five times more likely to die in the NHS than in the better run European alternatives

    • lifelogic
      Posted October 14, 2011 at 5:26 pm | Permalink

      Pretty much spot on – alas it is also a religious mantra that the free at the point of use NHS is vital. Promoted by the usual state sector unions, all political parties some charities and the BBC.

      Will it ever change?

  17. norman
    Posted October 14, 2011 at 9:48 am | Permalink

    There was an interesting article in The Spectator a couple of weeks ago. The gist of it was that the author had spent some time in Romanian hospitals and that they have a different mindset than what we would expect in terms of levels of care, what is and isn’t appropriate for a nurse to do, etc. She gave various examples of what she saw in her time over in Romania.

    She went on to wonder whether it is such a good thing that we’ve made our NHS more or less a melting pot of various nationalities all coming in with different standards and views. One of the items brought up, if memory serves, was the phasing out of what we’d think of as the old fashioned matron at the head of the ward.

    I imagine it’s available for free on the website if anyone is interested.

  18. Mark
    Posted October 14, 2011 at 11:10 am | Permalink

    I have had two conditions requiring hospital treatment in recent years. The first entailed minor surgery to remove a cyst: however, it was slightly awkward, and the consultant I had seen prior to surgery told me it needed to be done under general anesthetic because of proximity to certain nerves. The surgeon on the day decided he would save cost and do it under a local instead: he failed to remove it completely and it became infected afterwards. After weeks of treating the suppurating infection with daily health centre visits I had to go back and have the job done properly under general. Clinical misjudgement, or targets driven error that wound up being much more costly to the NHS and painful and time wasting for me than doing the right thing in the first place?

    The second time I was an emergency admission. The first day and night on the (mixed) medical assessment ward was a nightmare. I had to have a chest drain installed, which was done incompetently by a trainee while the supervising consultant discussed some drug addict patient on his mobile phone, not watching her botched and painful attempts: the general consultant eventually intervened, but as X ray and other events later revealed, failed to install it properly. Overnight I was attacked by a patient who should have been in a mental institution (who also attacked a nurse rather more violently: police were called). Having been moved to a different ward I spent several days on the drain hooked up to mild vacuum: eventually I remembered my physics and established that the one-way water valve on the drain had been grossly overfilled (despite the clear fill level mark), rendering it useless. I expressed my concern to the doctor on duty, and he did at least manage to arrange a replacement valve, correctly filled, and to educate the ward sister, who did at least then have the grace to apologise. The specialist consultant decided I needed surgery, and arranged for me to transfer to a different hospital with the necessary expertise and equipment. Three days after surgery, while I was still hooked up to vacuum, and after previous days’ X rays had shown I still needed time on vacuum, I was summarily told that I was going home: they needed a bed for another patient. I spent 9 months in painful recuperation at home – barely able to walk 100 yards for several of those – before I was finally discharged by the consultant, instead of the few weeks that is normal, purely because of my early discharge and premature removal of the drain and vacuum.

    I dread future encounters with NHS hospitals.

    • Electro-Kevin
      Posted October 14, 2011 at 4:07 pm | Permalink

      What a dreadful experience.

  19. Slim Jim
    Posted October 14, 2011 at 11:34 am | Permalink

    Having experienced the way my Mother-in-law has been treated in a degrading and humiliating way on more than one occasion in the NHS, I have identified 2 main areas that require ‘treatment’. These are Management and Recruitment. Too many managers chasing targets, and staff employed for reasons that amount to social engineering are rather obvious. Also, I have never, ever, been seen on time for any NHS or GP appointment. Too many patients who are just numbers being treated by too few staff. The NHS seems to have a policy of ‘never apologise – never explain’, but some good customer service training wouldn’t go amiss. It’s a mess, but the Left will simply not allow any criticism. Oh, fairly recently, Mum-in-law was given a scan at a private hospital. The difference was astonishing! I told the receptionist that she could go along the road to the NHS hospital and tell them how it should be done. The look on her face was priceless! Dignity and respect? We need lots more.

  20. Damien
    Posted October 14, 2011 at 11:53 am | Permalink

    My friends mother had a fall and was hospitalised for what she and we were were led to believe was a few days observation. In reality she was taken prisoner until a home assessment and care package was organised. Although she was quite well the bureaucracy took six weeks and during that time we saw a rapid deterioration in her morale as her release dates were repeatedly postponed.

