The Right Prescription

Socialized Medicine on Display

The first thing to remember is that criticism and whistleblowing will not to be tolerated, as British practice reminds us every day.

By 4.20.09

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Latest news in the exciting saga of Britain's socialized medicine is that a nurse, Margaret Haywood, aged 58, has been struck off for the crime of exposing neglect and mistreatment of elderly patients at the Royal Sussex Hospital on a television program. It was found that because of this: "It would not be in the public interest for her to be able to practise as a nurse."

Linda Read, chair of the panel responsible, said: "Although the conditions on the ward were dreadful, it was not necessary to breach confidentiality to seek to improve them by the method chosen."

After a decade of New Labour, much of Britain's hospital system is coming to defy description. Not even Cancer Ward, Solzhenitsyn's harrowing description of hospital treatment in Stalinist Russia, had quite such refinements of socialized medicine. And woe betide would-be whistle-blowers!

In March 2008, Lord Mancroft, a Tory peer who has held responsible positions in the public health area, claimed it was a miracle he was still alive after a stay in a filthy British public hospital with uncollected infected waste in the wards and dirty, drunken and sluttish nurses.

Instead of investigating Lord Mancroft's allegations, the leaders of both major parties turned on him. Tory leader David Cameron said he was "very cross" that Lord Mancroft had spoken like this. He had, he said, "told him in no uncertain terms" that his views did not represent the Tory Party, and that he "should think more carefully before opening his mouth."

The Labour government was of course more than happy to attack Lord Mancroft also. Health minister Ann Keen said: "I am appalled at his comments and I'm sure the rest of the British public is too. The entire country holds nurses in the highest regard. People will want to know what action David Cameron is taking on this matter or if David Cameron shares his views."

The hospital's chief executive, James Scott, said: "I believe it is wrong to make allegations like this without putting any evidence before us or giving us the opportunity to respond."

He continued with righteous indignation that "I hope Lord Mancroft will now reflect on the damage he has done to the general reputation and moral standing of the nursing profession and the impact this has had on the 1,600 nursing staff at the RUH who are extremely distressed and upset at his comments."

Dr. Peter Carter, chief executive of the Royal College of Nursing, accused him of making "sweeping generalisations about nurses and sexist insults about the behaviour of British women."

It had already been established that filthy conditions in British hospitals have been the cause of many deaths. The Daily Telegraph wrote in 2007 that in the hospitals run by the Maidstone and Tunbridge Wells National Health Service Trust staff told patients suffering from diarrhea to "go in their beds." Between 2004 and 2006, 90 patients there died from Clostridium difficile, and the disease was a factor in the death of a further 241: "Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died. Indeed, they would not have contracted C. diff. at all unless they had gone into hospital. So, after 150 years' advance of education, technology, prosperity and science, we have lost what Florence Nightingale taught [about cleanliness]."

Recently, at Eastbourne General hospital in East Sussex, another 13 patients died after an outbreak of Clostridium diff. Several wards have now been closed for cleaning. Others have died in the East Sussex Hospital. "Hospital care for the elderly has been given a very low priority," says Sarah Harman, a solicitor representing families of several victims.

A senior Conservative MP, Nigel Evans, demanded an inquiry into "shocking" failures of care after his elderly mother died of C. diff. He demanded to know why she had not been tested sooner and he criticized doctors for the off-hand way in which they told the family she had died.

"First of all this infection can and should be prevented, and secondly it can be treated if it's diagnosed in time," he said. "Neither of these things happened. There are thousands of families up and down the country grieving for the same reason."

Mr. Evans's sister said: "We were told to leave the room and a doctor came and asked us whether we'd discussed resuscitation. When we looked shocked, he said: 'I can tell you weren't expecting this.' It was only then that we realized she was dying." She said she had found patches of grime in the corners of bathrooms at the hospital as well as under beds. "The whole thing was like a horror film."

Deaths involving C. diff. in England and Wales doubled from 3,757 in 2005 to 8,324 in 2007, the vast majority of them elderly people, before a decline last year. It appears that while restaurants are prosecuted for unsanitary conditions, hospitals are not.

Well, we didn't know the half of it, although Mr. Cameron and Ms. Keen should have. It has now come to light that up to 1,200 -- yes, that's right, one thousand two hundred -- patients may have died through bad nursing and filthy conditions at a single National Health Service hospital in Staffordshire.

This is not a matter of sensational or exaggerated media reporting. It is an official government figure. Britain's bizarrely ineffectual Prime Minister Gordon Brown and Alan Johnson, the Health Secretary, have made abject if useless apologies in Parliament for the "inexcusable" failings (so far as I know nobody has made any apologies to Lord Mancroft).

The Prime Minister said: "We do apologize to all those people who have suffered from the mistakes that have been made in the Stafford Hospital," adding that it "should never be allowed to happen again." Indeed one might well agree that it shouldn't be allowed to happen again. Whether or not it will be allowed to happen again, however, is another matter entirely.

Johnson told the Parliament that the failings were "inexcusable." He said that the official report detailed "astonishing failures at every level," adding, "It is a catalogue of individual and systemic failings that have no place in any NHS hospital, but which were allowed to happen by a board that steadfastly refused to acknowledge the serious concerns about the poor standard of care raised by patients and staff." In another, not so distant, age which took honor seriously, under the doctrine of ministerial responsibility there is no doubt that the minister whose department was responsible would have resigned.

Families described some neglected patients at the hospital drinking water from flower vases because they were so thirsty -- it was apparently beyond the interest or the competence of the nursing staff or any supervisors to get them a glass of water -- and others screaming in pain. Patients described one ward as a "war zone" and said people were often left waiting in Accident and Emergency for hours covered in their own blood and without pain relief even with serious injuries. Others were left without food or drink, some received the wrong medication, or none at all, and blood and feces were left on lavatories and on floors.

