Sunday, 29 November 2009

It's time for change

It seems as though the wheels are finally coming off the government’s NHS propaganda machine. The years of nonsensical statistics, Stalinist five-year plans, ministerial edicts or any of the other untreated bullshit that’s been foisted upon the staff of the NHS is coming to light.

The news that Bolton, Greater Manchester and Basildon NHS trusts – the elite NHS Foundation Trusts – had death rates far higher than the national average is bound to start people asking questions about the management of our hospitals.

Finding out what hospitals are really like is pretty tricky. If you ask patients while they're in hospital,  then most will feel so grateful, needy or intimidated they dare not speak out of turn in case they’re refused treatment or simply ignored when they ring for a bedpan. When you’re on the ward you simply don’t rock the boat because you’re so vulnerable. Once most people leave hospital, the nightmare of ward life, filthy toilets and facilities that make Kabul General Hospital look well appointed, begin to fade and complaining is no longer an urgent priority. And as for those who don’t make it through the NHS machine’s 'caring' hands… well, they’re hardly in a position to comment, are they?

So what’s going to happen next? Will someone actually have the nerve to stand up and say parts of the NHS are simply not ‘fit for purpose’? The NHS is like an over-loved teddy. It needs a lot of repair work rather than simply being sprayed with perfume and given a new suit of clothes. It has to take on board patients’ criticisms rather than the pathetic reams of toilet paper produced by overpaid management consultants. The windows need to be opened and the stale air replaced by the invigorating breeze of an open mind that can look at fixing the NHS rather than hosing it down with money that just drains away and empties into the nearest trough for managers and bureaucrats to soak up.

I remember feeling so afraid when I started my blog that criticised the food that was actually hindering my recovery and in danger of making me really ill after ten weeks of nothing else. I was so worried people might spit in my food (or worse) that I knew I had to be anonymous. For all I know, someone may have spat and urinated in my food, but as I hardly ate any of it I’m not all that bothered.

The day after my blog was splashed all over the UK and global media, I felt physically sick for a day or two. I turned down interviews with GMTV, BBC and just about every other media outlet except a couple of radio stations in Perth and Darwin. I was so afraid of being bundled out of my bed for stepping out of line. Actually, I couldn’t step anywhere but you get my drift.

A day or two later the head of finance at the trust where I was being treated visited me because she’d apparently never seen anyone in traction before and was interested. Really? It was so surreal as I lay there explaining how my traction worked as she simply stared at me trying to figure out if I was a lunatic, security risk or just plain trouble. I’d clearly been rumbled at that point.

Perhaps it’s time more patients were given the confidence and encouragement to 'step out of line' and criticise some of the unacceptable practices that are causing people to die needlessly. The NHS can be great but it can also be very bad. It’s time the NHS was stripped of its ‘sacred cow’ status and was forced to face reality and put the patient first. If that happens, then the needless deaths that occur every year in our hospitals won’t have been in vain.


  1. I'm really glad you started to raise these issues. It is not only patients who have a difficult job speaking up but staff. There is also a hostility from some who believe that criticising the NHS will undermine the principle of a health service which is free at the point of delivery. I strongly support that principle and I know that all is not well with many of the services. There is not just a problem with under-resourcing but with top-heavy management, inefficient spending and a tyranny of government targets which mean that the most important issues are sometimes neglected in favour of ticking the right boxes.

  2. I owe my life to the NHS but some of my treatment exacerbated the problems I had. That said, I was very grateful of a health service that is free at the point of delivery to those who've made themselves eligible by paying their taxes etc. That's such a valuable principle but if we're to hold on to that cherished ideal, then common sense must prevail. Changes must be made, working practices changed and management overhauled. Ministers should leave health professionals get on with their work and concentrate on the funding.

    I don't have all the answers but I know that's what being done now is not it. Some taboos must be broken to improve the service and its delivery to the people who fund it. How hard can it be? Are there some other countries where good ideas can be taken from? Sometimes I wonder if the current NHS management hasn't been sent in to destroy it rather than improve it.

    No... they wouldn't do that, would they?

