Francis 243 – 0 Hunt: NHS staffing, wilful ignorance – and a plan

Jeremy Hunt’s announcement in Parliament last Tuesday on the changes he is planning in the wake of the Francis Report into events at Stafford Hospital was remarkable for two things: the complete absence of the key factor that Robert Francis identified as being at the heart of the poor care at the hospital and as clear a case of “giving away the ‘master’-plan” as you will ever see.

Or not wish to see, since for all Hunt’s timorousness and petulance it will be an absolute disaster for hundreds of thousands of people.

The problem that never was, or ‘out of sight, out of mind?’

Hunt prefaced his announcement of his measures by genuflecting before the altar of the Francis report:

I also pay tribute to Robert Francis QC for his work in producing a seminal report that will, I believe, mark a turning point in the history of the NHS…Our actions must ensure that the NHS is what every health professional and patient wants: a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion..The Government accept the essence of the inquiry’s recommendations and will respond to them in full in due course.

Always good to make a show of piety. Unfortunately, as we’ll see, Hunt’s devotion to Robert Francis’ is mere lip service for form’s sake – and for the sake of a goal which has nothing to do with putting ‘a service that is true to NHS values, that puts patients first, and that treats people with dignity, respect and compassion.’

Hunt then goes on to list the 5 ‘key’ areas that he is addressing, based on the Francis report – a list in which something is conspicuous by its utter absence. Let’s take a brief look the areas he did mention, quoting his own (weasel) words:

1. preventing problems from arising by putting the needs of patients first
2. detecting problems early
3. taking action promptly
4. ensuring that there is robust accountability
5. leadership.

Can you see what’s missing? Here’s a clue.

Francis 243 – 0 Hunt

In the three volumes of his report and his executive summary, Robert Francis mentions a certain word no less than 243 times. That word is:

staffing

That’s 243 mentions of that exact word, broken down as follows:

Executive summary: 11
Volume 1:  82
Volume 2:  117
Volume 3:  33

That is not counting the various mentions of similar terms referring to the same issue, such as ‘staff levels’, staff numbers’, etc which would take the total far higher. 243 mentions of that particular word:

Staffing

Jeremy Hunt paid tribute to Mr Francis for his work and the report that resulted from it. He said the government accepted the report. He said the government would act upon it.

How many times did he mention ‘staffing’ in his announcement?

0

Yes, zero. None at all. But perhaps he just didn’t use that term – perhaps he said ‘staff numbers’, or ‘complements’, or just ‘numbers’, or some other variant?

How many times did Mr Hunt refer to staff numbers in any way during his speech?

0

Hmmmmm. Do you get the feeling that there’s a subject he wants to steer clear of?

In every single one of his five ‘keys’ that will ‘mark a turning point in the history of the NHS‘, the notion of understaffing is conspicuous by its absence. What we get instead is a series of measures designed to give the impression of doing something popular (and largely impractical) while actually leading toward an ulterior motive that’s been common in almost every action of the Tories in government toward the NHS.

Here’s how Hunt elaborated on his 5 ‘action points’:

Prevent problems arising by putting needs of patients first

According to Hunt,

people have suffered on such a scale and died unnecessarily

and

To prevent problems from arising in the first place, we need to embed a culture of zero harm and compassionate care throughout the NHS

I have news for Mr Hunt. ‘Zero harm’ is already deeply embedded in the culture of NHS workers, from doctors’ vow of ‘first, do no harm’ downward. But if hospitals are seriously understaffed, the best intentions and efforts are doomed to fail often. But Mr Hunt knows that and isn’t unhappy about it, as we’ll see.

To achieve this ‘new’ culture, Mr Hunt proposes to make would-be nurses work as health-carers for a year in order to get funding for their nursing degree is deeply impractical and a way to provide cheap cannon-fodder to those hospitals who can afford it. Impractical because many hospitals are not going to be able to pay an influx of additional health-care assistants, so places will be in short supply.

Unless of course, he expects them to work for nothing – which wouldn’t be very surprising, really. No, hands-on caring should be part of nurses’ training, like it used to be – not a prerequisite for getting on a course in the first place.

Detecting problems early

Hunt said,

the most important thing that the country should know is that when it comes to failures in care, the buck stops in one place

Well yes, Mr Hunt. Except it should be the Health Secretary.

