Being a moderately busy type, I often have to catch up with news and programmes via podcast. Yesterday I listened to a remarkable edition of BBC Radio 4’s The Long View from 3 April. In this programme, titled ‘NHS Failings at Stafford’, presenter Jonathan Freedland interviews Julie Bailey, the founder of the Cure the NHS campaign group, about her experiences at Stafford hospital as part of a wider look at the issue of poor care and the supposed lack of compassion in the NHS.
Predictably, within a few seconds, Ms Bailey attacks the attitude of nurses on the ward where her mother died. Asked by Freedland “what was your own experience of shortages of nurses at Stafford hospital”, she says,
There was (sic) barely any nurses and those that were there were very uncaring..conditions on the ward were very unclean, there were..blood-spattered dressings on the floor..
the nurses had to pass four other bays before they reached my mum’s..you’d have to basically just care for the patients yourself.
However, apparently without realising it, she then makes a remarkable confession. Asked by Freedland, “how bad did things get, the conditions that you saw at Stafford?”, she answers,
Patients were just basically neglected, For the first 6 weeks of my mum’s stay in the hospital, we were able to get round the 8 patients and help them. But after my mum’s condition deteriorated..they were basically left to their own devices..
For the last 2 weeks of my mum’s life she just clung to me like a baby and whereas we were able to help the other patients before, the last 2 weeks we just couldn’t get to them, so you’d just hear the cries of “help, help”, you’d hear a thud as they fell onto the floor.
The doors would be shut, so you’d just presume that they’d fallen on the floor. You’d just have to leave them crying out “help, help”, then they’d go quiet”.
What?! Freedland just moves on to the next part of his programme, without doing his job and challenging that statement or asking for elaboration. But think about what Ms Bailey just said She was looking after patients until she was too busy to do it, and then after that she had to ignore them even though she knew they’d fallen and needed help – even though the reason for her own mother’s deterioration (and eventual tragic death) was a fall.
Ms Bailey has criticised the lack of compassion, the ‘callousness’ of staff, at Stafford hospital so vehemently that nurses have been spat at in the street and called ‘murderer’ in front of their children. Yet she ignored people that she knew were lying on the floor in serious trouble and needed help urgently, leaving them “there crying out ‘help help'” until they went quiet.
Because she had her hands too full looking after her mum.
In the space of a couple of paragraphs, Ms Bailey acknowledges that there were hardly any nurses on the ward and admits that she left patients to lie in trouble on the floor until they went quiet – yet she ignores the obvious conclusion: that so few nurses looking after not just one patient but a whole ward of seriously-ill patients couldn’t possibly meet all the many and various needs.
Instead, she calls them ‘very uncaring’ while her actions were apparently merely understandable. It would be unreasonable to expect a patient’s relative to tend to fallen, elderly patients – but she could certainly have shouted out until someone heard, rather than leaving them until they went quiet.
The fact that this statement passed unchallenged typifies what has been wrong with so much of the coverage of events at Mid Staffs and the interviews with Ms Bailey and other “Cure” campaigners. Statements of even the most vitriolic nature pass without challenge or query as interviewers fail to do their job and ask the difficult questions, instead just offering a ‘free pass’ to say whatever they want, however they want – on national television to millions of viewers, many of whom don’t know any better than to accept it as truth.
As I’ve written before, context is everything if you want to understand something properly. What might seem to be shocking callousness or neglect in one setting might be a heroic effort in another. But the context at Stafford has been almost completely ignored.
The cries from ‘Cure’ that nurses at Stafford didn’t care have been simply accepted as fact by far too many people who should know better. And they have been seized on by a Government keen to damage public affection for the NHS, eager to damage the Labour party’s perception as the creators and defenders of the NHS – and desperate to divert attention away from the real issues.
Yet in this interview, no doubt inadvertently, one of the NHS’ chief critics put her finger on short-staffing as the fundamental cause of poor care in the health service – and even admitted that she did the same and worse when her own time and resources were under pressure.
Jeremy Hunt has completely ignored the overwhelming conclusion of the Francis report, which mentions just the exact word ‘understaffing’ 243 times while Hunt mentioned it not once in his ‘response’ to the report. It’s not an omission you can make accidentally, and the only logical conclusion is that Hunt and his party have no intention of reversing the chronic understaffing they continue to inflict on the NHS, and so want the public’s attention elsewhere.
