Most of the speakers lined up to speak on the health bill in the Lords are not Conservative. One that was took the view that it was self evident that the health service must be subject to structural reform because it had failed. I know this is the perception that has been fostered for more than two years now in much of the national press, and I question where it comes from, and how well founded it is.
There are all the ingredients that we have heard so many times, Nurses that are “too posh to wash”; Hospitals full of bureaucrats rather than nurses and doctors; Top down targets causing bullying and lack of emphasis on quality; Doctors that do not speak English as their first language; all these “explanations” for what may have caused perceived “failure”, a perception which ignores all the international evidence on productivity and the national evidence of patient satisfaction.
I have spent a great deal of the last nine months sitting in the public gallery at the Mid Staffs Inquiry. Stafford is “exhibit A” of as an example of a hospital that failed, and I suspect Andrew Lansley set up the inquiry with the full expectation that it would be the justification for the major structural reforms that he wishes to make.
The press and media coverage of the Stafford Hospital story has been seriously distorted from the very start, relying on the “excess death” figures. This has fostered the story of a hospital where hundreds of people died unnecessarily, without anyone apparently noticing anything unusual. If it had happened that way it would of course be deeply disturbing. The inquiry has heard a great deal of evidence to show why it is that these figures, which were based on data that is accepted to be seriously flawed, and a calculation that no one accepts as legitimate and was leaked by an unknown person, are in the words of the Inquiry Chairman “unsafe”. None of this evidence has yet been adequately reported.
The Inquiry has also of course heard of a variety of real problems that did exist. I have looked at all of these to see if they are telling us that these “unsafe figures” could possibly be true. I found evidence of many problems that do occur in many hospitals throughout the country: Staffing problems at A&E, the problems of cover at nights and weekends, the wrong staffing levels and staffing mix to deal with the highly dependent frail elderly that make up the majority of the patients in our district hospitals. Some “adverse incidents” like slips, trips, falls, muddles with medicines, that do occur throughout the health service. All of these are matters that do need national attention, None of these appear, from the view of the experts to be happening to an extraordinary degree in Stafford.
There were certainly some real problems which are linked to the idea that is currently very fashionable. This involves cutting costs by reducing the number of staff in hospital and getting more care out into the community. This theory was unsuccessfully tried in Stafford from 2006 onwards. The problems this caused came to a head at a time when the regulatory structure was under stress because of re-organisation, so the regulators were slow to identify the fact that were major teething problems and staff were coming under intolerable stress. In the final week of the inquiry hearings we heard evidence which explained why a number of different factors came to a head at the end of 2007 and start of 2008. It is these events which I believe triggered the Health care commission investigation process.
We have also heard how destabilising this investigation process was for many of the staff working in the hospital, Many witness have spoken strongly to question the investigative methods and conclusions drawn from them. None of this evidence has yet been adequately reported.
What we perhaps saw at Stafford is a hospital that went through a temporary bad patch. It needed support and instead it got something close to the Spanish Inquisition.
What we have also seen as a result of Stafford and concerns about other hospitals is a complete overhaul of the regulatory systems. This includes some remarkable work on information systems and also some continuing work to be able to pick up “soft information” about any local concerns that the public may be expressing. We have also seen a complete change in the philosophy of regulation, which aims now to use experts to monitor the new sophisticated early warning information tools, and use these to prompt “intelligence driven” inspections, which are aimed at supporting hospitals through problems, rather than seeking to explain retrospectively what went wrong.
These important reforms have been carried out by the SHA and CQC and other bodies recognising that they need to share information effectively. They have reformed the systems from within. There is no need for structural change.
The 2006 Stafford experiment of passing more care into the community was not wrong, it was just something that needed to be worked out much more carefully. It is happening again now in Stafford, on a very much larger scale, and I suspect it will happen elsewhere too. Again, this does not need structural change, it simply needs Hospitals, Primary care and Social care to work together effectively. It also needs managers and commissioners to listen carefully to the concerns of staff, and to ensure that the service they are trying to offer can be realistically delivered.
From the time that Stafford first came to be used by the Conservatives as a justification for their health reforms I have felt deeply uneasy. If Stafford is the image of a failed health service in the mind of the Tory Lord I think it is important for him to know that the current public perception of what happened in Stafford is very far from the reality.
The one thing that we do know for certain from the Stafford experience is that structural re-organisation makes things much more difficult.
We are told that we "cannot do nothing". I would suggest that doing nothing, or doing the bare minimum to stabilise the system is exactly the right thing to do until we have seen the recommendations from the Midstaffs Inquiry.
Please stop the bill!
The one thing that we do know for certain from the Stafford experience is that structural re-organisation makes things much more difficult.
We are told that we "cannot do nothing". I would suggest that doing nothing, or doing the bare minimum to stabilise the system is exactly the right thing to do until we have seen the recommendations from the Midstaffs Inquiry.
Please stop the bill!
