Who Cares About the Patients?

THE UNSEEN SLAUGHTERHOUSE

On the NHS's own estimates, 34,000 people a year die unnecessarily each year in today's NHS hospitals. Other calculations come up with around 38,000 unnecessary deaths a year. Compare this to Iraq where the United Nations estimated 35,000 people were killed over the last few years and we called that a 'civil war'. Moreover, the NHS admits that another 25,000 people are unnecessarily permanently disabled in NHS hospitals every year.

The differences between the performance of Britain's health service and those of some of our European neighbours are worrying. Over 6,000 people a year (about 120 a week) die from hospital-acquired infections. If we could bring these down to the levels of other Northern European countries, we would only have 100 deaths a year from these infections (just 2 a week). Moreover, of the 157,000 people who die from serious illnesses like cancer or strokes each year, about 23,000 (over 400 a week) more would survive if they were treated in any other Northern European country rather than by our NHS.

THOUSANDS OF EASILY AVOIDABLE TRAGEDIES

But cold statistics give little real insight into the tens of thousands of family tragedies being caused by the NHS's problems. forty-year-old friend of mine was admitted to hospital with stomach pains. Over the next year, he suffered kidney failure three times in two different hospitals as a result of dehydration - not being given enough water to drink. The third time he went into hospital was just to have his little toe amputated. Two days after his operation, he was mistakenly discharged in kidney failure and that night went into a coma. He survived, but only after losing both legs, his eyesight and having a tracheotomy (his throat cut open and a pipe inserted to enable him to breathe). Under pressure to 'hot-bed' (free up his bed for another patient), doctors hadn't looked at the blood tests done that day which showed he would probably die if sent home. Finally, months later in increasing pain and unable to walk, talk, see or breathe properly, my friend committed suicide to spare his family the burden of looking after him.

Unfortunately, my friend's story is not just an isolated aberration. Thousands of people are dying every year in today's NHS because of a lack of basic care. A few months before my friend was discharged in kidney failure, an eight year old boy was discharged from the same hospital also in kidney failure - tragically he died when he got home. While visiting my friend in hospital, his wife saw several patients a week dying from neglect. The nurses called this 'hospital syndrome' and would often say to her, "last night we lost another one from hospital syndrome". However, relatives were always told by the doctors that the patients had died of natural causes - their illnesses. Moreover, since I published a book "Who cares?" about what happened to my friend, his wife and I have been contacted by people with over eight hundred similar stories - of relatives dying in NHS hospitals from poor care and lack of food and water. This widespread neglect seemed to be confirmed at a recent coroner's inquest, when a consultant physician giving evidence into the death of one patient said that he saw two to three patients dying from dehydration every week in just one hospital.

THE BREAKDOWN IN CARE

It seems incredible that such situations can occur in an advanced country like Britain. But it seems that in some hospitals we are seeing a breakdown in patient care.

To simplify, one could say that there are four groups of people that must work together to keep hospital patients alive - doctors, nurses, cleaners and caterers. As part of the trend towards cutting costs and outsourcing activities that are not considered 'core', NHS management decided that cleaning and catering should be handed over to the whichever private company was cheapest. For thousands of patients, this has proved to be a fatal mistake.

A cleaner employed by a hospital will get to know the nurses, become familiar with the wards and even become friendly with the patients. Even though they are 'just a cleaner', they will see themselves a part of a team responsible for patients' welfare. However, a cleaner employed on minimum wages by a low-cost cleaning company might be cleaning the toilets at a football ground one week, the next week it could be a factory, the week after it might be a hospital. They will not be so familiar with hospital procedures, will probably not get to know either nurses or patients and will be under pressure from managers to get the job done quickly. As the massive rise in superbug deaths has shown, proper cleaning is actually core to patients' health and the decision to outsource it a disaster.

Outsourcing catering has had similar unexpectedly dreadful effects. The people distributing the meals must get the meals out and then collected again within fixed times so that their employers can make profits on their contracts. They don't consider that some patients can't actually reach the food trays, that others might have conditions like arthritis which prevent them even opening some of the food or that some may be so sedated that their food has come and gone without them even being aware.

