I’ve had a week or so to look at the Francis report, and I
continue to light upon fresh aspects it reveals of what was a tragedy for the many people who died – probably
prematurely and in excessive numbers –
and the families who have been left to mourn them, as well as the organisational disaster that
will keep people in discussion of it for years.
The report –as you’d expect from a top QC – is in many
places forensically detailed and only
begins to wobble when we get on to the recommendations – an awful lot of them .
I tend to the view that any report that puts forward 290 recommendations has picked up the shot gun rather than the scalpel.
And if any government [regardless of party ] did implement them ? You could make a good case that if
implemented in full , proposals for more
regulation and sanctions might even reinforce the ‘evade the blame ‘ culture
that permeates such large complex bodies as hospitals , universities and
government at all levels
The report also refers back to the legacy of earlier
reports into hospital disasters. Francis
reminds us that the report into Bristol United Hospitals' Trust had many
mentions of that useful old friend of professional and organisational failure: ‘hindsight
‘ . Francis ruefully observes that in
the evidence transcript for Mid Staffs , there are 123 instances of ‘hindsight’ and 378 ‘with the benefit of
hindsight ‘.
His reference to the Bristol enquiry – where it was
determined that admirably enthusiastic surgeons were trying paediatric surgery
beyond their reach and kids were dying – made me think about trends in such hospital
disasters and whether they come in
different types .
And there are trends
; not all hospital disasters /scandals are the same , though they often have
one feature in common ; more on that below.
Some such disasters -
I think disproportionately many – emerge from within the still pretty closed world of care for people with
mental health or learning difficulties . The Ely hospital scandal in Cardiff
back in the 1960’s ; the Winterbourne assaults filmed for BBC Panorama last
year . These occurred where vulnerable people were in a closed institution , in
some instances people who couldn’t even express the reality of what was
happening to them . Even worse , you suspect in some cases they thought that
kind of treatment was normal practice.
Some scandals clearly arise from the [commendable?] ambition
of some medics to pioneer new developments, developments either beneficial to
them ; their hospital or for medical
science generally . Events at Bristol
and at Alder Hey [ where organs were stripped from dead infants and stored for
research ] fall into that category .
No less ghastly , but probably unclassifiable , is the occasional
solo deviancy of people such as Harold
Shipman and the other medical staff who have exploited their position to kill
or harm patients. We shall probably never know what motivated people such as these.
I think it’s interesting that if we compare the big hospital failures such
as Ely, Bristol Alder Hey, and Mid Staffs there are common factors as well as
differences, and the two that seem critical to me reflect both a changing set
of society values and changing technologies .
When I looked back at the Ely Report [ 1969 ] I was surprised
to find that the enquiry reported the balance of external [ family and carer ]
comment on the incidents examined in various wards of Ely Hospital was generally
positive – by a facto of about 5:1 as far as I can see. In Bristol, even at the
GMC hearings , there were parents and family willing to publicly support the
actions of surgical teams who were
considered on empirical evidence to be deficient in skills for the procedures
they carried out . Even Harold Shipman had patients and patients relatives
willing to provide positive comment on his medical care.
Such familial support for deficient, even neglectful and potentially
criminal practice , seems to be entirely
missing at Winterbourne and in Mid Staffs. That may be because of overwhelming evidence or it may signal the
complete collapse of patient deference for medical authority . Either is significant
.
The other factor that is critical in achieving comfort and assurance
on the quality of health care is information . As Robert Francis observes in
his summary : “Public should be able to compare relative performance “.
It’s worth considering some fundamental aspects of accessing and using such data :
- the starting point for the
growing anxiety about Mid Staffs was the publication of atypical death
rates at MS by Dr Foster , a private business ;
- when such data was made
available to decision makers in the hospital they looked the other way ;
challenged the data methodology and commissioned academic research to
challenge the methodology & conclusions that might be inferred from
the data;
- with the benefit of that famous
hindsight, or with ‘real time ‘ access to data on patient death certificates
in the GP practice where Shipman worked, someone
might have noticed that over an extended period Shipman had more patients
die than any of his colleagues .
Actually health service data remains very hard to access – whether
in England and Wales , or in Scotland [ where we have our own hospital problems
currently subject to scrutiny]. Data is getting better , but it still remains
occasionally ropey; hard to analyse and to derive any sound conclusions from.
I’m coming round to the view that as well as all the
necessary statutory initiatives, maybe, just maybe there’s a place for somebody
to launch ‘Patient Advisor’.
After all , a lot of people put a lot of energies into Trip
Advisor, and other people pay attention to it. Not as the only word , leave
alone the last word , but as a source of information they use for a much less important decision than people
entering hospital make.
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