A ‘lack of compassion’ is a convenient ‘straw man’ to attack for this purpose, and ittingly or unwittingly, Cure the NHS and the media have been complicit in this sleight of hand. The consequence of this is that nurses doing their best to cope with near-impossible demands have become demonised in the eyes of people who don’t know, or don’t care, what the real story is.
And last week’s Long View programme demonstrated that very clearly, if you have ears to hear it.
Dear Steve
I really appreciate all of your blogposts and your constant campaigning for the NHS. I have always been very supportive of you and your arguments, and I am certain that there are and were very good, compassionate and dedicated nurses at Stafford Hospital. My own experience there in the (lack of) care of my mother, and since the scandal the treatment recieved by my daughter, have shown a different aspect of nursing. I have never ‘gone public’ as I don’t want my experiences to be used against the NHS and nursing profession in general but you have probably not been a patient or relative of a patient in Stafford. I have been both and would not wish the experience on my worst enemy., However, I still disagree with the ‘downgrading’; change the management, change the culture, weed out the bad apples and the hospital will be fit for purpose.
Thank you! Nothing I write is to suggest that people don’t experience poor care sometimes, or that it shouldn’t be addressed when it happens. I just wish everyone showed the same foresight and restraint that you have!
I’m well aware that there are nurses who shouldn’t be nurses – but there are interests at work that will happily use any example to degrade public affection for the NHS. Most poor care is logistical – caused by too much demand for the numbers of nurses and the resources available, but the government is trying to turn the consequences of cuts into an excuse for more cuts and closures. Bad nurses exist and should be dealt with by disciplinary measures, without fanfare – but that wouldn’t sell papers or achieve political goals. 🙁
The irony now, of course, is that Stafford hospital is running well and could be a template for improvements – instead the government is promoting its closure or downgrading and using it as an excuse for putting more hospitals on the closure track.
I’m sure that hard-pressed staff who don’t get everything right greatly appreciate the balanced approach you have taken to bad things happening to your relatives. Nobody who has a vocation or cares about the NHS would have wanted that.
As SKW has replied and you have stated, the correct response is insisting on the right culture, weeding out bad staff (however awkward that is) and having appropriately motivated managers. Good care is, however, at least in the long term, predicated on having adequate numbers of permanent, suitably graded and trained front-line staff.
It is implausible that Stafford has some sort of intrinsic reason as a location to have poor care that does not exist elsewhere. Poor care exists in other DGHs and in big university hospitals. The “one-off-basket-case” narrative attached to Stafford has simply had the effect of allowing the government to side-step the main issues facing the NHS as a whole. Indeed it is the case that the real story here is Stafford’s recovery, not to a perfect institution but to one that offers good quality, safe care, very much accessible to it’s local population. If Mr Cameron and Mr Hunt really cared about ordinary patients, they would want to see how that has been achieved, support it and learn from it. Instead, the opposite, accompanied by considerable “indignation” is the plan.
An NHS that puts quality, safety and access ahead of finance would produce care that would be about as close as you could feasibly get to the service ordinary people want (and, ironically, would probably be cheaper).
You hit the nail on the head when you say the reporter should have challenged the interviewee on what had been said, and that people listening at home are simply going to accept what is said as fact because they don’t know better. As a reporter myself I deplore this lack of investigation – and it is rife in the BBC. We are constantly bombarded with reports that present something a person has said as fact when, thanks to the Internet, accurate information is only a few keystrokes away. Why is this allowed to go on?
Presumably because of the mistaken belief that poor journalism doesn’t have any important adverse effects (as compared to poor NHS care, poor policing, poor teaching etc). The Mid Staffs issue shows just how wrong that is.
There has to be a hidden agenda. 🙁
Context is the key to understanding, and however you wish to view Julie Bailey in the context of her interview, she has done more than many to bring to light the unacceptable conditions that vulnerable patients were exposed to at Mid Staffs. Whilst I respect your views, isn’t it the responsibility of hospital management to have prioritised
patient safety, rather than chasing Foundation Trust Status, in the vain hope of balancing their books at the expense of patients lives?
