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Rapid Responses: Rapid Responses published:
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Staff Concerns and Management Action - More Data Needed
- Peter A West (13 June 2009)
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Re: Staff Concerns and Management Action - More Data Needed
- Umesh Prabhu (14 June 2009)
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Where is the NHS Macpherson?
- Martin W McNicol (15 June 2009)
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Peter A West, Personal Communication SW20 0LP
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At one time in my career, before I joined the Healthcare Commission, I had an opportunity to scrutinise adverse incident reports in a large acute hospital. There was a very large spike in one specialty. Further scrutiny revealed that one member of the nursing team submitted an adverse incident form at the start of every shift, indicating that nursing levels were too low for safe and effective care to be fully assured. Management were satisfied that nursing was of an acceptable level and certainly without this individual's forms there would have been no spike in the specialty relative to others. In other words, other nurses were not submitting forms, whatever their views may have been. This is not to suggest that any concerns submitted by nurses and others in Staffs were not serious or justified. They may well have been. But before we can say that hospital workers' concerns were ignored in Staffs, we need to know in how many other places hospital workers' concerns are not acted on, and the extent to which this was due to management and workers taking a different view of the situation. It is possible that management not acting on workers' concerns is more common than a single case and so we need to understand more about what happens to workers' complaints and concerns in a much wider group of hospitals before we can conclude that what happened in this case was particularly extreme. Management may have neglected hospital workers' concerns but they may have felt that they were over- stated and that services were safe. Only a full enquiry locally and a larger study nationally can tell us what is really happening to medical, nursing and other workers' concerns which they report to management. Competing interests: Peter West was for three years the head of value for money at the Healthcare Commission |
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Umesh Prabhu, Consultant Paediatrician The Pennine Hospitals NHS Trust
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Dr West does raise an important aspect regarding our NHS culture and ethos. At one stage our NHS was dominated by consultants and one who made the loudest noise got what he/she wanted. It was not what patients needed but what these consultants wanted was important deciding factor. Today, it has changed and NHS is dominated by managers and some of them are medical managers and it is they decide what is needed for the Trust. Staff concerns regarding shortage of staff are ignored. Clinical incident forms have the habit of reaching black hole and nothing much happens except ticking the box. In some Trusts there is still so called 'club culture' and 'old boys network' and these are the people who decide what gets investigated and what doesn't. These are the sad realities of our NHS. NHS will and can improve when we put our patients and their needs first. It is their safety, their well being and their needs which should be at the heart of our NHS. It is equally important to make sure systems failures are addressed, doctors and nurses are helped, supported and guided to make sure that they are able to provide good quality care. Sadly in the modern NHS there is still blame culture, old boys’ network and club culture and it is these clubs and old boys who decide what happens locally. Many Board members and that too, non-executive members are oblivious as to what happens at the level of patients and in their wards. Of course, things have improved but we still have a long way to go. NHS needs an effective whistle blowing and that too someone outside the Board to whom patients, doctors and nurses can go in confidence and that someone must have the authority to investigate and if anyone fails to protect patients and their needs and if there is a blame culture then the Board should be held to account. Of course, accountability doesn’t mean dismissal of the Board or Board members but making sure that everyone learns lessons and patients are protected. Competing interests: None declared |
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Martin W McNicol, Retired Physician and HA adn Trust Chairman home - Old Minster School, 29a Minster Moorgate Beverley HU17 8HP
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Mid-Staffordshire Trust and Stand Up for Safety Where is the NHS Macpherson? MacPherson found an institutional problem with racism in the Metropolitan Police. The Health Service seems to have its own institutional problem about safety. Surely the failure of all the safety mechanisms at local, regional and national levels which were unable to prevent the problems in Staffordshire demand wider investigation than the narrow focus on the Trust by the Select Committee, and anecdotal approach described at the conference on Standing Up For Safety. That the responsible heads of the NHS should appear to suggest that it is up to juniors to “make waves” seems to be very superficial. The senior staff, medical and nursing, at Stafford tried to make waves, and were not heard. It is surely not for the Trust and its staff alone to “stand up for safety” What was happening at the PCT which commissioned health care from the Trust and should have been listening to the community and the medical and other professional staff working in hospital and community? Did they not hear or see the waves? Perhaps the local Member of Parliament if in touch with the constituency has a role in ensuring safe health care for his or her constituents might have heard. Is safety excluded from the remit of a Strategic organisation so that patient safety is of no concern to the SHA? Monitor surely should have a broader view of performance than purely financial issues, and the Health Care Commission itself seems to have been slow to recognise that there were problems, matters that appear to have been of common knowledge and concern to both medical and nursing staff. It seems that a lot of waves were made, but no one in the organisation with responsibility for oversight was able to see or hear them. The report by Nigel Hawkes (p. 1416) of the conference on Standing up for Safety outlines risks and the Medical Director of the NHS sets out challenges, but the organisation as a whole seems not to have the systemic approach that is required to make safety a priority. Unlike airlines it is not possible to make health care entirely risk free, but present approaches seem to verge on the futile. The CMO reported high risks of a fatal outcome, but in five years seems to have been unable to do anything about a potentially fatal hazard in drug administration. At the accident rates reported by the CMO, if the NHS was responsible for running an airline its performance would surely be regarded as unacceptable. Airbus and Boeing would be expected to respond more promptly to a design issue. Air France are replacing speed indicators on their aeroplanes. The NHS which must be a significant customer seems unable to exert any power as a commissioner. We need to look further than the problems of what was clearly an over ambitious trust. Encouraging junior doctors to raise concerns is laudable, but that is only a small part of the problem. Emphasis on it may take attention away from more fundamental issues. We need something better from our commissioners and higher management. Competing interests: None declared |
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