Comment
JAP Volume 7 Issue 1
patients have been failed by a culture of “corporate self-interest and cost control”, and a change to a patient-centred culture is imperative. Michael Farrar, the chief executive of the NHS Confederation, said that he felt “genuine shame”. Francis outlines 290 recommendations to improve care, the most important of which refer to making it a criminal offence to hide information about poor care, an obligation for staff to be candid with patients about any mistakes made, a code of conduct to be given to senior managers with the ability to disqualify them if they don’t comply, an overall increased focus on compassion in the recruitment, training and education of nurses, and regular competency checks for doctors. The Royal College of Anaesthetists offered sincere condolences to friends and
family of all who suffered at Stafford Hospital. “As the largest hospital medical specialty 70 percent of all inpatients will come into contact with an anaesthetist during their hospital stay. For this reason we feel particularly strongly about closer examination of the quality of care offered to patients and the need to ensure adherence to appropriate validated standards whilst looking for opportunities for service improvement and shared learning,” read a responding statement published by the RCoA. The AAGBI were also not far behind, expressing concern for the slipping
standards in this NHS Trust. “Those in management roles must listen and act, and those in senior NHS and political positions must engage with the realities of clinical service provision. Inspection and legal action will not automatically result in a safety culture change,” wrote the AAGBI. “The Council of the AAGBI believes that the question that every healthcare
professional should ask themselves is: ‘Would I want this sort of care for my family?’” Despite positive steps from bodies like the AAGBI, the RCoA, and many others, to hold negligent and unprofessional doctors and nurses accountable for allowing up to 1,200 unnecessary deaths, this isn’t enough. Health Secretary Jeremy Hunt’s focus on having the guilty “brought to book”, although important for justice for the people who suffered, is largely, and somewhat conveniently, missing the bigger picture: the situation should have never been allowed to get so extreme. The extent of negligence and unprofessionalism that the report uncovered at
all levels at Stafford really begs the question that Mr Hunt may not want closely explored: why did a system based on the National Health Service Act of 1946, which was designed with people in mind – to provide healthcare to everyone, rich or poor – turn into a soulless, corporate machine, interested only in money? Money pressures are at the core of the problem. The NHS didn’t put pressure on itself to provide ample healthcare whilst cutting spending, under the threat of closure where this is not achieved. If the events surrounding Lewisham Hospital are any example to go by, governmental attitude towards not meeting spending targets is genuinely one to be feared. Not that this excuses the situation at Stafford Hospital, and certainly not the appalling conduct of some staff towards their patients, but perhaps it’s not just the Mid-Staffordshire NHS trust that needs to take a hard look at the money-driven machine it has become. Mr Hunt may also want to look at the effects the Coalition’s spending cuts are having on the NHS and on innocent people – the cuts they promised wouldn’t happen. The coalition’s budget cuts to the NHS have had adverse effects for patients needing pain relief for years. GPs refusing to prescribe painkillers because they are too expensive, post-operative patients being told that if they are referred to pain clinics, there would be a several-week wait, and some long-term attendees of pain clinics suddenly being informed by the clinic’s funding body that they will no longer be seen because of policy changes are just a fraction of the aftermath. In the end, blame is unproductive. A change in attitudes is due all round, from
staff, to management, to regulatory bodies, and right up to the Health Secretary. “Changing culture will not be achieved overnight – it requires commitment from all levels of the healthcare system, but if we are to avoid more tragedies we need to tackle this problem now,” said Niall Dickson, Chief Executive of the GMC. The hope is that the Francis report will have sufficiently shamed everyone
involved, which will lead to a patient-centred culture and will return a little trust and heart into the NHS before anyone else gets ill. ■
AAGBI stated: “The AAGBI is greatly concerned by the Francis
Report and acknowledges that the harm done to those who were failed by the NHS and its staff is unacceptable. The AAGBI believes that what happened in Mid Staffordshire can be prevented in the future, but that this will need an ongoing commitment to patient safety at all levels of the NHS, including clinicians, managers, the Departments of Health and politicians. The efficiency savings demanded of the NHS are placing significant pressure on hospitals to deliver a greater volume of clinical services with fewer resources. The risks of clinical care are increased considerably if resources are inadequate. Patient safety must be the first priority in healthcare, an approach that the AAGBI has championed for 80 years.”
RCoA stated: “We look to a positive response from healthcare
professional bodies to examine closely the contents of the Mid Staffordshire report, to accept the highlighted criticisms and to work together towards NHS-wide improvement to ensure its recommendations are delivered. On 18 June 2013 the Royal College of Anaesthetists launches a voluntary accreditation service (Anaesthesia Clinical Services Accreditation (ACSA)) for NHS Trusts and Boards across the UK and for anaesthesia departments in the independent sector. This is a service that has been in development for over two years and benefits from learning from similar schemes which have been effective in other healthcare areas. Our ACSA review team will contain clinical and lay representatives to offer balance and whole service evaluation. ACSA is being widely piloted across the UK and has the support of national regulators and clinical standards organisations as a service which will set clear standards for best quality care in anaesthesia. The service relies on a close partnership between the professional body and the hospital to encourage sustainable improvement in patient care and to share best practice widely. We believe that the delivery of high quality patient care depends on the application of contemporary professional guidance, clearly focussed on patient safety and independent of business and financial target pressures. The engagement of external and expert professional organisations to ensure no one area becomes isolated from understanding what constitutes accepted good practice was clearly absent at Mid Staffordshire NHS Foundation Trust.”
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