Robert Francis’ report into the neglect and abuses at Mid Staffordshire Foundation Trust is 2,000 pages of horror stories about a hospital trust that was celebrated by NHS bosses and that went unnoticed by a “plethora” of regulators.
The abuses included: patients being left in excrement in soiled bedclothes for lengthy periods; water left out of reach so patients was forced to drink out of flower vases; patients denied help with eating and left to go hungry. The Trust had an abnormally high death rate and many patients were denied their basic human dignity even in death.
The report concludes with 290 recommendations aimed at preventing similar abuses in the future. However Francis skillfully avoids the big political question.
Francis argues that the problems at Mid-Staffs were systemic: the patients were “failed by a system...that put corporate self-interest and cost-control ahead of patients and their safety”.
The problems started in 2005/6 as the then Health Secretary tried to claw back some money after costly reorganisations. Pressure from the top called for tighter “financial turnaround”. New Labour had also launched the Foundation Trust initiative; Trusts, including Mid Staffs were trying to jump through the hoops to win FT status.
Management made cuts to staffing. They insisted that remaining staff spend their time producing statistics rather than looking after patients. Qualified nursing staff spent their shifts in front of computers managing targets whilst unqualified staff ran the wards — badly.
Management had no idea what was going on as they saw their role as processing the data and balancing the books. They never stepped onto the wards. Poor standards were tolerated so long as the stats looked good. Management did not want to hear bad news and downplayed criticism.
But this strategy worked in its own terms.
Mid Staffs Trust was able to produce enough paperwork and healthy looking balance sheets to impress Monitor — the quango charged with assessing Foundation Trust applications — and gain its FT status. As Francis states: “an elaborate, resource-consuming process failed to achieve what should have been its primary objective; ensuring that the only organisations authorised were those with minimum standards on a consistent and sustainable basis.”
But Francis is naive. The primary purpose of this exercise is to create autonomous bits of the NHS outside of the responsibility of the Secretary of State, that run on a competitive basis and would form the basis for future marketisation and privatisation.
The obsession with targets and data is part of the same process. The New Labour government had a new convert’s zeal for the free market which they worshipped like a god.
However, the NHS is particularly resistant to market interference. Affixing price tags to the healing arts is not straightforward. A hundred and one bits of data can be collected, but which ones reflect real health outcomes? Setting targets on the basis of these outcomes often just produces perverse results. But the main perverse result is that nurses are taken away from their patients to feed an ever growing market-based bureaucracy.
Capitalist ideology says the market can do what human beings cannot. It can regulate economic life with a precision and responsiveness that us mere mortals cannot replicate. But Mid-Staffs shows that the opposite is the case.
Here market-type systems absolved management and politicians of their responsibility and accountability, distorted priorities and provided misleading data.
When David Cameron responded to the report in the House of Commons he was adamant: “We need the words of patients and frontline staff to ring through the boardrooms of our hospitals and, frankly, right beyond into the regulators and into the Department of Health itself.” But how far is this from the Nye Bevan’s vision: “if a bedpan is dropped in Tredegar the sound should reverberate through the Palace of Westminster”?
Francis tactfully avoids any of these conclusions. Having talked repeatedly about “systemic failures” he stops short of naming the system that caused them.
His claims “it should be possible to protect patients... from unacceptable and unsafe care whatever the system of provision” is unconvincing. Presumably this is a sop to his paymasters, but it means the report is woefully inadequate.
Francis wants a “fundamental change” in the “culture of the NHS”. But culture does not drop from the sky. It is built upon material, structural, systemic foundations.
The culture in which patients were left “unwashed, unfed and without water” and were treated with “callous indifference” was built on the foundations of New Labour’s push to a market-based healthcare system. Far from calling for the abolition of this system Francis advises us to keep it in place but beef up regulatory regime and preach moral virtue to the nursing staff.
It should never be acceptable to leave vulnerable human beings sat in their own faeces for hours on end. However, our politicians with their fanatical desire to create a for-profit health economy have achieved it.
The working-class answer is to hand power back to the staff on the ground. The old system of block-grants, collaboration and risk-sharing was administered by an incredibly streamlined bureaucracy compared to the one that exists today. Accountability for the system went straight to the government.
A return to this highly efficient and evidence-based system of health provision would mean freeing up health professionals from pointless data entry, hoop jumping, target watching. It would allow frontline staff the freedom to exercise their objective clinical judgement.
This report will likely spawn a thousand working groups, policy initiatives and powerpoint presentations. None of it will prevent further abuses unless we tackle the bigger structural issues that made Mid-Staffs possible.
The Tories’ solution is to exacerbate all the trends that point in the direction of corporate self-interest, cost-control and placing finance above patient care.
They cannot be allowed to use this tragedy to further destroy the NHS.