Agree absolutely about FT status. However, all the evidence indicates that while the pursuit of it led to poor care on 3 wards, it did NOT lead to a higher death rate. Cost cuts lead to staff cuts lead to poor care – but at Stafford, the staff managed to prevent it causing more deaths.
Compassion and care for patients, adequate staffing and resourcing, a reasonable amount of pay, reasonable hours with voluntary overtime; reliable stocks of medicine(s) and equipment – apart from the onward-going care for buildings – a few of the basic requirements for a smoothly running NHS. But no! they are sadly lacking, why? Because this coalition do not wish to properly invest in something they get little if any profit from – so they simply continue to allow atrocious circumstances to remain whilst they quietly go about inviting private concerns to tender and ‘save’ the NHS from conditions they have purposely created. The majority of people in this country are being farmed for profit, the NHS is simply one (larger) part of an overall plan. The only ‘value’ most people represent to this coalition and others of similar ilk is simply how much money can be made from us……..
Another interesting insight into how and why News is often built on sand when subject to proper scrutiny:
http://m.hsj.co.uk/5057035.article.
This is such a complex situation to try to unravel. I understand the point you are making about whether the nurses were callous or just physically unable to attend to all patients, but surely it isn’t Julie Bailey’s job to make the distinction. She was a service user, worried sick about her mother and despairing at what she was witnessing. You seem to be holding her as accountable as the nurses for the care of the other patients on the ward. The most shocking part of this report for me is that she had been caring for the patients for 6 weeks. Is it fair to hold her responsible for whether the media is doing their job properly or how ignorant local people behave towards nurses? I’m sure the majority of nurses were not uncaring but nothing can justify what happened in that hospital. Blaming nurses is not the way forward but neither is blaming Julie Bailey.
No. I’m holding her accountable for what she has said about the care. You’re absolutely right that it’s not her job to make the distinction – but that’s exactly what she has done, calling staff callous and uncaring at every opportunity, and in the loudest and most emphatic way. My articles are an attempt to bring some much-needed balance – but the damage to public perception of Mid Staffs and the NHS in general is already done. That’s something for which she and ‘Cure’ have to bear much responsibility, even if they’ve been exploited by unscrupulous media and politicians.
I still don’t get it. I just don’t understand why you are so determined to make JB and CTNHS so wrong. They are a group of people who experienced treatment that makes me cringe in horror (as a human being) and embarrassment (as a former nurse). My heart goes out to all of them just as it does to the majority of nurses who were working in those appalling conditions. It sounds like Mid Staffs has responded and is now doing what it should have been then, which is excellent. I may be wrong but my understanding is that CTNHS want full accountability and justice for what happened …. and why shouldn’t they? We all seem to accept that people who have lost loved ones to violent acts need to see the culprit tried and punished to be able to start to heal and have closure – how is their situation different? They and their families were failed appallingly. Don’t you think the NHS has successfully damaged it’s own reputation? It’s up to the NHS and the nursing profession to demonstrate openly with dignity and transparency what has been learned and how the service is moving forward. I would suggest that blaming a traumatised group of service users actually undermines all the great work being done by nurses.
Hi Lynne, I’m not trying to ‘make them wrong’. I believe they are wrong – even if they started off meaning well. My view is that they’re doing a lot of damage to the NHS in general and to Stafford’s people and its services. It’s gone way beyond trying to draw attention to problems – that was accomplished ages ago. Now it’s about vengeance – calling for any head they think they can get to roll.
You compare them with victims of violent crime, but what happened to them wasn’t inflicted deliberately. And even victims of violent crime should only expect punishment of the guilty, not of their family and friends. What CtNHS are doing is hurting all kinds of people who have nothing to do with what happened at Stafford – and hurting Stafford, because the end result looks likely to be the closure of their hospital (which Cure have apparently called for on occasion).
You have it right that they were ‘failed’ – not targeted or maliciously attacked. The appropriate response is completely different.
The NHS and nurses have shown considerable dignity – and the NHS has gone too far in allowing all kinds of flawed accusations to pass uncontested. There’s been a fear of contradicting JB and her group in case it looks callous – and so they’ve had free rein. Where their facts are wrong and their claims unfounded, someone has to be prepared to grasp the nettle and point it out.
It’s gone well beyond the point now where they should retire from the limelight and consider any good things they’ve achieved. All it looks like now is a vendetta – and that’s not good for anyone.
