Saturday, 15 May 2010

Why There's No Improvement in the NHS



As most of us know improvement in any individual or business is usually achieved by criticism.

Parental criticism is our first experience, followed by teachers and finally, these days, university or college lecturers before anyone reaches the ability to provide for themselves by working.

In the workplace we also receive criticism. In my earlier career it was normally done gently with someone quietly saying where you could improve, but now it's done through formal 'assessments' which can destroy a person's confidence (as any criticism can), if not used objectively and positively.

I remember a long time ago, when assessments were introduced, listening to two older colleagues discussing a certain member of staff. In my opinion he was an efficient and effective team worker and always most courteous to all. A quiet man who worked hard. But one of these colleagues of mine (let's call him A) had a personal gripe with the employee (although I did not know that at the time) and voiced he was so delighted he would be involved with his yearly assessment, due within months. "I'll bring him down to earth," or some such words were used. I had a problem there because I respected the quiet man. After a couple of days pondering I decided to let him know what had been said by his 'executioner' who, after all, hadn't said it privately but over coffee prior to a regular meeting.

The quiet man put his resignation forward within a couple of weeks and moved onto bigger and better things. Was I a whistleblower? I certainly wouldn't have said so because the remark was in public and there was nothing I knew of to substantiate it. He was a valued member of my team. If you're interest in why A wanted to downgrade the quiet man, it was because his girlfriend used to go out with him. Yes, that's how it worked.

That's a long entry to the point of this post and I apologise if it's boring. But did you know University Hospitals Coventry and Warwickshire NHS Trust have spent £6 million on suspending a heart consultant who blew the whistle on high death rates?

Dr Raj Mattu last worked in 2002 after warning bosses that fatalities among heart patients in Coventry were too high. What did they do? Suspended him although, despite being found innocent of bullying staff members at Walgrave Hospital (after he had criticised the high death rates), he was not allowed back to work.

Some of you will say 'this is the English NHS' which is true. But the Scottish NHS doesn't come out well in a recent survey by the BMA. A study found that 40% of the 384 doctors questioned did not report issues of concern.

"Doctors tell us that they fear their careers can be affected by speaking out," said Dr Charles Saunders, chairman of the BMS's Scottish Consultants Committee.

It is never easy to complain about a colleague, but when life and death are concerned it must be made easier.

Knowing Nicola Sturgeon, the Scottish Health Secretary, she will look into the facts of the BMA survey with some urgency. Such a shame that England doesn't have someone who can resolves the issues of Dr Mattu quickly. Maybe it will take another 8 years and slightly more than another £6 million for them to see sense.

19 comments:

Anon said...

Excellent post!

- Aangirfan

Apogee said...

Hi SR.
Sadly this is not unusual, and happens any where the management structure allows it.It is a bullies charter because once some thing, supposed action, or in-action is written down, it becomes a "fact" and it can be very hard to prove or disprove. And having been written down, its in the record, your record, its a "fact" and for you to prove otherwise,so you are "probably" guilty. Allegedly !
And whistle blowers get no protection in this country,even though they may be right, they are on their own!
And remember, in Scotland two witnesses are needed. But if you do not have witnesses, two people can say you did something,tell the law and you are in deep doo-doo.Happens! Aint law wonderful !

subrosa said...

Thank you Anon. A compliment from you is highly appreciated.

subrosa said...

Yes of course Apogee, I forgot to say in the post 2 witnesses are required.

Law is a disgrace in this instance as it is in many others. It's no wonder the country is in the state it is right now.

wisnaeme said...

I know Dr Raj Mattu personally, actually.
... and I along with many others have lent our full and unconditional support for him at the way this man has been treated by folk with self serving interests within the Walsgrave hospital management goldfish bowl.
That folk in need of his professional services have been deprived of them for so long is utterly shameful. That such attempts to smear his good name and reputation is just one symptom of the malaise within the rotten core, managerial systems in that particular trust.
I write with knowledgeable authority on this subject. I fought long and hard to prevent such as this. Indeed some folk have said that I may have been partly responsible for the departure of one particular obnoxous chief executive, David Loughton. This hospital is a PFI scam where consideration for patients and staff and the systems they endure are placed secondary to the profit driven factor by the private provider.

For more history on this particular hospital trust and my involvement in it's affairs; I sugest you read chapter two (entitled hospital cases) of Captive State by George Monbiot.

M said...

I recently retired from a very senior and successful management position in industry and have recently had the misfortune of observing the NHS intensely at first hand whilst visiting some very sick relatives and can say with confidence that its a shambles that somehow or other muddles through.

I could spend hours writing about what is wrong with it but to save space will highlight the two most striking failures that I have seen which are (a) it operates as a multitude of fiefdoms that co-exist with other fiefdoms occasionally, and (b) it has a complete inability to communicate via 21st century solutions.

The changes that are required are so fundamental that its very hard to see how it can be achieved without a complete cultural change throughout the NHS brought about by privatisation.

M said...

Ref my last post I should have said "it operates as a multitude of fiefdoms that RELUCTANTLY co-exist with other fiefdoms occasionally,"

wisnaeme said...

Privatisation!!

