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NH MESS

17-10-2006

Around 1,000 operations are cancelled by the NHS every working day, mostly due to bureaucratic cock-ups, according to figures released by a Tory MP. Lynn Hawthorne reckons radical surgery is the answer.

Grant Shapps the Tory MP for Welwyn Hatfield has done us all a favour by highlighting the daily waste in the Health Service - his survey of NHS trusts suggests 250,000 ops are cancelled every year.

But let's face it - these kind of statistics are now becoming commonplace. Last week saw The Healthcare Commission and The Audit Commissiondeliver their verdict- and the results for the Midlandswere damning.

Of the 58 trusts in our region, 34 were classed as weak or fair and only two were given "excellent" ratingsby the Healthcare Commission. The majority of NHS bodies, Primary Care Trusts (PCTs), mental health services and ambulance services achieved a score of 2 on the audit commission's scale, which is “adequate, but only at minimum requirements.”

Now, coming from an education background, I know about the perils and pitfalls of statistics, league tables and snapshot judgements, so don't believe them implicitly. Another aspect of such ‘findings' is that they damage the goodwill and morale of individual hardworking staff doing their damndest to provide the best service they possibly can against the odds. Reports like these tend to have the effect of damaging the individual rather than the collective, which is the intended target. So what can we, the paying public, and the staff of the NHS actually do with these findings?

Well, I believe that the first thing the NHS needs to do is to listen to the public. Who actually wanted the merger of Sandwell and West Birmingham hospitals? Accountants, obviously, because otherwise those areas have very little in common. They're two different local authorities and two different social areas and the transport network between them is tortuous and time-consuming.

There is real fear amongst members of the public that Accident and Emergency will beclosed down completelyat either Sandwell or City, which will undoubtedly endanger lives as ambulance and paramedic crews battle with traffic. And whose idea was it to merge Rowley Regis and Tipton PCTs? How do these two areas fit together even geographically, let alone socially or economically?

The merger of trusts and the trend towards ‘specialisms' at hospitals has led to “significant increases in the levels of activity and expenditure on services commissioned from other NHS trusts”, according to one spokesman. Yet one of the guiding principles of the NHS was that local people should have access to the best possible care at their local hospital, not to have to troupe miles across country when ill or dying.

Perhaps the most alarming finding of these reports was that Sandwell & Birmingham NHS Trust, Dudley Group of Hospitals and Mid Staffordshire General Hospitals NHS Trust failed to meet core standards on infection control and decontamination of medical equipment last year.

Florence Nightingale must be spinning in her grave at such findings. Basic, thorough cleanliness was the first thing that nurses used to learn and we all have childhood memories of attending hospital andthe overpowering smell of bleach and disinfectant on entering the building. Not any more. “All you can smell now is the sickness,” said a friend recently.

During a spell in hospital, I watched the ‘cleaner' attend to the ward. A desultory and disinterested flick of a duster and not a mop, bucket or scrubbing brush in sight. This new ‘wonder gel' is all very well, but sometimes the old ways are the best.

And the quality of food is another issue. The logistics of hospital meals must be a nightmare, but do we really have to ship them into the Midlands from Wales, as I am informed happens? A hospital should at least be one place where we can guarantee a healthy meal. Try visiting the ‘restaurant' used by staff and visitors next time you go, and clock the mountain of chips being dished out on a daily basis. “Shouldn't we be promoting healthy eating around here?” I once overheard a doctor ask.

My mother-in-law has just spent a month in a local hospital. My husband and I both caught bad chest infections doing the rounds from visiting and she was discharged early when a diarrhoea bug swept the hospital and non-essential patients were sent home to avoid it. During that four-week period, she had her hair washed just once. If standards of personal cleanliness are allowed to fall, then it is hardly surprising that fixtures and fittings are left untouched.

In all of that time, we never saw a doctor once about her condition and were never offered information about her health. We had to ask every time and on admission to the ward, our source of information was a student nurse. If afternoon visiting time coincided with a visit from a physiotherapist or an Occupational Health nurse, only then did we find out what was going on.

The ward, full of hard-of-hearing geriatrics, was staffed mainly by ‘foreign' nurses. Now before I get accused of bigotry and racism, let me explain. The nurses were all very heavily-accented and I struggled to follow conversations, such as they were. How can a person with hearing loss be expected to communicate effectively in such a situation? Being ‘foreign' is not a disqualification in terms of nursing skill if courses studied abroad match British standards of medical education, but surely the deployment of resources is important and deserves serious consideration?

It is this deployment of resources which these reports criticise most, and the blame for that firmly lies with management. When trusts that run hospitals in the West Midlands are planning large-scale job cuts to tackle mounting debts, it will be frontline staff we will lose, not management.

What the NHS needs desperately is a complete shake-up. It must begin by redefining its core principles and deciding WHAT it will provide FOR WHOM and BY WHOM and WHERE. Then it must take a long, hard look at itself and not be afraid to identify the problems.

Concentrate on the basics: health and hygiene go hand-in-hand. Put the patients back into the centre of the NHS universe and re-classify them as human beings with feelings, needs and dignity and promise them that the NHS will do its utmost to provide them with the healthcare they need, desire and deserve.

Healthcare cannot be provided ‘on the cheap', but you can be selective about HOW you spend money. NHS managers must ask themselves what will benefit the public most and endeavour to get the best people for the job. And do it soon.

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