‘Shocking accounts of hospital care’

Civitas, 27 August 2009

The Patients Association today releases a compendium of sixteen stories from patients that have contacted them with ‘shocking accounts of hospital care’; that, extrapolating from the hundreds of phone calls they have received in recent times and from the two per cent of patients who rate their care as ‘poor’, they say could reflect the experiences of up to one million patients between 2002 and 2008.

Whether or not the one million figure is true (it’s a great headline grabber, but the statistical basis for such a claim is unsound), we should take note.  Certainly, the Patients Association don’t hold back.  “I am sickened by what has happened to some part of my profession of which I was so proud”, says Claire Rayner, a former nurse and chair of the Patients Association.  The stories that are present deserve to be read; they document appalling standards of care; a lack of responsibility; leadership; care; compassion; and accountability.

It is possible, also, that the picture presents even more challenges.  Christine Beasley, Nursing Director at the Department of Health, responded on the Today programme this morning that the number of patients that rated the care they received as excellent had increased from 38% in 2002 to 43% in 2008, in Healthcare Commission (now Care Quality Commission) surveys.  This may be true, but academic research has shown that when asked to comment on specific aspects of treatment and the detail of the process of care, the same patients report problems. In one study, 55 per cent of patients who described their care as excellent said they had experienced four or more problems; 13 per cent of those saying the care was excellent reported 10 or more process problems.

Indeed, when we look at the detail, there is much room for improvement and the gaps between the best and worst performing are significant.  In the latest inpatient survey, in 2008, while 77 per cent of patients rated their care as “excellent” in the best-performing trust, only 24 per cent did in the lowest performing.  And a closer look at the detail shows:

Respect and dignity
79% of NHS patients say they are “always” treated with respect and dignity, and 52% say they are “definitely” involved as much as they wanted to be in decisions about their care.

Cleanliness
Only 60% of NHS patients rate their room or ward as ‘very clean’; and 74% said they thought doctors and nurses always cleaned their hands between touching patients.

Nursing care
75% of patients said they “always” had confidence and trust in the nurses.  Just 56% said that nurses answered their call bells within two minutes.

So, what to do?  The Patients Association has a few ideas; two of which are particularly noteworthy.  One that the CQC should get out into hospitals more and ‘introduce extensive clinical area visits into its assessment programmes to cover all aspects of hospital care with a particular focus on the quality of care being provided on hospital wards’.  As this blog has written before, the current data-driven approach misses what happens in that moment of care and risks an Ofsted-esque fallacy.  The second is that PCTs should see all complaints lodged against a hospital trust.  Why not?  It is they that are ultimately footing the bill and supposed to be conducting ‘world class commissioning’ – a key part of which is assessing the outcomes of the care they buy.

But, aside from this, the Patients Association seems to miss a trick… which is this: that the stories it presents are indicative of a deep cultural problem in the NHS – best represented by the response of the one trust that the Patients Association said ‘raised the spectre of legal action if we publish this material’.  And that ‘others have been unhelpful, not answering relatives’ letters and not investigating their complaint’.

As we argued in a recent publication, Putting Patients Last, far too often NHS organisations are found wanting when it comes to a culture of service.  Attitudes such as ‘take it or leave it’ still prevail; targets are put before patient care; lines of accountability are confused.

The Patients Association focus on the need to ‘urgently reconsider the resources made available to hospitals and how they are spent… to urgently reconsider how hospitals are regulated and supervised’.  It also goes right for the HR line; talking the hard ball of ‘striking these nurses off the register’. Well, maybe, in some cases this would be the correct course, and maybe regulation needs to be looked at (again), but regulation and supervision can never cure all ills.  The desire for the quick fix has too often been to the detriment of care.

Instead, organisations should seek to instil professional and corporate commitment to continuous improvement in patient care.  Being a professional, after all, is very fuel of giving service.  You’d bet your bottom dollar world-class companies wouldn’t ignore the complaints of their customers; they’d engage with them and seek to use the complaints as a motivation to improve.   But, then, is the customer of the NHS really the patient?