Healthcare staff should lose their jobs if care falls short

Last year, stimulated by the Patients Association report on the terrible experiences of some patients and their families within the National Health Service, I highlighted the gulf that exists between the expressed values of the NHS constitution and the realities of care as experienced by vulnerable patients in our health and social care system (BMJ 2010;340:c3166, doi:10.1136/bmj.c3166). I called for a change in culture whereby basic human kindness, or at least the avoidance of unkindness, should be adopted as an absolute value for our health service.

The recent report on the care of elderly people in the NHS from Ann Abraham, the health service ombudsman, has led me to rethink (BMJ 2011;342:d1064, doi:10.1136/bmj.d1064). It highlights 10 cases that fill you with a sense of incredulity about the status of caring within the NHS. How is it that caring for patients—basic, precious, hands on, face to face care—has become a low priority task that might get done, probably by a relatively untrained and lowly member of staff, after all the other boxes have been ticked?

A lot will be said after …