Senior managers’ reluctance to take the blame for the deaths at Stafford hospital indicates a sickness in the system
Patients die in abject misery in Stafford hospital; another five trusts are under investigation. The Care Quality Commission warns that thousands of psychiatric patients are also receiving substandard care. Meanwhile, the Francis inquiry offers 290 recommendations that spin a thick, impenetrable managerial cocoon around an abstract notion that the culture was culpable but another culture will somehow be the cure. Since this new culture is to be built on the jelly-like foundation that nobody can be held to account, something is missing.
It is missing in the health and social care system and it manifests itself in the actions of many of the professionals, personified in the shameful refusal to resign of Sir David Nicholson, NHS chief executive, who was at the time the head of a body responsible for standards at Stafford hospital. What’s missing is an understanding of how human beings behave. What really makes the milk of human kindness flow?
Over several years, a number of inquiries have been conducted into medical training and “modernising medical careers”. One report, “Aspiring to Excellence”, quotes Sir William Osler, the father of modern medicine, who defined the medical role as “to prevent disease, to relieve suffering and to heal the sick”. What that leaves out is how human beings tick above and beyond their symptoms and, sometimes, because of them. That may come with experience, but a solid and sustained grounding during training would help.
It would also help the way managers and care staff work with each other. Why, for instance, has the desperately needed integration of health and social care proved so difficult to deliver? Is it again a question of “culture”? Or, more specifically, the unwillingness of consultants et al to become team players? Ask district nurses why they can’t deliver good preventative care in the community. Answer? Because some GPs say that’s trespassing on “their” territory, and they prefer to leave a vacant lot. Under the Labour government, “nudging”, the science of suggesting, rather than imposing, behaviour, became the vogue. Show a person the word “wrinkles” and he or she walks more slowly. The government’s behavioural insights team is still at work. A letter to individuals informing them that most people in their area had paid their tax, for instance, increased repayment by 15%. “Behavioural insights could save millions of pounds”, was the Cabinet Office’s proud headline. In early training in health and social care, it could also save lives.
The qualities required in care are well understood. “Compassion in Practice”, published in December, for example, refers to the six “cs” – care, compassion, competence, communication, courage and commitment. What’s absent is practice and a perception of what happens when you mix lists with human nature. For the most part, training for health professionals gives cursory attention to ethics, psychology and simulated patient exercises, while managerial bonding adventures are not enough to remind us that behind the targets behaviour, sometimes aberrant, also requires accounting.
Cut frontline staff and collaboration splinters. My father had a dedicated consultant during years with dementia. Much of her work was reduced to tick box online diagnosis; remote control management. It may be the prevailing culture, but that’s not how you bring out the best in people. Or for people.