Erm ah don't think so M.

banned said...

Shades of the Baby Peter case in which the four senior members of front line staff at the NHS unit which saw him had complained about low staffing levels producing poor clinical reults (ie death). By the time of the Baby P enquiry one was suspended (since recinded), two had left and the fourth was off long-term sick (if memory serves correctly).

Sell the NHS to Tesco says I.

subrosa said...

It's appalling that story wisnaeme and to think there was nobody in government with enough balls to sort it out.

Let's hope the new health secretary does something.

I admire you getting involved. It's not easy fighting such a system and I have just ordered Monboit's book.

subrosa said...

M, you may not know one of my readers, Clarinda, is also very well informed regarding the NHS. She says exactly the same although doesn't agree with privatisation. An efficient service could be offered using taxpayers' money - if it was used wisely which of course it hasn't been.

Even as an occasional patient I can see and feel the animosity and inefficiencies. Health boards think that if they tart up the building patients will think the setup is efficient. All gloss and no substance.

Germany, Switzerland, France etc put us to shame where healthcare is concerned.

subrosa said...

Wisnaeme, I think M is in England where healthcare is already well on the way to privatisation.

subrosa said...

I think you're accurate banned (if my memory serves me well). People get away with murder, quite literally, these days.

Morrisons maybe or Waitrose but oh, not Tesco!

wisnaeme said...

Subrosa, there were two Labour grandees with considerable clout in governance although it wasn't within their ministerial remit.Both were stauch advocates of PFI. Indeed one of them was in charge of putting into practice this flagship policy of privatisation. Geoffrey Robinson MP was Paymaster General of the treasury and responsible for the fiscal planning of many of these PFI scams. The other new Labour grandee just happened to have the Walsgrave hospital in his constituency and was none other than the late unlamented Minister for Defence, the cretinous runt, Bob Ainsworth.

Sad to report, that despite their shortcomings in governance all three of Coventry's New Labour MPs have been relected to serve themselves. The third New Labour personage being one Jim Cunningham a former union comrade in the Imperial Steelworks in Airdrie where in the early 1970's we didn't exactly have a working relationship..
... and one

douglas clark said...

Subrosa,

My post seems to have not appeared. Was it too controversial or summat?

Clarinda said...

Subrosa - you are correct that I do not favour the wholesale privatisation of the NHS - but having some experience of the management infrastructure and purpose within some private health organisations (albeit selective in their clinical focus and patient choice)- the advantage of streamlined, competent and efficient management free of political input and managerial self-propagation appears to be a clear advantage in terms of financial, clincal and organisational efficiency.

I and many of my 'old school' colleagues might be willing, at no fee, to enable current medical, nursing and other clinically relevant professional staff to suggest what managerial deadwood could be cut out of our NHS - saving considerable money and time better reinvested in direct patient care. We cannot return to the alleged good old days but there were too many babies thrown out with the bath-water that ought to have been saved. For this, I also lay blame at the professional medical and nursing colleges who did not defend their moral authority and professional practice under the fire of being accused of either being "god-like" or "too powerful" - well look at who's powerful now and rates of re-admission, costs and hospital acquired infection etc., have rarely been higher (often due to managerial decisions). However, I strongly suspect that what NHS improvements that have been made come from clinical research and innovation and rarely from political or managerial initiative.

Sadly, I think the NHS politico-managerial behemoth has become so ingrained and eye-wateringly expensive - along with some very suspect and short-sighted medical application and training initiatives - that it will take the better examples of privatisation and the continued emigration of our expensively educated doctors and nurses to galvanise the NHS to function more effectively. Filling medical practice with so-called nurse specialists and nursing practice with unqualified personnel is no substitute - perhaps I fear the infamous 4th pane in Johari's Window where the unknown remains unknown to the unknowing. Angels ought to fear a bit more where fools rush in?

Isn't it worrying that we are losing hundreds of doctors and nurses to Australia, New Zealand etc. but no NHS managers?

Too many NHS suspensions have come about through the use of power in the hands of either the ingnorant or the knee-jerk apologist, driven to erect a 'seen to be doing something' defence. I wonder how many times this particular doctor had reported his concerns to management who suddenly realised that they might be blamed and effectively silenced him through 'immediate' suspension? It's frequently the case that managerial inadequacy to react appropriately to medical and nursing concerns results in the reporting medic or nurse being suspended and not the incompetent manager who failed to react earlier in a more subtle and competent maner. Oh for the boot to be on the other foot!

wv - docksac!

subrosa said...

Wisnaeme, I've heard Ainsworth was a poor MP or should I say is. What do these labour MPs do for their electorate? Few even bother to answer emails.

I'm sure you have it all recorded. It would be worth doing a mini-series just to bring the politics of healthcare to the attention of more folk.

subrosa said...

Douglas, this is the only comment I've received. Are you sure it actually posted? Is it too much trouble to do it again? Please.

subrosa said...

Excellent post as always Clarinda. Yes it is worrying we don't lose NHS managers to down under, although the reason is obvious.

I have a suggestion. Isn't it time you started to correspond with Ms Sturgeon - I mean you and your clinical colleagues.

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