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UK Health Secretary Jeremy Hunt has attacked mediocre hospitals that “cruise along” rather than striving for “world class levels of excellence”. He referred to Mid Staffordshire, where failings led to unnecessary suffering and death.
Yet staff at this Trust, far from coasting, were striving desperately hard – for the wrong goals. If the government repeats the same mistakes, more patients will be harmed and the NHS undermined.
At a Nuffield Trust event on 8 March 2013, Hunt condemned NHS hospitals that do not try to be first, like Olympic competitors, but rather just to meet basic standards. He claimed that too much of the NHS is focused “Not on achieving world class levels of excellence - the gold medals of healthcare - but meeting minimum standards”.
"Coasting can kill. Not straight away, but over time as complacency sets in, organisations look inwards, standards drop and then, suddenly, something gives,” he said. The lesson of Mid Staffs is “surely that we need to understand why they fail in the first place - which means tackling low expectations before they turn into failure and tragedy."
Yet this dangerously misses the point. In the NHS, many staff have spent much of the past few years in a state of constant anxiety. Successive governments have issued constant directives and pushed for a more “commercial” focus, distracting hospitals from their core functions. If top politicians carry on, there will be more such tragedies.
Robert Francis QC led two inquiries on the failings of Mid Staffordshire NHS Foundation Trust, examining what went wrong and why problems were not tackled earlier. What they portray is an organisational culture in which managers strove for “excellence” in terms set by government, and frontline staff struggled to keep managers happy. Those who protested were ignored.
To quote from the Executive Summary of the first Inquiry report, the causes of poor care “included, in a small number of cases, staff who appeared uncaring." More often there were inadequate numbers of staff on duty with the right skills and support. In the Trust “a high priority was placed on the achievement of targets, and in particular the A&E waiting time target. The pressure to meet this generated a fear, whether justified or not, that failure to meet targets could lead to the sack."
“Much of management thinking during the period under review was dominated by financial pressures,” the report explained, while the pressures of applying for foundation trust status “are likely to have distracted the Board from other tasks.”
A statement by Francis on the second Inquiry’s report, published in February 2013, further highlighted the risks of a system directed to the wrong ends and disrupted by major reorganisations. He called for “a common patient centred culture which produces at the very least the fundamental standards of care to which we are all entitled, at the same time as celebrating and supporting the provision of excellence in healthcare.” Getting the basics right in treatment and care is more important than frantically trying to be best at things which matter less.
Hunt rightly highlighted the usefulness of listening to and learning from patients. This is entirely different from competing for the approval of top decision-makers against a background of constant change. At present the system is undergoing a major overhaul and harsh cuts, which increase the risk of further calamities.
While ministers can usually afford to pay for private hospital care, most people cannot. A better NHS in which staff feel valued, and are supported to value patients, is vital.
(c) Savitri Hensman is a regular Christian commentator on politics, social justice and religion. She is an Ekklesia associate.Tweet