    The family decided with her that in order to avoid this in future she should have some home adaptations such as a stair lift, shower hand rails and better lighting etc. She also pays for her own personal assistants who pop in for meal times and personal help. She was specific that she didn’t want strangers in her home with different agency staff turning up everyday. This seems to be a common concern for the elderly so we have divide the home visits among a number of regular personal assistants.

    The lesson learnt was that many elderly people would prefer to stay in their homes but do not have the skills to organise the adaptions and care package to help them do so. There is also a genuine fear that a temporary hospital visit can quickly turn into a hostage situation where the family are powerless to negotiate the prisoner release. Elderly people need a bill of rights that puts their interests before the vested interests of others!

  21. forthurst
    Posted October 14, 2011 at 12:14 pm | Permalink

    About four years ago, after my mother had been confined to bed for about three weeks following a fall, she was referred to her local NHS (teaching) hospital by her GP. After admission she was examined by what I took to be either trainees or total novice doctors who opined that she hadn’t broken anything. There appeared to be a registrar in overall charge of admissions who took no particular interest. She remained in hospital for several days until one morning she was taken for an x-ray and died immediately afterwards from a heart attack; I had been on my way to see her.

    The impression I had of this episode was that there appeared to be no leadership, no urgency, no liaison with family and some trainees who weren’t being properly supervised. Furthermore the quality of nursing, especially with the apparent language problems left me with the impression that patients were required to be far more robust than some might inevitably be to survive the experience.

    My mother had fractured her hip which at her age would have left her in a precarious position which she as an ex-nurse would have recognised; no doubt being told whilst no family were present what the x-ray had revealed would have been the coup de grace for her.

    I can’t help feeling that the overall cost burden of not acting in a timely and professional fashion in diagnosing and treating patients is huge. I also suspect that there are teaching hospitals which are too unprofessional themselves to impart proper standards to aspirant practitioners.

    • forthurst
      Posted October 14, 2011 at 12:19 pm | Permalink

      I should add that my father who had been a GP considered the local NHS hospital an extremely dangerous place which he himself refused to use for treatment.

      • rose
        Posted October 14, 2011 at 6:06 pm | Permalink

        I have always been given to undersand that a broken hip is a death sentence. Not because of the fracture, but the resultant experience in hospital.

  22. rose
    Posted October 14, 2011 at 12:15 pm | Permalink

    My husband was taken into hospital in an emergency by our young son and an ambulance. In the morning I rushed in as soon as I was allowed, to see him, having understood that he had passed a good night. To my fury I found him still on the trolley he had been put on in A and E the day before. What was even worse was that when they saw me coming, they quickly rustled up a bed. If he had been alone in the world, he would have stayed on that trolley. As it was, he developed an embolism. Lots more examples of worse and more protracted neglect than this for you, but too upsetting and personal to describe here.

  23. sm
    Posted October 14, 2011 at 1:54 pm | Permalink

    Not just nursing and not all.

    1) Poor co-ordination and probably too many layers involved. Delays magnifying delays.
    2) I had a Porter refusing to push a trolleybed, because he was told the px would be in a chair! I was not allowed to push it (Health & Safety-2 woman job) or help.
    3) Ambulances worried about getting a trolley back, not wanting to leave a bed bound patient at a health centre for a dental appointment.
    4) Low level admin at sharp end despairing of the demarcation rules and persistent loss of vital patient transfer information resulting in delays & waste.
    5) Good emergency response but much improvement beneath it required.
    6) Patient outcome needs and consequent risks associated with delays not seemingly balanced with decision to action treatment.
    7) Early and correct diagnosis being very important in all settings , GP’s,Hospitals, carehome call-outs.

    Finally, hygiene should be up there at 1) first do no harm! Hospitals should have 24/7 cleaning teams assigned to each ward and responsible to Sister along with ensuring food/water is taken and if not why not? The cost of hygiene surely is surely a saver in the long run.

  24. Griffin
    Posted October 14, 2011 at 2:18 pm | Permalink

    It isn’t only some nurses who so conspicuously lack imagination and empathy. This absence is all too noticeable throughout society these days, including of course in attitudes to the old. At 84 I can’t help but feel saddened by the decline in recent years in courtesy and consideration for others and by the general coarsening of life in this once most civilized of countries, which in my youth was a beacon to the rest of Europe. Why has this happened? Perhaps inadequate leadership, excessive egalitarianism and the baleful influence of much television have something to do with it.