  3. Under resourcing, top heavy management, lots of well paid ineffective staff carrying clip boards. I echo the sentiments of the poster above and I should know. Its just 12 months since I walked away from a ward I once loved with colleagues I adored working with. I just couldn't live with the stress of not being able to give the care to my patients that they deserved. Incident form after form, letters to the Director of Nursing produced nothing. I wasn't alone immediate management and colleagues all emphasised how un safe we were working. As someone recently said "the NHS is paper safe not patient safe'
    Hope you have blown that tyre up and girded you loins for another adventure x

  4. Very nicely said (ex)TM - the 'management' of patient care in NHS hospitals amounts to nothing less than gross negligence and bullying on behalf of the pen-pushing micro- managers who infest today's hospitals like a virulent virus.

    There are a great many superb staff in hospitals simply trying to do their jobs to the best of their abilities but who are severely limited by those in charge.

    Poor hospital food is but one of the symptoms of a much larger problem. I do hope that you can start the ball rolling on getting these issues resolved.

    Hope your leg continues to improve, and thanks for keeping the excellent blog going!

  5. xtm for health minister - get rid of the swathes of overpaid managers who are so detatched with what goes on on the shop floor, and start involving those who are - and that includes everyone from domestic staff up - to help to shake up what should be the greatest thing about great britain, before it is lost forever. I left secondary care because it gave me a headache, I now work in primary care where my workplace is small enough to be excellent and efficient. statistics can be twisted to say whatever you want them to, and inspecting a hospital should always be an unannounced event

  6. The one advantage I have over the existing health secretary is a deep insight into hospital practice gained over the past year. I'm not a politician (although I did once want to be one until I found out what they were like) but I think almost anyone with a modicum of intelligence, compassion and experience of being a patient or frontline NHS worker could write a prescription to fix the system. Why do we all know about the legions of useless administrators with their non-jobs, and yet Andy Burnham doesn't? What experience does he have to do his job? Has he ever had a proper job?

    When the NHS is finally rid of the placemen, charlatans, hangers on and rank amateurs that pass for senior management, we might begin to get somewhere. Let's start at the top and work down!

  7. You seem to have got your fight back after a few days of ambivalent blogging...

    Nice to have you back.

    Cate x


    I thoroughly agree with you and the future of the NHS. It really does seem to be haemorrhaging tens of billions of pounds to create the ‘management’ of statistics and targets.

    It’s two years since my successful heart bypass operation – a near-death experience with 4 hours of deep anaesthesia. It appears that whilst waking up, I was unacceptably disinhibited and my language was seriously abusive. I was unaware of this at the time, but the recovery nurses and their other colleagues were - and later used it as an excuse for making my life as miserable as they could. The senior recovery nurse insisted that I should apologise before he allowed me to have some water to ease my parched throat. It was only later that I found out from an experienced post-op nurse, that disinhibition was a routine side-effect and was no big deal. So much for the inexperienced and over-worked staff, who realised that there was no career structure in place and that they would have to work for agencies (who helped themselves to multiples of these nurses’ wages in fees) and earn less money than the NHS had paid them.

    As I was not the only patient of many to take exception to the slap-dash and discourteous nursing, the Cardiac Rehab nurses advised me to complain to the Chief Executive directly which I did. His reply was patently a copy/paste from subordinate managers’ reports and he found it quite acceptable that the nurses had seen fit to treat me the way they had. The rest of his letter was remarkably irrelevant. So I wrote to the Health Care Commission. Being careful to put nothing in writing, they phoned up to tell me that they would not be opening a file nor could they go forward with my complaint, as the Chief Executive’s letter was too unsatisfactory. His second letter was no better; he had obviously found a winning stratagem…

    And the local MP’s representative said, ‘He’s a very busy man. What precisely do you think he can do for you?’

    And of the local newpapers, only one acknowledged my email. The other just loves printing letters from happy, still alive, patients about their wonderful hospital.

    And this ignores the three incompetent registrars, the secretive administrator, the defective machinery, and the four PALs behind the desk who really didn’t want to tell me how many beds were in the hospital.

