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.
This is so sad, Steve. Those poor people. Have tweeted the link. Hope you don’t mind. See you in Bristol soon, I hope. Steve
Not at all! Look forward to it mate.
I agree with most of what you have written, except for. ‘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’. Unfortunately this situation was happening under the last Labour Government not just this, excuse of a Government. Sadly, with this Government in power, things will get much worse.
The last Labour government put a huge amount of money into the NHS – with the result that patient satisfaction reached record levels. Unfortunately, the misguided Foundation Trust programme led to ‘microclimates’ of underfunding in some hospitals – pockets of what the government has now made endemic (and then used as a weapon when problems arise).
Reblogged this on patricktsudlow and commented:
Just like those on benefits or the less able, NHS staff are being vilified by the Government and their subservient media.
I’m not a nurse Steve but all that you have written I know to be true, I have a friend who nursed at Stafford hospital for years, she tried I think to blow the whistle and was working in an atmosphere that was less and healthy for patients or staff. My friend left when her health began to suffer, she was a good nurse, she loved her job and her patients but she felt she was failing the patients because she couldn’t help make the change that was so badly needed.
I think these stories are so typical all around the country. I really feel for all of them, I could cry for them. The problems are at the top, and admin, not on the wards. They are just scapegoats.
I feel so sad a few years ago before the first enquiry my mum had awful care at Stafford but it has changed and the care and compassion I received after my sudden cardiac arrest was second to non, I was so happy to meet two of those nurses yesterday and I felt quite emotional, not only did they care for me with compassion and were highly skilled they cared for my family and when I felt able we laugh together. If being on a critical care unit could ever be a good experience the nursing staff made it so. You talk of the lack of openness and incident forms going missing I can support this from my experience but again this was not anything to do with the quality of nursing care in my case it was i feel through the management structure and fear of reprisals by senior consultants Nurses must hold their heads high and know that many of us are truly grateful for their dedication and hard work
The NHS is being systematically attacked and underfunded as it was by Thatcher, every day now whether you open a paper, watch television or just surf the net, up pops an advert selling private medical insurance, this of course is not by chance but all part of this Coalition’s vile campaign.
This of course happened under Thatcher and so Cameron has had a blue print to work to, what he thinks though is that we are all stupid and have forgotten. These people are evil and this country needs to wake up.
What also saddens me is there is absolutely no opposition, these Tories have been allowed to get away with this because Blue Labour have the same agenda as New Labour, Ed Balls was responsible for selling the liberalisation of the City of London to Europe and actively set up a task force under New Labour to deliver that, I do not believe that Ed Balls has changed and will push through their Neo-Liberal agenda to the bitter end.
Ed Miliband should and could stop this witch hunt but I am afraid like the Tories he has the same agenda. New Labour introduced the marketisation into the Health Service, with a bogus internal market, David Owen has now jumped on the bandwagon saying no to an external market yes to an internal market. That in reality is the Trojan Horse and is no different in nature to any form of marketisation. Once you hand control to the private sector you lose skills and experience and ultimately control itself, for the services you rely on, allowing them to charge whatever they like, just like the Rail system now which we subsidise.
I feel there has to be a massive fight back, even the Church of England warn people not to rely on politicians, I have recently joined a trade union retired pensioners group to increase awareness of amongst people who you would think would know, but in reality do not. It’s time people started to organise themselves into all the groups that are fighting the cuts. If we do not fight to save the NHS it go and Blue Labour will let it. They have already said there will be no more top down reorganisation, I wonder what Nye Bevan would have thought about that.
Best set of excuses yet.
Not a lot about the 1200 & their relatives. They must come first in all of this
There was no ‘1200’. Read this and learn: http://skwalker1964.wordpress.com/2013/02/26/the-real-mid-staffs-story-one-excess-death-if-that/
Relatives get stuff wrong. They deserve sympathy, but they’re not clinicians – and the stats were garbage, because they were built from garbage.
I tried to get to the bottom of what happened to me when I was pronounced dead then twenty ministers later my family were told that they had found a pulse . My husband and daughters had phone everyone and even had two sympathy cards. But I can believe how nurses incident forms went missing I know that one about me did and when I asked the consultant what he would have done differently to make sure it never happened to anyone else he said…. And I quote ” I would be more assertive with the nurses” I was furious how dare he be so arrogant , it was obvious that he didn’t know the true meaning of assertiveness!
You have witnessed what it is to keep to your vocation against all the odds. But a side effect of that is the loss of energy for anything else – like fighting the unfairness of your treatment individually or as a group. Let us hope the citizens of Mid Staffs have the energy to fight the stitch-up that is the proposed closure of ALL (yes all) acute services for that population and that others will follow your example in helping to expose the reality – because if that can be achieved, the NHS can learn the real lessons – and maybe the result will be a safer, kinder, more accessible yet (very likely) cheaper service for ordinary people. The people of Mid Staffs know what a good hospital they have now and may show more anger at the proposals than HMG is expecting!
Reblogged
I cried While reading this, especially the ending. One day the truth will out sadly it might be too late to exonerate these brave people.