  25. LJH
    Posted October 14, 2011 at 2:19 pm | Permalink

    The emphasis in the NHS is the “management” of patients rather than the “caring” for them. Rules and regulations prevent those clinical staff who really do “care” from going that extra mile to ensure the comfort of individual patients and find themselves constrained and condemned by those staff whose standards the show up. Hospitals should be competing for patients on the basis of hygiene and nursing standards. Consultants should be self-employed and not part of the hospital. They would then be in a position to choose the better hospitals to operate out of and let the bad go to the wall. I have myself had a recent health scare and was in a position to compare the layers of bureaucracy and jobsworth staff, none of whom had a stake or pride in efficiency and service, to its detriment with a budget third world screening service where staff’s job satisfaction depended on team work and getting a same day diagnosis to every patient referred from a large geographic area, seen within a week of referral. The NHS is an expensive self serving rotting from the head dinosaur.

  26. Peter Turner
    Posted October 14, 2011 at 2:23 pm | Permalink

    Simple really. The whole edifice has grown too large, ultimate power is too distant and too far away from the patient and bureacracy can never respond rapidly to change particularly in the case of a complex organisation which has to perform in a dynamic enviroment. The Health Service needs space to innovate because one model does not fit the needs of rural, urban and regional requirements and new developments must be introduced where appropriate. What suits A will not suit B nor C. Local flexibility is essential. It must be remembered and appreciated that the Health Service is full of all sorts of expertise in all sorts of disciplines. It is not just staffed by doctors and nurses but by many other professional staff whose qualities must be recognised and who are encouraged to contribute to the whole. Maybe we need a culture shift, certainly we need a rethink from top to bottom especially in what we are trying to achieve and how the organisational structure should be changes to achieve our goals.

  27. PedroelIngles
    Posted October 14, 2011 at 3:26 pm | Permalink

    Having read these anectdotes and being 82 with a wife of 84 I am really horrified and sad. Whilst I still have my marbles can anyone advise on how one goes about getting a one-way ticket to Switzerland.

  28. Chris
    Posted October 14, 2011 at 4:02 pm | Permalink

    Mr Redwood, are you wanting information regarding anywhere in the UK, or your constituency? There is a torrent of responses relating one horror story after another in the comment sections of all the newspapers which have reported it. I cannot understand why anyone would want to retain an NHS in its current form – it is desperately in need of reform, starting with nurses’ reeducation, and the reintroduction of matrons on each ward, who would be personally responsible/accountable for the level of care afforded on the ward. All the more worrying that the Question Time session last night apparently never gave the issue of disgraceful standards of care any coverage (the CQC report) but instead seemed to be designed to enable a very fierce left wing attack to be launched on Andrew Lansley. I switched the programme off as I felt the BBC is using its position/powers to attack government, rather than being an independent organisation.

    Reply: Yes, wish to hear about any place in the UK under the NHS.

    • uanime5
      Posted October 14, 2011 at 5:25 pm | Permalink

      The problem with the NHS is that managers are not punished for their failings so they have no incentive to change. Making nurses responsible anything that goes wrong is akin to punishing those those least able to change anything.

      Also matrons still exist, though they’re normally called ‘Clinical Nurse Managers’.

  29. NickW
    Posted October 14, 2011 at 4:08 pm | Permalink

    I challenge any Labour MP or Guardianista to read this catalogue of failure and then argue that the NHS is “The envy of the World” and must not be changed.

    The question has to be why the media are so keen to defend the indefensible when they could usefully participate in the formation of a climate of opinion in favour of improvement and reform.

    • NickW
      Posted October 14, 2011 at 4:13 pm | Permalink

      Pathological changes very rapidly become irreversible, so it is very much a case of “Treatment delayed; Treatment denied”.

      Many of the sad stories above bear witness to that fundamental truth.

    • uanime5
      Posted October 14, 2011 at 5:26 pm | Permalink

      Most people defend the NHS because they know just how bad the private sector is.

      • Peter Turner
        Posted October 14, 2011 at 5:56 pm | Permalink

        The Private Sector may be expensive but I know of no evidence that it is bad. There is a lot that can be learnt from the Private Sector particularly how to treat patients with dignity and attention.

      • Electro-Kevin
        Posted October 14, 2011 at 11:44 pm | Permalink

        Most people defend the NHS because they have been indoctrinated into believing that it is the only way.