    So ETM, the problem you have, is too find out whether my horror story is indicative of 20% of the NHS’s routine patients who prefer not to complain because they’re still alive.

    In the meantime, may I wish you every success with your physiotherapy.

  9. I have had too many experiences of being in hospital and I'm afraid we realised 11 yrs ago that the there were far too many in admin and not enough nursing staff. I had a 5 hour op and for some reason thought I had twin daughters of school age going off to the moon on a school visit without their packed lunch. When I was back on the ward I was desperately thirsty but unable to sit up I called for a nurse but noone came. A sister just stood at the end of the ward and watched as I struggled to try and get a drink, a visitor to the patient in the next bed came and helped me and tore her off a strip and told my husband when he came in, after that my life was made hell by her. I contracted MRSA and they would not admit for a week that it was that we were just told that it was a bug. It was not until my husband threatened to go to the papers that they finally admitted what it was.

    About 5 years ago my mother in law fell and had to go in to hospital, we received a phone call telleing us that she was unable to dress herself, was incontinent and something else that I can't remember. I jumped in the car and went straight up. She had been asked to wear the clothes of another patient and would not do it, had called for assistance to go to the loo and no one came so she had an accident. I went absolutely bolistic and demanded to see the matron. I got a right bullying session from the staff. Ihad also arranged to move her into a nursing home next door to her house and they did everything in their power to stop me including telling her that she would never be able to live by herself again without any family present. My friend is a doctor and that was in no way true but she believed it and I honestly believe that induced her death as she gave up.
    None likes you to question the NHS and if you do you will get lies in return.

    Since moving to France we have had excellent health care, you can see the doctor within hours of calling for an appointment. I had to see a consultant and the appointment was made for the next week. I believe there are too few hospitals with too few actual dedicated nursing professionals in the UK and it is probably too late to turn the tide.

    If you do embark on this cause I wish you every success as it will be very slow, time consuming and you will encounter lies and hurdles along the way from the very people who should not be in the profession.

    Sorry I still get so mad over Mum's treatment.

    Take care all of you.

    another grumpy oldish woman

  10. I remember, many years ago, a certain member of the Royal Family having a stay in our NHS facility because he believed in the quality of NHS care. All well and good BUT it meant that a whole floor of one part of the hospital was out of bounds. There were more police per square inch than have ever been seen (even during a bomb threat!), and you can gaurantee he did not receive the same food as everyone else! Also, who else would be allowed to have their spouse at their bedside out of visiting hours and accompanying them to theatre???

    No! The only way people can get a real feel for what is happening within the NHS to patients on the wards or in clincs is to actually be one, properly be one, not just pretend. Like XTM, to be there, genuinly injured and in great need and see what actually happens and how!

    Until I became a patient the first time I had no real idea how it felt. Then I became one on my speciality! OMG! How awful to be feeling so ill, push the button to call a nurse and end up having to wait for ever for someone to come and see what was up! NIGHTMARE! Thank goodness my other half was there and could go in search of help. I couldn't!

    When my son has been admitted to paediatrics it made me realise what a lack of understanding staff have of hidden disabilities. A child in a wheelchair obviously has impairments but a child with communication difficulties is not. So, they are ignored. When attached to monitors, oxygen and drips, how is this person meant to get washed? Go to the loo???? Who attends when an alarm sounds? No one! That is who!

    Until you experience these problems, how can a 'manager' tell a nurse what is and isn't a priority?

    Get the managers on the wards and mucking in! Really talking to those receiving care. Or better still, break their legs and let them see what it is really like! LOL! (JOKE!)

    Keep up the fight XTM!

  11. Thanks, Nurse. If I get any more worked up I will break their legs. That sort of handiwork is quite reasonable during a recession. I think senior management should work one day a month for a year as an HCA. I think we'd have a different health service if they did. Chairmen of trusts are simply political appointees who are being rewarded with a fat salary for keeping their mouths shut about things. Make them hold monthly meetings where the public can hold them to account. At those meetings, make them read out how many infections and deaths have been caused on their watch. And then let them explain and apologise!

