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How to find the Bad Guys in the NHS scandal.

After the wonderful tribute to the NHS during the Olympic Opening Ceremony (if you\’re American, you may not have seen it – see a clip here, buy the full DVD here), the NHS has been basking in its popularity.

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Unfortunately, there has been trouble brewing in the NHS for years. Its proudest boast is that it\’s free at the point of delivery. This means that at exactly the moment when you\’re most likely to be unable to pay for medical treatment, you won\’t have to pay for it. When you\’re ill, the NHS treats you for nothing.

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I have good cause to be very grateful for this: when my husband Chris fell ill 13 years ago with lung cancer, he had what the director of a famous US cancer clinic called \”the gold standard treatment\” which would have cost us at least $250,000 at the time (more like a million dollars now). He didn\’t have to make the choice too many American cancer victims have to make, between having treatment and beggaring his family. The entire cost of his operation, radiotherapy and chemotherapy was borne by the NHS.

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No, he didn\’t get better – like most people then with the kind of cancer he had, he died 18 months later. But me and my three children (14, 12 and 6 years old) weren\’t homeless or destitute either.

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However, there is no such thing as a free lunch and the NHS isn\’t free either. It\’s hugely expensive. UK citizens pay for it through taxes. It\’s a massive bureacracy, employing 1.7 million people and costing £106 billion per year, or thereabouts. Like most large bureaucratic institutions it\’s very hard to know what\’s going on inside it.

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There were signs of trouble when Chris was in hospital all those years ago. The oncology ward at the Royal Cornwall Hospital, Treliske, where he was treated for his cancer was spotless, well-run and caring. The consultants were expert and the nursing was excellent.

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Unfortunately the first ward he was on before he was diagnosed, a general one, was a rat\’s nest. It was disorganised, dirty, untidy. The food was terrible. I have very low housekeeping standards, but the showers and toilets he was expected to use were so filthy, I brought cleaner and bleach in and scrubbed them. I also brought him food every day because he couldn’t eat the stuff he was offered. Later, while he was having radiotherapy at Derriford hospital in Plymouth, he caught intestinal worms.

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The trouble has clearly got a lot worse since then. There have been some horrific scandals – Mid Staffordshire hospital for instance – where, in 2007, patients were left dirty, hungry and so thirsty they drank from flower vases. Some of them died. This was at a time when the Labour government was pouring money into the NHS and imposing a complicated set of cost-cutting targets and management systems.

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The NHS bureaucracy is protecting its own and bleating that nobody should be \”scapegoated\” ie blamed.  Conversely, the media are baying for blood – not unreasonably asking why Sir David Nicholson. the person who was in charge of the Strategic Health Authority overseeing Mid-Staffordshire at the time, is now head of the whole NHS Commissioning Board. There\’s huge confusion over how these scandals could have happened. People blame something called \”the culture\” or even the nurses.

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OK, so this is my take. Every single account of shocking neglect I have read has included the words \”staff shortages.\” Not only were the wards dangerously understaffed, most of the staff they did have weren\’t even nurses, they were unqualified \”health care assistants.\”

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Wherever a ward is disastrously understaffed, a kind of evil selection takes place, as I said on Facebook. Good nurses either leave because they won\’t lower their standards, burn out trying to maintain them or complain and are forced to resign. Those who stay will be the ones who don\’t care, keep their heads down and get on with box-ticking. Over time this means that the only people working on that ward will be unprofessional, uncaring and possibly even sadistic.

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Meanwhile the professional bodies were corrupted and went over to the management side – while the management are exclusively focussed on cutting costs. Nobody paid any attention to the relatives who annoyingly moaned about urine-soaked sheets, because cost-cutting came first. How do you cut costs in a huge labour-intensive organisation? Easy! You cut staff because your wages bill is always going to be your biggest item.

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So it\’s also easy to find out who to blame. Look for the managers who were rewarded for cutting costs, as many of them were. Look at what happened to the hospitals where they did that. If there were excess deaths (ie more people died in the hospital than you\’d expect) you know who to blame.

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Fire them. In the worst cases, prosecute for criminal neglect and manslaughter.

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We could start with Sir David Nicholson

2 Comments

  1. claire says:

    excellent analysis

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