I am honoured to be asked to post this blog by Laura Robinson, Policy & Communications Advisor for ‘National Voices’ as it raises fundamental issues around patient care and patient safety, following the independent inquiry in Mid Staffordshire…
When someone tells us that their friend or relative has recently gone into hospital, our automatic response is often: ‘at least they’re in the best place’.
We like to imagine them wrapped up in crisp white sheets, surrounded by doctors and nurses who understand their condition and treat them with respect and compassion. As Lord Darzi noted in his interim report on the NHS Next Stage Review: people rightly expect to receive the safest possible care and to be confident that this will be the case.
Mid Staffordshire
It is the sharp contrast with these beliefs and perceptions that made the findings of the independent inquiry into the Mid Staffordshire NHS Foundation Trust all the more shocking. The catalogue of errors, listed throughout the final report and the summary of the evidence, demonstrate how systems failed to protect some of the most vulnerable patients in their care.
Many of these people were confused or suffering from dementia. As Robert Francis, Chair of the Inquiry, stated, it could be argued that such vulnerable patients are entitled to greater protection as they are often unable to protect themselves.
One case study spoke of an elderly lady with vascular dementia. She was ignored for long periods by nurses and given no support with drinking or eating. She was left with faeces in her hair but her family was told that staff were too busy to help her shower. She subsequently developed bedsores which took four months to heal. This is sadly only one of the examples documented.
But the key concern is that such risks aren’t unique to Mid Staffordshire. The issues which culminated in these breaches of patient safety must be acknowledged and addressed urgently to avoid other people and their carers having to unnecessarily experience similar harm and distress.
In 2010, Andrew Lansley announced that there would be a full public inquiry, which would consider why the serious problems were not identified and acted on sooner and identify the lessons to be learnt. The findings of this inquiry have since been delayed twice. Most recently, they were due out on Monday – 15 October – but they have now been delayed until January 2013.
Not the Francis Report
There is already much collective wisdom and widespread consensus on what needs to be done to ensure that care is safe, effective and responsive to patients’ needs. ‘Not the Francis report’, published by National Voices this week, brings this together in a series of recommendations and urges the Government and NHS leaders to drive forward improvements across the whole system of health and social care. Some of the key messages are summarised below.
Prevention is better than cure
The lack of holistic care delivered close to the home results in too many people being admitted to hospital, staying too long and deteriorating during their stay. The Alzheimer Society’s ‘Counting the Cost’ report found that 54% of carers felt that being in hospital had a significant negative effect on the symptoms of dementia and they call for more coordinated, community-based services.
We need to create a system which provides people with the right care, in the right place at the right time. This means genuine care planning and named care coordinators to help vulnerable people to live well and avoid unnecessary hospital admissions, a properly funded social care system and good out of hours care.
Listen and learn
Evidence shows that involving people in decisions about their care can significantly improve outcomes. However, between one third and one half of patients in England are not as involved as they wish to be, with the figure lying around 42% in relation to those with dementia. Information and advocacy are critical to enabling real involvement, as is better training and education for professionals.
Francis noted the importance of listening and responding to patient experiences at the launch of his inquiry but 2011 statistics – which came out two years after the issues in Mid Staffordshire came to light – still indicate that 87% of inpatients feel that they were not offered the opportunity to give their views on care quality. Health and care leaders need to welcome patient feedback and act quickly and effectively on early warning signals. Results should be openly reported at all levels and so there is no hiding place for patches of poor care.
A culture of openness
Health and care leaders need to champion a culture which encourages people to raise concerns safely and without fear of reprisal. The Speaking Up Charter, launched this week, has been designed to support this shift; it recognises that safety should be at the heart of all care and is the responsibility of everyone involved in the provision of health and social care services.
The NHS Constitution also includes a pledge which encourages staff to be open with patients and carers and report and learn from errors. This could be strengthened through a statutory duty of candour, whereby NHS organisations must tell patients and families if things have gone wrong.