  12. I sat for nearly an hour and a half on the loo once as I couldn't get up myself. I rang the panic bell several times and it was only when I started calling out that I got help. I know it sounds funny but it was actually quite sore. In the mornings a basin of hot water was put at the bottom of my bed. I couldn't reach it. Fortunately the lady in the bed opposite helped. I kept asking if I could clean my teeth or get my hair washed. Not once was it done. It was horrible.

    Last time I was in I was mobile and I was treated completely differently. I think because you can help other patients (although in a helpful mode I put an old lady back in her bed and heard someone screaming 5 minutes later 'nurse, nurse, there's an old lady in my bed - oops').

  13. Reading the other commenters experiences really makes me angry. Having been a nurse, albeit in a military setting, we would have been bounced off the walls by matron had we not given the patients proper care and attention, as well as keeping the wards clean.

    And it isn't going to get any better. The government's ludicrous scheme of making people get a degree before becoming a nurse is doomed to fail. You can't teach someone to care. I've worked with some of these so-called degree educated nurses and everything from making a bed to changing a dressing is beneath them.

  14. Henry is so right, you can't really teach to have a true compassion for others in a classroom, it is done by experiencing pain/discomfort. Unless they are born with it or developed it growing up.

    My province hired Dr. Stephen Duckett to sort out our provincial health system...he did his 'magic' in England and Australia with their medical situations. He is an economist, not a medical person. Does his name ring a bell? It is still too early to see if his restructuring will be better, but right now no one knows what to do and it seems like they're replacing managers with other managers, just different positions doing different things (most seem to be PR positions).

    I wonder if the NHS today is his baby. Hope not.

    Libby, Canada

  15. I totally agree with Henry's second paragraph specifically. He has hit the nail on the head.

    My 74 year old stepfather was rushed into the hospital where I work a few weeks ago and his treatment was apalling. I popped in to see him during my working day on his third day of admission and found him in tears. He had been sitting in his chair for six hours and could not get back into bed himself, he had a drip on one side and a catheter bag on the other. As he was "nil by mouth" nobody had been in to see him for any reason. He had been ringing his bell for over an hour and still nobody came. I marched up to the Nurses station and asked for someone to come and help him. On seeing my hospital id badge a snotty young staff nurse said "and WHO are you?" (in other words "mind your own business!"). I said "actually, I am his daughter". Funny how his care changed from that day, everyone was fawning over him, couldn't do enough! Makes me sick! I am not management but my job enables me to make life a little more difficult for clinical staff should I choose to take that route. I don't actually choose to do that because I really don't care anymore, being only 17 months from retirement. It's not to say I don't do my job - I do it damned well - but I just can't be bothered to play the stupid games now.


    PS - glad to hear of your progress XTM

  16. "Sometimes I wonder if the current NHS management hasn't been sent in to destroy it rather than improve it."

    I rather agree with that. I could tell harrowing tales of spiteful managers and dedicated NHS staff crying because they weren't allowed to do their jobs - i.e. look after patients. It's since these heartless, non-NHS trained bureaucrats were made to spend some time looking after patients - not just being patients because that will give them more excuses to make life hell.

    I trained as a nurse and we didn't have stupid managers then, or if we did they were soon taught some basic health priorities by the nursing and medical staff. I specialised in theatre nursing, and even there in theatre there was care and compassion for patients in all areas - recovery, anaesthetics, theatre itself, and we respected the patients whether they were conscious or not. We all knew that recovering patients would sometimes become verbally aggressive; we knew why so didn't get phased by it at all - refusing water because of someone coming out of a deep anaesthetic and letting loose is UNFORGIVEABLE.

    Some years ago after a big op the management wanted to turf me out of bed and off home, despite the fact that I could still barely walk, and I lived alone. I said no, I couldn't go home yet because I couldn't care for myself let alone manage showering, cooking, lifting a kettle (the consultant had been very strict about what I could and couldn't do). I had to really put my foot down and refuse to leave. Finally they spoke to the consultant who backed me up and they gave me two more days. What if I had been someone who didn't have the confidence to stand up for myself. I wasn't assigned any district nursing or care and it took me a good fifteen minutes to get out of bed at home even after two days extra, so imagine someone less stubborn having to cope with living alone and managing after a major op.