I’m confused. You claim that under-staffing, ergo lack of investment, is the root cause of poor care. Given the recent improvement of care at Stafford DGH, and very little meaningful investment then what’s changed? Is more effort being made? Has more money and staff been added? Or have the historic events made staff up their game to the required standards?
I believe nurses do a fine job btw.
Stafford is now one of the best DGHs in the country. Things have improved and change of focus has helped, but also understaffing more chronic in NHS as a whole will affect the average.
Also, without question the board will have reallocated resources into problem areas, demonstrating that improved resourcing solves the problem – but with risk of overstretch in other areas. Probably, in this context, in administrative functions – with potential effects not yet seen, as happened with the coding dept that led to the furore in the first place.
Either way, the premise that short-staffing will lead to poor care undoubtedly still holds true.
What I can’t Hack Steve is that if JB has the power that her position suggests why didn’t she go in and grab her mum and take her home. In 2002 I was admitted to Ward 11 in a coma with a complete Renal Shut Down and not even expected to survive the Ambulance Journey. This was due to Chronic Alcoholism over a good few years in other words a complete and utter waste of space. The Staff obviously played a blinder which launched me into a programme of sustained sobriety which I still enjoy today after almost eleven years. I use the staff even today in my thoughts as an immense gratitude for them all.Right from the Specialist to the Cleaners and porters they were there for me when I needed the most. Prior to that I was visited by the Police who informed me that my own aged Mom was stopped walking down the A51 at Little Haywood at 22.30 Hrs and would I go over to see her. I relocated and moved in and nursed her through Alzheimers to her eventual death at 81. Shortly before last Christmas I was admitted to Ward 2 Acute Cardiac with a sticky heart valve and again my treatment was absolutely magnificent. I I may also add that I tragically lost a beloved wife of 27 days marriage due to a varicose vein in the Trachma with the team working all night and the next morning trying to save her.They all did their absolute best. as always.
I would argue that under-staffing is a huge issue in the NHS, but the solution isn’t more money, more staff, the solution is, as the above, using what you have more effectively. Until this is the case, as thankfully it now appears to be at Stafford, then similar problems will continue to put pressure on those that care the most, namely the front-line staff.
That isn’t to say that more money and front line staff aren’t needed, of course they are, but we need to use what we do have in the most effective way at all times.
We struggle to fund the NHS as it is, chucking more money at it s part of the solution, but so is aligning the top heavy structure to free up cash for reinvestment in front line services. With people living longer, and the population ageing some big decisions are needed.
Actually, funding the NHS should be no trouble at all. We spend less than 10% of GBP on it, and that’s far less than almost any other country – and certainly any country that offers fully-socialised healthcare. The NHS is a bargain – and if we want good healthcare, we have to pay for it – many of those who can most afford to pay only want to pay for their own, though, and that should be called as the selfish small-mindedness that it is, rather than dressed up as ‘reform’.
The ‘top-heavy’ structure was introduced by the party leading the current government – and cuts are not being used to funnel funds to the front line. They’re being ‘clawed back’ by the treasury or used as simply part of much bigger cuts.
It’s unsound to think that the radical funding cuts now being imposed can just be ‘organised away’, though mate. Of course organise efficiently – but underfunded and understaffed is still underfunded and understaffed. The damage is just mitigated a little.
Less than 10% of GDP whilst a fair statistic doesn’t tell the whole story. The figure doubled in a decade and needs to continue to rise as the population ages and is living longer. Like pensions it’s a ticking time bomb that needs to be debated and some firm actions put in play. I don’t want my children’s inheritance to be a life of paying high taxes because my generation didnt plan for the future, but at the same time I don’t want politicians to make judgements based on ideology that don’t conform to reality.
No, that’s the paradigm they want you to buy into, but it’s not true. There is no shortage of funds, but much is in the wrong places. The solution is to make those who can afford it pay properly, not to cut.
Our children face a life of paying high taxes from a pittance because of misguided and ideologically-driven cuts now and because of the commitment to protecting the wealth of those at the top. Everything about the current austerity-narrative is aimed at getting us to buy into actions and policies that are against the interests of the vast majority of us.