Looking forward
Life can often only be understood backwards, but it must be lived forwards.It is important and necessary to look back and understand what went wrong in Mid Staffordshire and ensure that the voices of those affected have been adequately heard. But it is also vital that we now look forward and learn the lessons to create a system in which poor quality and unsafe care can no longer be ignored.
Click here to see a full copy of National Voices’ ‘Not the Francis Report’.
Whose Shoes? A catalyst for change in health and social care 
The mid Staffordshire report is but the tip of the iceberg.
Doctors nurses physios OT’s and health carers now form Multi Disciplinary Teams. Sounds good, but is a complete recipe for disaster. My wife, who has quite severe Alzheimer’s suffered a L sided stroke. Only her L arm and leg. No facial problems. The dr’s report to the scanning team was “L facial weakness” Absolutely incorrect. Before going into hosp. she could walk short distances with a rollater, and go up and down stairs. Physio recorded she walked with a stick. Never. Her balance was not good enough. She was well nourished.
In hospital she was denied rehabilitative physio- i.e.not transferred to a special unit, she lost 8kilos weight- pointed out by ME,- over 7 weeks, and was adjudged to be in “imminent danger of malnutrition”, (In 21st Cent, in UK in hospital!!) She refused medication in tablet form, and was not given liquid medicine. Her eye drops for glaucoma treatment were not always kept in the fridge, the physios denied she had had falls at home- when in fact she had been admitted to the same hospital with a fract thoracic vert from a fall in the garden, and the OT recorded in the current admission notes she had fallen in the dining room at home trying to get from her chair. The Dr recorded in the notes “that husband difficult to contact to get baseline for wife”- when I was feeding my wife at 5.30pm every day, AND 2 days earlier had given details of my wife’s baseline activities to the OT, who recorded it in the notes.Thus the MDT neither talks to each other, nor reads what others have written in the notes. Health care workers are not aware that falling wt measurements are significant, and Sisters do not BOTHER to look at records, nor do the doctors, or at 4kg loss someone would surely have done something. Nurses are few and far between, and know nothing of Alzh disease in spite of their MA’s, (no one reported her hallucinations, till I witnessed them and asked for a dr to be called). Not recorded in the notes. My meetings with Sisters, consultants were not recorded in the notes. The SW did not inform me of my wife’s rights to an assessment for continuing NHS care- later she was declared ineligible -and ALL the day to day care is left to care workers who know less. I toileted her every morning after a shower. It got to be a type of reflex. The hospital recorded this but left her lying on an Inco pad for 4 hours at a time. She was practically forced to become doubly incontinent. (She was given 2 types of laxative daily). Before she left hosp, it was recorded she “was unable to weight bear”. The physio report said,”can manage stairs with 2 people”. This is a terminological inexactitude. If you cannot weight bear, you have to be dragged upstairs. The management, care and treatment of my wife was appalling in the extreme. I am a retired GP.
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It’s so easy as “just one carer” to feel overwhelmed, outnumbered and outgunned by the powers-that-be who seem oblivious to the problems we see as glaringly obvious! So it’s great to read this, to feel not alone, to know that there is a ground-swell of voices beginning to make a difference on behalf of all those vulnerable dementia sufferers in our country. But I do grieve for all for the folk – so many of them – carers and dementia sufferers who are continuing to suffer the appalling care/lack of care/lack of support which appears to be the norm in this country.
I asked for a reassessment of my husband in January. A very young and inexperienced social worker turned up unannounced at the care home, spoke to my husband (who is well-spoken and sometimes presents well), and believed every word he said. From the report it was obvious that much was inaccurate. But the result was a phone call to me saying there was nothing much the matter with my husband, that he should be at home, that the social worker’s grandfather had Alzheimer’s and was much worse but he lived alone and managed fine (Oh I pity the grandfather!) and that there was no way he would recommend any financial help for us.
When I mentioned my health problems and my fear of my husband’s aggressiveness etc., he told me I wasn’t his problem! So we’re back to square one, I’m trying to sell our house to free up money for the care home fees … but of course, houses aren’t selling.
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