A government commission launched an inquiry after concerns were raised about the high death-rates at the hospital between 2005 and last year. This followed prolonged efforts to bring the matter to official attention by the daughters of two elderly patients who were horrified by the treatment their mothers received,

Its report said that the trust responsible for administering the hospital argued at first that these high death-rates were due to problems with its recording of data rather than the quality of care for patients. This explanation was rejected and a formal investigation was begun last year, examining more than 1,000 documents and interviewing 300 people. It found deficiencies at virtually every stage, including inadequately trained staff who were too few in number and dirty wards and bathrooms.

Poorly-trained nurses turned off equipment because they did not know how to work it, newly-qualified doctors were left to care for patients recovering from surgery at night, patients were left for hours in soiled bedclothes, and reception staff with no medical training whatsoever were expected to judge the seriousness of the condition of patients arriving at accident and emergency admission. It was a far cry from George Orwell's pre-war observation, made when compiling a grim chronicle of the conditions of the British poor, that, whatever else might be said against it, Britain then had a class of highly professional and efficient nurses.

Doctors were diverted from serious to minor problems to stop the trust breaching the government's four-hour waiting time target. Patients' relatives told of nurses shouting at patients, staff failing to treat patients with compassion or dignity and respect, lack of help with meals or drinks (a matter that has been the subject of complaints in many other stories of British hospitals -- frail or comatose patients being tossed sealed packets of sandwiches that they are too weak to open, for example), and failures to treat bed-sores. (When my mother was a nurse she told me there would be serious professional and career trouble for any nurse who, as distinct from failing to treat a patient's bed-sore, allowed one to develop at all.)

Two-thirds of the doctors said they would not be happy to have their own relatives treated at the hospital.

The trust, it was found, was concerned with "targets," gaining Foundation Trust status and PR marketing and had lost sight of patient care. The report went on that it was not yet clear how many patients died as a direct result but mortality rates in emergency care were between 27% and 45% higher than would be expected, equating to between 400 and 1,200 more deaths over the period.

Sir Ian Kennedy, chairman of the Healthcare Commission, said the report was a shocking story and that there were failures at almost every stage of care of emergency patients: "There is no doubt that patients will have suffered and some of them will have died as a result." Sir Bruce Keogh, medical director of the NHS, described the failures as a "gross and terrible breach of trust."

Now patient groups say that managers who failed to raise the alarm have been promoted to key jobs in the NHS and healthcare regulation.

Trust chief executive Martin Yeates and chairman Toni Brisby both stepped down recently and Yeates, who is reportedly paid a salary of £160,000, is suspended on full pay while an independent investigation is carried out.

Director of the Patients' Association, Katherine Murphy, said: "How can any patient have trust in the managers and systems that have allowed this disaster to run and run? It is not enough for the Chairman and Chief Executive to take the fall for this. Government targets have directly impaired safe clinical practice and money and greed for Foundation Trust benefits has taken priority over patients' lives."

This, of course, if probably the key point: not that the administration of the hospital went rotten but that it was allowed to go on rotting for year after year, with, apparently, no complaints being made, or, if such complaints were made, no action being taken.

There are many unanswered questions here: Did no patient or family complain to his or her Member of Parliament? Did no Members of Parliament complain to the Minister? Did no doctor or nurse or administrator or even cleaner complain to their professional bodies or unions, and, if they did so complain, why was no action taken? Is nobody really responsible for hospital; standards? Are the British people actually so mentally and spiritually bludgeoned by socialism and nanny-statism that they took it all for granted? The fact the mistreatment of patients should have been able to go on for so long uninterrupted seems in a way worse and more disturbing than the mistreatment itself. Where is the initiative? Where is the gumption? Why did it take so long for any decent honest anger to be generated? Although the government behaved -- perhaps with good reason -- as if it thought it could get away with treating this as a one-off aberration, it looks like a general systemic and even cultural and spiritual failure of the sort associated with the latter days of the USSR.

Local Tory MP Bill Cash has now raised the question of charges of corporate manslaughter being laid but it remains to be seen if anything will happen in that direction.

After the general story of the hospital broke, the Daily Mail found another angle. It reported

Chief executive Martin Yeates told the parents of 20-year-old John Moore-Robinson it was time to "move on" [after] Mr. Moore-Robinson died because doctors at the hospital failed to discover he had ruptured his spleen in a cycling accident.

They sent him home with pain-killers -- and he bled to death. A year later, an inquest told the hospital to improve its standard of care. But it was another nine months before Mr. Yeates wrote to the family.

He told them: "I hope that the way the matters have been resolved speedily will go some way to help and your family feel that it's time to put the matter behind you and move on. Please accept my apologies and regret for the death of your son."

Apart from the stunning arrogance with which this letter seems to drip (How grimly accurate does Evelyn Waugh's prediction of a socialist Britain as a two-class state of proletariat and officials seem!), one wonders what actually happened following that particular inquest result -- apparently nothing. It has recently emerged that warnings -- apparently quite unaccompanied by action -- were raised about the hospital's standards as long ago as 2002.

Patient groups are said to be angered that Cynthia Bower, who was chief executive of the West Midlands Strategic Health Authority, the organization with responsibility for checking standards at the hospital, from July 2006, is to set to become the new head of the health super-regulator, the Care Quality Commission.

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About the Author

Hal G.P. Colebatch, a lawyer and author, has lectured in International Law and International Relations at Notre Dame University and Edith Cowan University in Western Australia and worked on the staff of two Australian Federal Ministers.