Instead, Mr Hunt has decided to create a new ‘Chief Inspector of Hospitals’ – which fits perfectly with the Tories’ love of devolving blame. No amount of inspection, though, will allow nurses and doctors to do more than is humanly possible. The Health Secretary is imposing an official to to detect failure without addressing the core reason identified by Robert Francis for poor care.

‘Setting up to fail – and making more sure failure is caught’, in other words. Which leads us to the 4th – and central – measure Hunt outlined.

Take action promptly

Hunt said,

The problem with Mid Staffs was not that the problems were unknown; it was that nothing was done.

The problem with this is that, although it’s part of the popular perception fostered by the media, it’s simply not true. Martin Yeates, the former chief executive of Mid Staffs, instigated a series of checks that ensured that if Doctor Foster Intelligence alerted them of any increase in death rates, cases were reviewed by other doctors to make sure there were no issues. Two surgeons were removed from their posts because of poor technique uncovered.

But Mr Yeates was forced to step down – by the rage and furore surrounding issues that he was taking steps to address – to the dismay of staff at the hospital who could see that he was doing a good job.

Hunt went on,

No hospital will be rated as good or outstanding if fundamental standards are breached, and trusts will be given a strictly limited period of time to rectify any such breaches. If they fail to do that, they will be put into a failure regime that could ultimately lead to special administration and the automatic suspension of the board.

Ah, now we come to the nub. Hunt has tried to be subtle, but in fact he’s given away his game like a poor poker-player. Hunt is trying to dress up his ‘turning point in the history of the NHS‘ as a plan constructed for the good of the NHS’ patients and potential patients. But it’s nothing of the sort.

What it is is quite simple, really:

1. Ignore the central cause of poor care in the NHS, leaving hospitals underfunded, under pressure and understaffed.
2. Appoint an inspector to make sure that the resulting, inevitable failures are identified more quickly and are ‘shouted loudly’.
3. Take action. Action to address funding and staffing issues so that people dependent on a failing hospital receive better treatment? Nope.

Mr Hunt is going to ‘save’ the NHS, and ‘save’ the people who depend on hospitals, by giving them a short time to solve their problems without the remotest hope of the means of doing so – appointing more staff. And then he’ll put them into ‘failure regimes’ and administration.

Instead of having a struggling hospital, local people will have no hospital at all, as the one they’ve relied on is shut down, or broken up and absorbed into other, more distant hospitals or bought up by private health companies.

Just ask the people of Stafford what that feels like. While you’re about it, ask them whether they feel ‘saved’ by what’s being done to their local hospital and services – and why thousands of them are signing petitions, protesting, delivering leaflets and appealing to politicians and lawyers to help them genuinely save their hospital.

He marched them up to the top of the hill..

Mr Hunt’s 5th point was leadership. But ask any general what his chances of success are if he’s starved of the weapons and materiel he needs to fight the battle. By wilfully ignoring the most crucial issue identified by the Francis report and doing nothing to address the staffing shortages and the funding issues that create them, Hunt is merely setting up the NHS to fail, ensuring failure is punished by counterproductive measures – and leading the NHS into a dead end where it can be picked off, piecemeal.

The blueprint

As I predicted a month ago, the Tories see Stafford as an opportunity and a blueprint. Stafford hospital has been turned around completely and is now among the best district general hospitals in the country – and is about to be closed down, unless its local people are able to save it against the odds.

In his speech, Hunt said,

I want Mid Staffs to be not a byword for failure but a catalyst for change

Stafford could actually be the blueprint for a big, positive change in the NHS – a blueprint titled ‘How to turn around a struggling hospital’ – but that opportunity is being thrown away by the plan to break it up.

Instead, Hunt plans to use the same ‘identify, target, denigrate, close‘ model that has been used to attack Stafford to attack other hospitals – and has targeted 10% of England’s hospitals for his first phase.

Hunt called what happened at Stafford

a betrayal of the worst kind

But it wasn’t – there’s a far greater betrayal couched in Hunt’s words and intentions. A betrayal that involves taking away people’s cherished, vital hospitals – and telling them that he’s only doing it for their good. A betrayal that dresses up a plan to inflict deadly wounds on the NHS that will lead to many deaths and much misery as one motivated by the desire to improve people’s lives and health.

A betrayal that knows exactly what is needed to address the problem – and ignores it completely.

Francis 243 – 0 Hunt.

Don’t forget.