What the staff of Stafford Hospital have had to put up with is quite a story (ie gross understaffing and bullying followed by a public lashing or as Sir Stephen Moss, Chairman of the Trust after the original Board resigned, put it – “you (staff) are working under more pressure than any staff in the NHS have ever worked under, or will ever work under”).
However, think of it from the point of view of the ordinary people of Mid Staffs (300,000 of them, who live in a land area of 325 sq miles). Some patients have experienced poor or very poor care. Instead of that issue being addressed at Stafford and elsewhere in the West Midlands and UK, the population have been worried by the massive furore (and false suggestion that there were large numbers of excess deaths). This has resulted in some patients travelling away from a hospital that’s improving to hospitals that may not be and at the same time contributing to the pressure the hospital faces. Net result: the people of Mid Staffs are scheduled to have ALL acute services (acute medicine and surgery, A&E, critical care, maternity, paediatrics etc) taken out of their locality, from an institution that is doing it well.
If you talk to the government about this they will come up with all sorts of management and finance-speak. If you talk to anyone on the street they simply think the world’s gone mad.
If you think about it stafford was born out of the closures of the general infirmary, groundslow , burton house. The princes royal Telford came about to facilitate the closure of the cottage hospitals and Wrekin maternity unit…. What next …….. Before it goes full circle as it does in social care.
Amalgamating many small specialised units that already existed in a locality into a DGH (with average travel/accessibility the same) is a long way from deleting the resulting DGHs altogether. To join the North/South divide you will now also have the metropolis/rural divide. Very bad luck if you live in the rural north!
Very well said, Steve. Its a sad story of how the ‘system’ and the ‘culture’ led to blame and vilifcation being heaped on the very people who did the most to bring the problems to the attention of people higher up.
Just come across a survey carried out amongst UK doctors (more than 100 respondents) on one of their website fora on the day the original HCC report on Stafford Hospital broke in the media:
18/03/2009 8pm
Who read the “list of horrors” at Stafford Hospital and thought………?
It happens here every day!
65%
No way! That’s so awful. Unimaginable at my Trust.
14%
Hmmm, maybe I’ll get the receptionist to go to Resus and turn on the monitors.
21%
ie about 85% of doctors who joined that forum that day felt that the description of Stafford Hospital (dreadful though the description was) applied pretty much to their place of work also. Yet really only one set of staff have been subject to spotlighting, regulatory visits, scrutiny, media intrusion and bullying.
That the care has improved so much in that hospital despite all of that is an amazing story. Well done the nurses in particular. Pity the NHS powers that be are so keen NOT to learn from it.
Fascinating stuff! Sadly, I agree 100% with your conclusion.
NEWS for April:
1) Year end financial position of MSFT (unconfirmed): better than plan agreed with Monitor (by about 100k) – “with no impact on quality or patient safety”. Ye gods, the staff are a determined lot – that’s the second year in a row!
2) Administrator arriving imminently, sent in by (the self same) Monitor. Likely to close all acute services on Financial grounds.
Err ……what?
It’s crazy. They’re clearly doing it just because they think they can. Is there a source I could link to confirming it?
In Trust staff news to all staff (and presumably interested parties outside) ie in public domain. Pretty much the same information on page 6 (graph) of
http://www.midstaffs.nhs.uk/getattachment/About-Us/Trust-Board-(1)/Board-Meetings/2013/28-03-2013-(1)/Agenda/Item07-4-Finance.pdf.aspx
It will be interesting to see how much is spent on the (no doubt) heavyweight Administrator team sent in to put the boot in (currently rumoured to be made up of people from E&Y – surely the “independent” administrator team who are supposed to come in unbiased to assess the CPT report and other options afresh can’t come from the same organisation responsible for the CPT report – Oh yes they can!).
Is the info about the ‘independent’ assessment team in the linked document? I can’t find it but it would be very useful to have a source!
V late back. Administrators now in so personnel should be easily searchable and investigable (and I do hear that E&Y are in there). The CVs of the “clinicians” are often worth a look.
I was watching the Commons Select Committee interview partners from the 4 main auditors, Grant Thorton, PcW, Ernst & Young and another one. Even the Chair, questioned the fact, someone from E&Y gave technical advise to HMCE tax inspectors and Government and a new tax scheme. For that same person to back to work with E&Y, to design a plan for their customers, to take advantages of tax-loop holes within that very tax scheme, they helped set-up. It is totally unethical but that does not bother them, ‘profits before people and principles’.
Independent administrator – previous efforts include rail track.
Accountants to assist administrator = E&Y.
“Clinician” = Hugo Mascie-Taylor.
Previous Monitor CPT Team
Accountants = E&Y.
“Clinician” = Hugo Mascie-Taylor.
What are the chances of an independent assessment?
What are the chances that anyone has any concept of the purpose of District General Hospitals?
What are the chances that anyone has any inkling of the lifestyle, worries, transport arrangements, domestic responsibilities etc of ordinary people?
The people of Mid Staffs and the staff of their hospitals have got used to being stabbed in the back. This looks like a team sent in to stab us in the front!
That’s ridiculous! Not even bothering to make an effort to pretend!