    I know beds are at a premium but I think management need to have some basic NHS training and some practical experience on the wards, as suggested earlier, as nursing aides. The whole works - shifts, working unpaid overtime, dealing with people in pain. Some of them have never even spoken to a patient. It doesn't surprise me XTM, that some grey suit had no idea about traction. They don't have a clue.

  17. Perhaps it's time for some enterprising journalist to delve into the background of the chairmen and chief executives of our top trusts and find out if there is a common thread. What are their professional backgrounds? Are they overwhelmingly lawyers or accountants... or are they specially trained as NHS mismanagers from the moment they gain their masters degree? I imagine if a competent manager from the private sector applied for a management job in the NHS they wouldn't make the shortlist. It's a clique... a bit like local government. These morons are manufactured and trained somewhere. In fact, many are so universally useless I rather suspect they all come from the same mould. It's time to find out who the chief execs really are. As for the chairmen... it's pure political cronyism and patronage.

  18. Well what we DO know is that some of these managers come from Marks and Sparks, Woolies, and other high street chain stores and have as much idea about patient care as Genghis Khan would have had about needlepoint. They never have the guts to talk to patients with problems.

    I know for a fact, because I was there, that a handful of years ago, one hospital in London advertised an assistant manager's post at ... wait for it ... £50K. FIFTY GRAND A YEAR for an assistant manager's job.

    They join the NHS for the money and for the fact that it looks good on the cv, then create mayhem and misery everywhere, move on a year or two later, leaving someone else to pick up the mess and make more mess. It's bloody disgusting, the waste of money on manager salaries. Yet, we (I was working as a med sec at the time) were being told to replace broken equipment like transcriber headphones at our own expense because there was no budget ...

    Sack the whole blasted lot of them. Employ only those people who have a track record in the NHS. Make it a partnership with the medical, nursing and allied staff rather than a war of attrition, with patients losing out. Trouble is, patients are not able to vent their frustrations at the people who cause the problems (because they hide like cowards in their offices or blame other people), and it's the medical and nursing staff who get it in the neck because they're front line.

    I'm angry. Can ya tell ..

  19. Sooz, that explains why I never could get a managers job in the hospital. Not that I would actually want one but with 25 years NHS experience, 15 of them in management in General Practice I thoughtI would move up through the hospital career ladder quite easily. Too much experience I guess, too big for me own boots. Not sure what our chief execs background is - will have to check it out. Not that we ever see him walking the floor. Not even sure what our Hospital Manager's background is either.

    When I started at the hospital a few years ago I was a Receptionist on Outpatients (not a very pleasant job I can assure you - we were always being left to explain to the patients why some faceless moron had cancelled their appointment but forgotton to let them know)we had to buy our own pens and notepaper!


  20. Gill you have exacly the kind of experience that would be so useful, and yet yes, you know too much. You care about people and you know about patient care.

    This is a subject that really does get my Billy Goat Gruff. I really do think sometimes, as XTM said earlier, that this breed of "management" is geared towards demolishing the NHS.

    Would you employ a group captain of a flying squad with no experience of flying? Would you engage the services of a ship's captain who couldn't read a chart? This is no less important and these people have people's lives in their hands, and yet don't seem to care a jot about that.

    There are some who do their job brilliantly and know what's important, but they're few and far between. In fact one, who worked at a London hospital, was treated incredibly badly by other managers simply because she knew what she was talking about and the others felt threatened. She left eventually - what a loss.

  21. Quite agree that the in-patient is generally in such a poor position to take a stand. First off you're sick and not feeling chipper. Second, you are at the mercy of the hospital and its staff. Third, we all tend to presume 'Doctor [Nurse] knows best', even when often it's patent they don't.