I’m certainly not believing the hype, but do you seriously think the public finances are OK? Do you seriously think that by making better judgements the situation will simply right itself? I’m not so confident. Some non-party and credible independant reports place national debt at a staggering 900% of GDP. No economy has ever recovered from this, if these figures are in any way accurate is clearly debatable, with some arguing that 500-600% is probably nearer the truth. Either way I’m not sure borrowing more is the answer, and reusing what we have in different areas can only do so much.
That’s what I mean. The government presents it as a matter of cuts vs borrowing, and tries to make out that it’s like household finances. If you’re spending more than you’re making, you have the option of making more if you can find another job and have the time – but a country can increase its income in a wide variety of ways. More income means lower deficit without extra borrowing. The idea that this can’t be done (or rather, doesn’t even exist as an option according to the lack of mention it gets by govt spokespeople) is the Big Lie that too many are buying into.
Why should rich people and companies make fortunes here and pay almost nothing by comparison? The income of the top 1% has risen by 60% over a period of 10 years or so, but their tax contribution has gone up by only 27-28% (http://skwalker1964.wordpress.com/2013/01/05/yes-the-top-1-pay-27-of-tax-no-theyre-not-paying-their-share/). That’s a massive hole in the national finances and it’s purely down to ineffective taxation. The corporate tax picture is even worse, with far more going into company profits and less into wages than used to be the case (http://skwalker1964.wordpress.com/2012/07/08/the-lie-of-unaffordability-the-foundations-of-the-welfare-state-and-the-real-structural-problems/).
The problem isn’t a lack of funds in the slightest – it’s about imbalance, an imbalance that has been consciously worsened by those who should know better but had other agendas.
Hi Dave, just had to interject. National debt of 900% of GDP is true – except it is overwhelmingly private debt. Public debt (including the cost of the bank bailouts) is approximately 120% of GDP. Household (mortgage debt) is 100% and personal debt (loans etc) is 100%. So who makes up the difference? The banks… The banks borrowed and lent 600% of GDP – and it is this which we have all been forced to underwrite. As you can see ‘we’ weren’t living beyond our means, THEY were.
We are living through the crime of the century.
Granted, comparing household budgets with national budgets are pointless and 100% agree that companies and individuals should pay their taxes.
It would certainly help enormously to claw this tax back, whilst also closing loop holes and tax havens.
It doesn’t tell quite the story though. Many high net worth individuals donate substantial amounts to charities of their choice. These have historically been tax deductible. So whilst their money does benefit wider society this isn’t always shown in tax revenue figures.
If I was a rich man (in money terms) as I consider wealth on different emotional levels than cash in the bank, I’d be in favour of philanthropic gifts as its the only way you know your input isn’t wasted by politicians on all sides of the House.
The sadness here is that HMG have even taken back about £2bn from the 2012/3 Health budget back into the treasury savings pot – rather than INVESTING in items to help frontline staff do their job and improve quality in struggling hospitals. Most bodies external to the NHS think (and still think) the NHS is phenomenal value compared to most health systems. It beggars belief that we are copying them (particularly the USA which is the least efficient of all).
You may be wondering why big University hospitals don’t figure in most of these “scandals” (except when there is a particular catastrophe). This article contains a very interesting explanation (and something HMG are taking advantage of in the current round of investigations into high HSMR hospitals (“dreadful …. they must be closed ……”).
http://m.hsj.co.uk/5057035.article.
I think this is fascinating (and brave) in terms of having the courage to challenge the current discourse around ” evil nurses” where I sense it is taboo to say anything that can be labeled “denial” , about what” really happened” . It would be a shame if the pendulum swings from failing to take seriously some shocking patients narratives that should have been heeded a long time ago, to the same patterns of power swinging in the other direction to silence some of the stories that the nurses have to tell, that equally need to be heard. Both help illuminate the context, and can also help inform what we might need to change to make a difference. Which might help reach the parts that I fear a new inspector of hospitals will fail to reach.
Karen
Thank you! I don’t think of it as brave so much as stubborn – but wholeheartedly agree with your point!
Situations are often complex and the correct solutions developmental. The Government are, of course, failing to appreciate this (or worse, knowingly ignoring it). The question I have for Robert Francis is this – if you had found yourself in a ward so understaffed that you and an HCA, looking after a ward at night, had to make a decision between dealing with a patient in severe respiratory distress and dealing with two patients both needing help to go to the loo – what would you, with all your brain power, have done?