I had the privilege yesterday of meeting some of the nurses from Stafford hospital. I’ve written various articles about what has gone on at and around Stafford hospital, from the massive media and political misrepresentation of the mortality statistics to the Tories’ cynical use of Stafford as a tool to hammer the wider NHS in spite of ludicrously-flawed data, to Jeremy Hunt’s remarkable omission in his statement on the lessons of the Francis report and the near-flawless assessment of the hospital’s performance in two recent inspections by the Care Quality Commission (CQC), and far more besides.
I’ve also written a couple of pieces titled ‘A day in the Life of an NHS nurse’ and one on the crucial importance of context for a proper understanding of any story or situation – context ignored by the media.
If you were to believe what you read or hear in much of the media, you might think that the nurses at Stafford hospital have horns and pitchforks, or at the least are heartless, cruel people who either took pleasure in inflicting suffering on helpless patients or at best just didn’t care.
So I asked to meet some of the nurses from Stafford hospital and for them to come prepared to tell me their stories. Since the staff at the hospital have been ordered not to speak to the media, they were taking a significant risk in doing so – and showing a degree of trust in me that I found very humbling, to present the stories carefully and properly.
I met them all in a small room in one of the pubs in Stafford town centre. When I looked around the table, I didn’t see any horns or pitchforks; nor did I see any callousness. What I did see what a group of people who managed the very impressive feat of being completely ordinary and yet very remarkable at the same time.
As the conversation started to flow, the emotions that have been mostly pent up until now were mixed but unmissable. Pain and grief stood out. So too did pride – and at the same time shame. Not the shame of people who’ve been caught out doing something they shouldn’t, but the shame of people who feel a genuine vocation to care for others and have found themselves prevented from fulfilling that mission as they would wish. The shame of people who know that they are scapegoats and not culprits, yet are unable quite to excuse themselves as fully as they would be entitled to because their sense of responsibility and obligation to those who rely on them is so strong, so deeply ingrained.
I’m going to try to convey just a little of what I heard in a way that conveys some truths about what went on at Stafford that you won’t hear from the media or from some campaigners. I’m going to add little to what they say, as they deserve the chance to speak for themselves.
I hope I do them justice and give them their voice.
Denial’s not a river in Stafford..
Time and again I heard some variation of
Every time we challenge anything, they say we’re just in denial. We’re not in denial – we know there was poor care, and it broke our hearts go home knowing we were unable to provide the care we wanted to give. But we’ve never been allowed to tell our story and give a balanced view, and if we try to say anything we’re just shouted down or banned from speaking. Please get the word out, so people don’t just believe there’s no other side to the story.
There but for the grace of God..
One theme that came out strongly all through the discussion was the conviction that Stafford was not some grotesque exception or freak occurrence. Nurses reported in turn how they had received supportive comments from nurses at many other hospitals that grasped hands and said ‘There but for the grace of God go we’.
One nurse told me of speaking at a conference of the Royal College of Nurses (RCN). In the couple of days of the event before she spoke, she and her colleagues were shunned by some of their fellow nurses. But when she stood up to speak, in 15 minutes the atmosphere transformed as the audience understood that these were not monsters but victims of circumstance – and that any one of those listening could, with a little worse luck, easily have found himself or herself facing the same vilification.
The factors that robbed some of Stafford’s nurses of the opportunity to provide the care that they wanted to, and robbed some of its patients of the care they deserved, are being imposed on almost every ward in almost every hospital.
Short-staffing, overloading, reduction in bed numbers but not patient numbers stretching physical and mental resources to the breaking point; these are not exceptions but the rule under this government. The miracle – and the tribute to the calibre and heart of the majority of health workers – is that there are not more cases of ‘appalling care’ in an environment that is being systematically, cynically starved.
Apologies and viciousness
Several of the nurses told me of their frustration at the media’s acceptance of the claims by campaign group Cure the NHS (‘Cure’) that nobody from the hospital had apologised to them for the poor care they felt their relatives had received. Two nurses told me that they had apologised in person to Cure leaders – even though they were apologising for something beyond their ability to prevent – and had been thanked for doing so.
One nurse told me of a day that she had worked an extra 12-hour shift at the hospital because there was no one else available to provide cover. As she left the ward, exhausted, at the end of a shift she wasn’t obliged to do, she saw that someone had scrawled on the notice board,
ALL A&E NURSES ARE BITCHES!