    I had an appalling experience some ten years ago when admitted through A&E in the most god-forsaken pain. Turned out I was passing a kidney stone, but for hours the medical staff either couldn't or wouldn't make that simple diagnosis. I remember one 'doctor' holding up my X-ray to the ceiling light as if supposedly reading it!

    My wife, at home looking after the child, got a phone call asking if I was mentally ill. They assumed I was a frigging Munchausen case and shunted me off into a side room totally unattended!

    It was only when my ma-in-law, a retired consultant oncologist, sailed into A&E and demanded that they get their frigging act into gear that anything was done.

    She was then in her late seventies, but still knew how to take command and control of a bunch of medical low-life. She demanded that if they couldn't find out what was wrong then they could effing well get someone who could. So a urologist was pulled from his bed at 4.00 a.m. who promptly said "Look at the frigging X-Ray properly - if you can't see the kidney stone then shoot yourself."

    I remember at the time - pretty stoned on the morphine they'd given me - how utterly powerless I felt. Here was I, supposedly someone who works to make the NHS function better, knowing all the angles, just lying there taking it.

    There was never any apology, or any retraction of the 'nutter' tag. For all I know my medical notes still read 'Mr. Numbnut.'

    It was the worst kind of bullying.

  22. Peter, that is awful but oh so common. Bullying is rife in the NHS at all levels, of patients, of staff, nobody is excluded. We have a bullying and harrassment policy but it never means anything other than it's another bloody box ticked.

    Sooz, now you know why I can't wait to retire. Roll on 6/5/11! If I need to supplement my pension I shall go stack shelves somewhere rather than face staying on in the NHS. Then I shall write a bloody book about the gross incompetence of those who run the NHS..........


  23. Peter P
    It is generally reckoned in medical circles that a kidney stone is the single most painful medical complaint to suffer from. You have my sympathy. Sadly, not everyone has a retired consultant in the family to whip these bright young graduates into shape.

    My Godfather was a consulting eye surgeon who specialised in traumatic diplopia (squints) – which happened to many WW2 RAF pilots when their heads hit the instrument panel in crash landings. On one occasion, he told the story of his mentor, who was known to like cash payments for his private work and for which he kept a safe in his consulting room. He also kept a pistol and a few bullets there. Being asked why, he replied, “If ever I remove the wrong eye from one of my patients, I’ll be able shoot myself.”

    Thanks for your sympathetic comments (re disinhibition and post-op thirst). At the time, I hardly expected to be bullied by a nurse as I had explained to my anaesthetist my worries about recovering consciousness.

    What is absolutely wonderful about all the comments on XTM’s eloquent blogs, is the way that other people are shown to be much more important than ourselves. What a shame that so many members of the NHS at all levels have completely forgotten that they are there to ‘exercise’ the same compassion.

  24. All these stories of appalling failures in care from staff in hospitals, as well as my experiences as a nurse, wife and mother, are why I cannot bring myself to return to working clinically in the NHS! The thought of being on a unit where patients are routinely neglected or abused makes me feel physically sick.

    I NEED to get a job. My sickly offspring is a lot better so nothing to prevent me working at the moment but I cannot work the job I love as it is no longer there. The thought of working with staff who hold a patient responsible for what they say under the influence of anaesthesia, or leave a patient on the loo for 90 minutes without realising they were gone for so long just makes me realise that the job I trained over 3 years to do is no longer anything to be proud of.

    I was so proud to be accepted on to nurse training. I was immensley proud when I qualified and I worked under a bully of a sister! BUT, I learnt how to manage a patient workload without abusing or bullying. I learnt that management were not there to help you, even when things went way wrong. I learnt that even when I was vomitting, I would have to keep working because the management couldn't step in as they were not clinical nurses! They were so far removed from ward work.

    I can't go back to the NHS as it is. To have to try and justify myself as I am NOT a degree qualified nurse is one hurdle I would be willing to take if the job was good but I did not fight to qualify as a nurse to work in the NHS as it stands.

    I used to defend the NHS to the hilt but not now.

    There are some wonderful nurses, medics and support staff out there and they have my utmost respect but I am not strong enough to be there anymore.