        Most people find the idea that one person can be cured over another (because of wealth) morally repugnant. The NHS is defended vigorously like a religion – well … not Christianity (the altruism of which went some way to founding it), but maybe Islam.

        The country is packed to the gunnels with nut jobs who think that money can be magic-ed out of thin air.

        The Tories are pinned down over it. If they try anything over the NHS they’ll be out at the next election.

        • lifelogic
          Posted October 15, 2011 at 7:42 am | Permalink

          At this rate the Tories (currently acting a surrogate libdems anyway) will be out anyway. We would be better with Lib/Lab coalition now and at least the posibility of sensible tories in 2015.

    • rose
      Posted October 14, 2011 at 6:18 pm | Permalink

      Did anyone see Zoe Williams of the Guardian dismissing the findings, and saying it was all the fault of agency nurses? On the contrary, agency nurses are shocked at the standards they encounter on the NHS wards, and do what they can to help individual patients in a hostile climate.

  30. uanime5
    Posted October 14, 2011 at 5:21 pm | Permalink

    One of the main reasons why bad treatment remains in the NHS is that whistle blowers are harshly punished. For example Margaret Haywood was struck off by the Nursing and Midwifery Council (NMC) for secretly filming elderly patients being neglected (later reduced to a one year caution).

    Until the Government implements laws to protect whistle blowers and punish NHS managers who are incompetent mistreatment will continue.

  31. Kenneth R Moore
    Posted October 14, 2011 at 5:55 pm | Permalink

    Nurses are not all angels and therefore beyond criticism. That has to be said.

    It’s true that many are immensely hard working and do a very difficult job. Some however are lazy and uncaring – there is no excuse for a patient being denied food and water.

    I don’t see why nurses cannot be trained in the use of new technology but also be instilled with the values of kindness, compassion and respect for the dignity of the patient drummed into any nurse trained in the 1960’s.

    It does seem that far too much of the NHS budget doesn’t get anywhere near providing front line services. The NHS is organised primarily for the benefit of the legions of managers and advisors – treating patients is secondary. I’m sure Mr Redwood already knows this – unfortunately the conservative party seems incapable of taking on the vested interests involved. Cameron and his useless left wing coalition government put the white flag up by increasing the budget – more spending isn’t the solution it is the problem.

    My own local hospital (Scarborough) is a disgrace. I witnesses filthy toilets and filthy wards while the nurses just sit in a corner and chat.
    In the old days a matron would have ensured the nurses got off their bottoms and had the wards spotless.

  32. Iain Gill
    Posted October 14, 2011 at 9:00 pm | Permalink

    I watched my dad die last year, and the long long run up to it
    Over the course of it he was in various hospitals and hospices
    It is still far too painful for me, but I am appalled at the British medical system it stinks top to bottom
    I am sure he would still be alive in any other Western nation, the notion that handing out pain relief is acceptable while failing from the beginning to undertake any of the life prolonging treatments routine in the rest of the Western world, it staggers me
    The standard of care in the General Hospitals was very very bad, they take all the pain medicine off him when he is admitted and then make him wait an hour for it when a wave of pain hits, really a case study in how not to do it. I wouldn’t feed anyone what they laughably call food.
    And the hospice doctors quite willing to open up and expose some of the massive failings in the general hospitals once they trust you, can see you are educated and on the side of the patients. The hospice docs KNOW of many patients who could have lived years longer killed over a weekend admission to the local general hospital.
    The NHS ended up euthanising him, the “pathway of care” for terminally ill patients is a death sentence. Nobody even fit and well people could survive being sedated and having all fluids withdrawn! Death by dehydration while the death certificate says cancer – who is kidding who?
    There is much wrong with the system. The only way to fix it is to give the patients real buying power.
    Some of the consultants and senior managers need kicking out of the profession in a big sweep up reform, there is so much obviously wrong to a casual outsider.