A quote from just one of the hundreds of people who contacted ME graphically describes how we are neglecting vulnerable patients, "I experienced at first hand shocking examples of dreadful care of the elderly in a hospital ward. Women in their 80s, 90s, often after a stroke or fall, some blind, some in plaster, many immobile needing help to get about - the food was placed on trays on their bed tables and just left whilst the staff went to the staff room for a chatter. We could hear laughter and raised jolly voices as all the elderly women sat unable to eat without help. Some were placed too far from their food and could not reach. Some, being blind, could not see it to eat. Some were unable to eat due to stroke symptoms. Some were without appetite and needed encouragement. All were failed by the staff. After about 30 minutes, staff would reappear and very quickly whisk away all the trays so many were left not having touched a thing!"

As nurses are in constant attendance on the wards, it is theoretically their job to coordinate patient care. But nurses are being drowned in a sea of new paperwork which is distracting them from the job they want to do. And when nurses do get the chance to see to their patients, they face time-wasting obstacles - for example, if a vulnerable patient is moved into a bed where there is blood and faeces on the curtains around the bed, the nurse has to phone the manager responsible for working with the outside cleaning company to get a cleaner in to sort out the problem. This can sometimes take a day - plenty of time for a newly-operated patient to catch a life-threatening infection.

BRING ON THE BUREAUCRATS

While the number of medical staff has increased by about 10% under this Government, the number of managers in the NHS has doubled from around 20,000 in 1997 to about 40,000 today. Yet despite this army of new managers, the NHS spends over £600m a year on management consultants to tell the managers how to do their job. That's about £15,000 per manager.

Moreover, the Government has set up at least six new quangos to improve our healthcare. These include the Health Protection Agency (£252m a year), the Healthcare Commission (only £80m a year), Monitor (a mere £13m a year), the National Patient Safety Agency (£30m per year) and a few others all duplicating and triplicating each other's work and all costing over £722m a year. So we now pay more than twice as much for bureaucrats as we did in 1997. In its 1997 election manifesto New Labour promised, "The key is to root out unnecessary administrative cost and to spend money on the right things - frontline patient care". The rising toll of unnecessary deaths suggests the Government has failed to deliver on its commitment.

THE 'COVER-UP' CULTURE

But perhaps the most dangerous consequence of the Government's healthcare reforms is that the public service ethos of the NHS has been replaced by a kind of corporate cover-up culture. When an oil company has a spillage that pollutes huge stretches of coastline or there is an explosion in a chemical works that kills people, we expect these corporations to deny, cover up and generally do all they can to avoid responsibility for their actions. However, this is not what we expect from a public service organisation like the NHS.

When my friend was discharged in kidney failure, hospital managers claimed that there were no blood tests done on Paul showing he was not well enough to have been discharged. However, a nurse was so outraged at this, that she sent his wife a copy of blood tests done on the day of his discharge. These proved that my friend was discharged in kidney failure. Managers then claimed that they had never seen these blood tests. But the nurse sent us an internal memo from the hospital records manager confirming that she had carried out managers' instruction to reprint all his blood tests, including the ones proving he had been discharged in kidney failure. And even when they were confronted by all the proof of this cover-up, the NHS lawyers continued to try every trick and delaying tactic they could to avoid admission of responsibility and payment of damages. When the NHS did finally make my friend an offer of compensation for his horrific injuries, this was withdrawn by the NHS lawyers within an hour of his suicide on the basis that as he was dead, he wasn't likely to need the compensation money any more. The hospital involved has for the last two years been rated as the most dangerous hospital in England. Yet nothing changes and the appalling care and high levels of unnecessary deaths continue.

In today's NHS, patients are dying from neglect, cover-ups are widespread and figures are fudged so that managers can further their own careers by appearing to meet targets dreamed up by their bosses at the Department of Health. Rather than seeing patients as their responsibility, these managers refer to them disparagingly as 'bed-blockers' when they stay in hospital longer than the managers have planned and as 'frequent flyers' when patients have serious conditions that require them to keep going back to hospital. This is not the NHS that this Government inherited.

David Craig is the publisher of "Who cares? One family's shocking story of 'care' in today's NHS". He is also the author of several current affairs books including "Squandered: How Gordon Brown is wasting over one trillion pounds of our money" (Constable 2008) and "Fleeced! How we've been betrayed by the politicians, bureaucrats and bankers" (Constable 2009). You can find out more about his books, buy them or contact David Craig through David's website snouts-in-the-trough.com snouts-in-the-trough.com