There was a sense of helplessness to put forward a counter-view, as all staff had been banned by the new chief executive from making any positive statements or responses on the grounds that it would be ‘insensitive to the families’. Yet when staff appealed to him to stop people from coming into the Accident and Emergency unit and abusing staff, he told them,
I can’t do that.
Staff are still banned from speaking out, especially to the press. But there was no such restraint in the opposite direction. One nurse was spat upon in the street several times, while others were called murderers as they walked with their young children. As I heard these stories, the outrage I felt was barely mirrored in the faces of those telling them. Instead there were red eyes, and tears – a sense of hurt and grief more than resentment.
These were not hard-hearted harpies, but kindly, capable women treated like monsters for circumstances outside their control. One told me:
They said everyone was responsible – but it wasn’t true. There was a lack of resources, a lack of numbers, a lack of even the right forms – how can we be responsible for that?
The enemy within?
The abuse didn’t just come from families and other members of the public. One nurse, her own eyes filling with tears for the first time even though I sensed she wasn’t someone who cried easily, told me of a governors’ meeting, at which
We were verbally abused until we just stood and cried.
Nurses were so scapegoated that even doing the right thing could be a cause for persecution. One nurse, who struck me as extremely tender-hearted, told me that she had called the CQC to warn them that staff numbers were falling dangerously again. After she had finished her shift, they arrived to inspect the situation. Early the next morning a friend had called her:
I just wanted to warn you – your name’s out there.
Almost breaking down, she described what happened when she arrived at work:
Medical staff hunted me down – hunted me – demanding ‘What have you said?!’
Another – the one I suspect doesn’t cry easily – told me of even worse occurrences:
I’ve put in IR (incident report) after IR. I once had to put a lady in a slightly inappropriate place – on a monitor but in a room off a corridor so that we couldn’t keep a constant eye on her. Not the best place, but we just had nowhere else. She passed away. I was never asked to the coroner’s inquiry – and the IRs were never discussed. They had disappeared.
Another picked up the thread:
We were told we didn’t follow the escalation process, but we did. The information was blocked and diverted. One relative queried the circumstances of a patient’s death after a buzzer wasn’t answered. The buzzers weren’t working – but the IR about them was ignored, and later removed.
Then I heard a couple of accounts that seemed to encapsulate the problems faced by health staff trying hard to do the right thing. One nurse told me that he had trained his staff in infection-control procedures, and a representative of the Healthcare Commission (HCC) came onto the ward:
You’ve trained all these people – why aren’t they wearing gloves and aprons?!
I told them, “We haven’t got any” – and we didn’t have. The last ones had been used and were scrunched up in a pile for disposal. We escalated the problems. We told the HCC – and all that happened was that senior staff came down demanding to know who had spoken to them.
Another told me,
I blew the whistle about something. The next thing, I was ‘named and shamed’ in a staff meeting, with minutes and everything. I rang the NMC (Nursing and Midwifery Council) and the RCN in flood of tears and was told:
“You can fight it – but it’s Stafford. You won’t get anywhere.”
Broken hearts and stubborn dedication
The cumulative effect of all this was no less tragic for being predictable. One account typified:
I’d achieved the goals they set me. I had lots of letters of thanks from patients and relatives – and then they sacked me from my position of responsibility. I was so fragile by then, I just didn’t have the heart to fight it.
Yet in spite of everything, commitment and dedication refused to die:
We only put ourselves through all this because we care about our patients and the people we work with.
My husband and kids say to me, “why don’t you take your bed and live there?” – but we can’t do any less. We give it everything – because we’re nurses.
It was an incredibly moving time. All through that discussion, that mix of pride, grief and unwarranted shame was clearly in evidence. There was remarkably little resentment toward those local people who had acted and spoken so hurtfully – but there was a strong sense of betrayal that those who should have spoken up for them and their colleagues had not only failed to do so but actively contributed to the witch-hunt.
It was a betrayal that went up to the highest levels.There is much more I could tell you from the discussion, but I’m going to end with a quote – with a question, in fact – and then you can make your own mind up whether the front-line staff have been fairly condemned, or unfairly scapegoated by those with their own agendas.
This quote was from the small, tough nurse that I suspect doesn’t cry easily – but who has, I don’t doubt, shed a lot of tears nonetheless:
Why did our Prime Minister take hearsay and accusations with no evidence to support them and just put it out to the world as fact? How could he do that when he must have known better? I can never forgive that.
If she’s right (and I am certain that she is), then the public’s anger has been directed at the wrong people – and we shouldn’t forgive the misdirection either.