by Sam Fowles
I really miss the days when the worst we thought Jeremy Hunt could do to the NHS was privatise it. At least you knew what you were getting with privatisation. But what Mr Hunt is doing, incredibly, manages to be worse. It is an act of legislative contortion which would have done credit to Mitt Romney on his most pliable days: In an (apparent) attempt to “get tough” on standards and ensure the high quality of the NHS, Mr Hunt has made certain that it cannot possibly offer anything but a substandard service.
At least one can see a logical argument of privatising the NHS. It may be exceptionally wrongheaded, but the case has a logical progression: Competing providers will force standards up as a result of their competition for consumers. The problem with this is, of course, that demand for healthcare is inherently almost completely elastic. As such, the impact of market forces on quality and price of provision will only ever be exceptionally limited, leading to monopolistic tendencies and, inevitably, substandard service. But at least there is a justification based on some sort of reasoned analysis.
Mr Hunt’s response to the Francis Report is a masterclass in irrationality.
One of the central issues in the report was poor patient care. Beds were not changed, patients were not fed; essentially the care and attention necessary for a decent quality of existence were absent. Unless the nurses at Mid Staffs spent their days playing scrabble and watching repeats of Monarch of the Glen (in my experience, pretty much the only thing on hospital television) one might perhaps assume that neglect is a function of understaffing. Stunningly this was also one of the conclusions of the Francis review.
Much of the review focused on governance issues, particularly regarding oversight organisations and community engagement (which Mr Hunt’s substantive proposals have singularly failed to address). Those sections which concentrated on the day to day running of wards recommended a more labour and resource intensive model. This is hardly surprising. One doesn’t have to be an expert in healthcare management to realise that if, as a patient, you get more focused attention more of the time, you’re going to have a better experience. The logical corollary of this is that, if everyone is to have more focused attention more of the time then the hospital might need to employ more people to provide it.
It should be noted that the Mid Staffordshire scandal took place under a Labour government. However, the Coalition’s reforms have included real terms cuts to hospital budgets leaving the NHS unable to fill over 20 000 nursing vacancies. In restricting the flow of skilled workers, the Coalition’s immigration cap has made it more difficult to bring in doctors and nurses from other states to plug short term gaps in staffing.
Yet rather than actually tackle the problem of understaffing, as Francis suggested, Mr Hunt has decided to fine hospitals which cover up instances of neglect. While neglect is hardly something to be tolerated in the NHS, if an institution has taken steps to cover it up, i.e. actively lied to the public whom it is meant to serve, then perhaps the immediate course of action should be to fire those who instigated the deception rather than further restrict funding for patient services.
Covering up neglect is unforgivable. If the NHS is to be democratically accountable (one of the big advantages of a state run healthcare system) then it needs to be transparent. But fining trusts which cover up neglect will simply mean that they have even less money to spend on patients, thus putting greater stress on staffing and resource levels and increasing the liklihood of future neglect.
Similarly, preventing offending hospitals from benefitting from the NHS Litigation Authority, limits the economies of scale gained from having one fund covering all NHS litigation and payouts. Thus meaning litigation takes up a larger proportion of the total NHS budget meaning less is available for patient care.
You don’t make a lame horse run by whipping it harder. Covering up neglect should be punished and punished hard. But that punishment should fall on the individuals responsible, not on the institution (and, by inevitable extension, patients). Mr Hunt’s reforms will protect negligent and fraudulent bureaucrats at the expense of patients.
It’s rare in public policy that there are simple solutions and, as George Eaton has blogged for the New Statesman, finding the money to the pay for the NHS is anything but simple. However, the practical response to the ward level issues raised in the Francis report is relatively obvious (not least because Mr Francis wrote a three volume report telling us):
- Guarantee the minimum staff requirement for wards and then pay and train those staff to a level that will attract the best talent.
- Institute proper whistle blowing procedures. Francis noted that the abuses in Mid Staffordshire could have been avoided had greater attention been paid to whistleblowers.
- Leave the NHS alone to do its job.
In other words Mr Hunt: either solve the problems or give someone else a shot. Right now you’re just making things worse.
Sam Fowles is a researcher in International Law and Politics at Queen Mary, University of London and blogs at the Huffington Post
Tags: Francis report, Jeremy Hunt, Mid Staffs, NHS, privatisation, Sam Fowles, staffing
Well lets look at this rationally not emotionally. Who was responsible for Stafford, lets start with the nursing staff, did they report what was going on through their incident reporting system, did they contact their union and professional organisations to take advice about what they saw or perceived as happening. What was the chief nurse up to, I believe she has since relinquished or been suspended from practice. I ask the same question about the medical staff.
What about non professionally accountable managers such as business managers and others of this group, they are not accountable for their actions, in that hey cannot be deprived of the ability to practice unlike the professional groups ie nurses doctors and AHP’s. The chief executive at the time has cited long term sickness for not giving evidence at the Francis Enquiry.
New law is an attempt to make non professionally accountable staff accountable in law, The Health and Safety at Work Act is difficult to use in these sort of cases and the police and the CPS are too cowardly to act.
The main question has to be, where were the RCN, Unison GMB and Unite during this time, not wanting to cause trouble for the Labour government and in particular the SoS’s during this period. The culture at Stafford at the time mitigated due to bullying against whistle-blowers.
Staffing is a difficult problem, you have to take into account workload and in particular patient dependency, an ill confused elderly person may need three staff to prevent them harming themselves, the care of a dying patient one person but six patients two days post surgery may only need on member of staff Add to this seasonal variability, emergencies, mandatory, staff training annual leave and the greatest unknown sickness, then try to plan a rota. A minimum level will be taken as the required number not a guide but a standard which does not allow for any variability.
@bob
Stafford (and others) were under Labour and Burnham. Funny how Labour aparatchiks like Sam forget all this. I think we can all see what patient care meant under Labour.
The way around things like this is to make gagging whistle-blowers illegal – even go as far as make it a criminal offence to know something is not being done right and fail to report it.
Stafford, East Kent and Basildon, were all under Labour’s watch. The CQC was politically influenced if not bullied by ministers and their hirelings like Nicholson and Bower to only give good news, you just have to look at the investigation which is on going into Morcambe Bay, and the placing into special measures of 15 other hospital trusts. The NHS and local authority culture is for collective responsibility, decisions made at meeting on a collective basis, this allows no one to be held to account because no individual makes the decision.
Until the police and the HSE go into these hospitals and prosecute managers and if necessary politicians for corporate manslaughter and Section 3 of the 1974 HSaW Act, people will absolve themselves of responsibility.
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well said Bob, and its not only NHS managers its those who aren’t at the hopsitals in local govenement and at the trust who should be done for both corporate manslaighter, or HS act