    • Iain Gill
      Posted October 14, 2011 at 9:36 pm | Permalink

      oh yea nurses i forgot

      very very variable

      and far too powerful and out of control

      i dont for instance think people should be put in the fridge on the basis of a nurses signature as happens now, im old fashioned i think we all deserve a once over by a doc to confirm we are dead before we are put in the fridge not many hours after!

      no real rewards for doing a good job its an easy job to coast and sit in the corner chatting

      and no real respect for substance or people who like doing the job well

      all avenues of getting extra cash involve less hands on work

  33. Atypical
    Posted October 15, 2011 at 12:28 am | Permalink

    Ah, the NHS, the sacred cow, not to be tampered with, ring-fenced (as all our ineffectual leaders past and present like to proclaim), the bottomless pit where money pours with no improvements whatsoever apparent.
    You ask for personal examples: extreme leg injury where movement was very painful. Rang several times for a nurse, sorry I meant someone who was lower than a nurse because they don’t do menial tasks anymore, with no response. Finally managed to get to the adjacent bed and ‘borrowed’ my co-sufferers bottle. Needless to say by this time there wasn’t time for the nicities of life ie drawing the curtain so I had my pee there and then in the bottle. Lo and behold a passing nurse, yes passing with no view of answering my call, proceeded to take me to task for not drawing the curtain. My releif was enhanced by explaining to this co-called carer where she could, if she so choose, get off.
    Another personal example is where the consultant of the ward where I was rushed into chose to ignore my GPs diagnosis and took me off morphine because according to him I had a chest infection. The DVT turned into a PE from which I nearly died with the knock-on effects of this mis-diagnosis still with me to this day.
    It is widely acknowledged that operating theatres are empty from lunch-time on Fridays because, traditionally, surgeons finish for the week at this time – how many more operations could be carried out over the course of a year if this practice was stopped?
    Why has it seemingly come as a complete surprise that the elderly are treated abominably by NHS hospitals and ‘care’-homes? We know this already. I will appeal to the great and the good of this country to stop taking the populace as complete fools and idiots – do something about this unhappy state of affairs before even more people die ignominious deaths.

  34. Kenneth R Moore
    Posted October 15, 2011 at 1:19 am | Permalink

    Much of the increased spending on the NHS has gone into improving GP’s and nurses pay. The evidence is that this extra money hasn’t done anything to motivate or improve performance. Infact it seems to have done the opposite.
    I think it was Sir John Harvey Jones who said that ‘bad money’ , and I think he meant money that is awarded without a clear expectation of improvement in performance , was a de-motivator.

    Despite all the evidence the majority of the MP’s on both sides of the house will still defend the position that there is a never ending proportional link between spending and the quality of NHS care.

    The focus should be on making sure everyone working for the NHS has the right values and establishing the right culture to provide the best possible care.

    The all consuming obsession over ‘resources’ has de-humanised the NHS to such an extent that patients routinely die for want of basic needs.

  35. Ralph Corderoy
    Posted October 15, 2011 at 1:42 pm | Permalink

    Andrew Neil made an interesting comment on this week’s This Week related to this. Something like “Given these reports it’s hard to see why the line about the NHS being the envy of the world isn’t attacked and reform pushed through”. He also mentioned statistics showing the UK isn’t the country to fall ill from cancer, etc., based on recovery rates with other similar countries.

  36. Conrad Jones (Cheam)
    Posted October 16, 2011 at 5:14 pm | Permalink

    From my own experience of my Father’s stay in Hospital after he collapsed with a mini stroke, it is apparent that the Nurses mean well but appear to have absolutely no training with people who have Dementia and refuse to take their medication.

    Unfortunately, the best care is received by private Nursing Homes who specialise in administering medication to reluctant patients.

    If the NHS is serious about looking after elderley patients who are not capable of accepting medication and treatment from NHS staff, then the NHS should have special wards dedicated to Alzheimer and Dementia sufferers.

    Nurses and Doctors do not appear to have any training in dealing with difficult patients who suffer from Alzheimer’s. They expect some help from their patients – which is understandable; but Dementia patients do not understand what is going on and refuse to accept that anything is wrong with them.

    As always, it comes down to money.

  37. Paul Coats
    Posted October 17, 2011 at 10:31 am | Permalink

    Looking through comments, I came across two that left a bad taste in my mouth. “African nurses” who “couldn’t understand” patient comments, and “staffing related to social engineering”.
    Barely disguised racism. In my experience, black nurses are UK born and bred.
    Perhaps a smidgeon of moderati0n?

    Reply: This site condemns racism and does seek to moderate out racist comments.Where did you find these?

    • rose
      Posted October 18, 2011 at 3:32 pm | Permalink

      “Racism” is an unhelpful word, as is “sexism”, “heterosexism”, “speciesism”, and the rest. Its use in this way usually betrays an intolerance or prejudice in itself. It is done to silence or traduce others, rather than listen and engage with their arguments. “Little Englandism” is the one most often hurled in this direction. For some reason we still haven’t got “classism” in our vocabulary of disapproval and censorship.

      Unfortunately Mr R has to go along with the concept of “racism” being uniquely evil, and therefore to be watched for even when it isn’t there. Such is the intolerance in public life, that if he didn’t toe the line rigidly, he would be hounded out. So if you think his moderation has fallen short, you must be intolerant indeed!

  38. Yellow Jester
    Posted October 17, 2011 at 6:31 pm | Permalink

    I’m sure that the redesign of many hospitals doesn’t help. Having wards divided into smaller rooms with a nurses’ station in the corridor means that patients are conveniently out of sight and out of mind, while providing a social centre for the nurses. When my elderly mother had an operation in Whiston hospital about 11 years ago she was in an “old fashioned” ward, with the sickest patients placed closest to the nurse’s desk so that they could be closely watched. The standard of care was not brilliant, but at least acceptable.

    She died about 4 years ago after 8 months of being shunted backwards and forwards between Wigan Infirmary and Whelley Hospital, after an entirerly avoidable admission for a minor infection left untreated by a lazy locum GP. The time she spent there was a nightmare – we are sure that she would have died much sooner had it not been for us bringing in PALS on a number of occasions because we were so horrified by the lack of care.

    Where is the sense in discharging someone on a Friday afternoon (to clear beds for the weekend?) who has been weakened by 3 weeks of illness and lack of food, only to readmit them on Sunday morning with pneumonia after they have collapsed at home and lain on a floor all night? Where is the sense in leaving them lying in one position for long enough to develop a bedsore before providing a suitable mattress to make up for the lack of turning? Where is the sense in neglecting basic hygiene until that bedsore is infected iwth MRSA?

    On one occasion I sat with my mother in her single room (because of the hospital-acquired infection) and watched the lunch trolleys going past. When nobody came into the room to offer her anything to eat, I went and interrupted the 6 nurses who were chatting at their “station” to ask if she could have some soup, only to be told that it was too late – they’d stopped doing lunches. When I asked why she had not been offered any lunch I was informed that I must be wrong – she would have been. It was only when I persisted that a nurse eventually shouted out to discover which care assistant had given out the lunches (the nurses obviously had no idea what was going on), only to have it confirmed that nobody had been near my mother.

    When she was “recuperating”, the physiotherapist stressed that she must get out of bed and sit up daily – but we frequently arried to visit to discover that the nurses had been “too busy” or “having a lazy day” to bother to get her up – even when we had seen 8 of them sitting talking together on arrival. Little wonder that she continued to weaken until succumbing to c. diff and another bout of pneumonia.

    In the meantime, my mother’s 65 year-old friend suffered a fall at home and was not discovered for 48 hours, and was admitted to hospital bruised, shaken and in need of her blood sugar stabilising after 48 hours without foor or water. After a few days she was getting around the ward with a walking frame – until she “fell in the shower” (where she was supposed to have been supervised by 2 nurses) and ended up flat n her back on strong painkillers for over a week before they actually investigated and discovered that she had broken her back in the hospital fall. By then she had contracted MRSA and pneumonia, and died a few days later.

    I could write a book about specific incidents, but suffice it to say that most of the nurses that I encountered were lazy, indifferent, negigent, patronising or downright rude – although I remember two who were wonderful, so there is still some light in the darkness!

  39. scottspeig
    Posted October 18, 2011 at 12:28 pm | Permalink

    A bit late, but I hope you read this John,

    My mum is a senior nurse in a community hospital and has been complaining about the new nurses.

    The biggest problem is that the training is mostly academic with little experience so you get nurses with degrees who should understand the basics, but cannot perform the menial tasks (such as cathaters (sp) changing dressings) or think it is below them (changing adult nappies and cleaning the faeces covered patient).

    What is required is for the training programmes to go back to how they were with student nurses in the wards with a matron who knows the ins and outs of all the patients watching and training. The job of a nurse is in my opinion more to do with experience and practice than understanding the complex components of a blood cell.

    • rose
      Posted October 18, 2011 at 9:41 pm | Permalink

      Hear, hear.

  • About John Redwood


    John Redwood won a free place at Kent College, Canterbury, He graduated from Magdalen College Oxford, has a DPhil and is a fellow of All Souls College. A businessman by background, he has been a director of NM Rothschild merchant bank and chairman of a quoted industrial PLC.

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