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Being squeamish about the NHS won’t stop another Stafford Hospital

7 February 2013

Should heads roll over the Mid Staffordshire Hospitals Trust scandal? I ask only because as I listened to Mark Carney giving evidence to the Treasury Select Committee for several hours this morning, I found myself browsing through a number of articles on this site and others about the Libor scandal. Back in those heady days of George Osborne accusing Ed Balls of having questions to answer, and Bob Diamond resigning from Barclays ahead of his appearance before the same select committee, people were very keen for heads to roll, and not just those sitting on bankers’ necks. They were also keen that those who performed badly when questioned about their suspicions of Libor fixing didn’t rise to higher positions, with Paul Tucker watching his own shot at the job Carney has now won slipping away.

Quite unsurprisingly in the circumstances, the relatives whose campaigning brought matters to a head do want Sir David Nicholson to resign as NHS chief executive. But David Cameron himself was very careful to echo the Francis Report’s insistence that the response to the scandal shouldn’t involve seeking out scapegoats. When journalists asked the Downing Street spokeswoman about it this afternoon, she repeated the PM’s scapegoats line, adding that since the Mid-Staffs scandal, a number of changes have already been carried out. And as Dan Hodges points out in his Telegraph blog, those on the left who usually expend considerable effort attacking the government on health matters were just a little quiet yesterday when the Francis report was published. There has been a noticeable reluctance to apportion individual blame in these circumstances when other scandals have led not just to a great deal of soul-searching about how the system worked, but about its protagonists, too. No doctors or nurses have been struck off, although Cameron was more robust on this yesterday, arguing that the regulators involved needed to answer questions about why healthcare professionals were not held accountable. Will heads roll at the regulators, too?

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Now, obviously in many cases it’s easy for witch hunts that force a resignation to start, particularly when 24 hour news and social media means that everything moves at double-speed. But whether or not heads should roll at the top, there’s an important lesson from this which is that the NHS remains so sacrosanct even after yesterday’s revelations that parts, including its staff, remain untouchable. As well as avoiding blaming anyone, including those members of the last Labour government opposite him in the Chamber as he delivered the statement, David Cameron made sure he started his statement with that familiar ‘I love the NHS’ caveat.

This problem goes beyond whether people should or shouldn’t be sacked, because it’s even more important that things change to stop another Stafford Hospital situation occurring in the future. It shows quite how nervous politicians are about appearing to go too far on the NHS. And that is a big problem because, as Ross Clark explores in his cover feature for this week’s Spectator, there needs to be a solution beyond ‘lessons learned’ for those failing hospitals like Stafford. That could well involve allowing private-sector providers to take over the running of hospitals, a suggestion which immediately provokes that accusation of going too far from trade unions and commentators alike. If politicians are going to continue to be squeamish about blaming NHS employees – whether at the top of the service or those changing the bed sheets –  they’ll be squeamish about suggesting that anything other than a state-owned monolith might be a sensible way of running the free at the point of delivery health service that the British public feels so emotional about. And as anyone who works in the health service knows, squeamishness is not a helpful character trait at all.

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  • richard williams

    Of course Sir David Nicholson should resign. He was and is responsible for gods sake. It’s no good to dumb this down to suggesting politely that staff should not abuse patients ending in the deaths of some of them. It’s a management issue. The management of the whole sorry mess is just that, a sorry mess.
    For the sake of clarity, I do not believe it’s a money issue; quite possibly the reverse. Some staff have had pretty big salary increases, and deemed to be “professionals” quite possibly resulting in the “too posh to wash” syndrome.
    It’s not the staff at the sharp end, people are people and performance expectations of them are set by (you guessed it) management

  • Fergus Pickering

    These are witch hunts with real witches. Keep it up I say.And make sure the people who suffer are at the top not near the bottom. Some nurses are terrible cows, that’s always been true, but they should be kept in check by management.

  • Russell

    No wonder the opposition (Labour) are keeping ntheir heads down and not demanding heads roll!
    It seems to have slipped everyone’s memory that Alan Johnson (Labour Minister) was Minister of Health at the time and Burnham followed whilst unnecessary deaths were still taking place. It was Labour who were responsible for the chaos of PCT’s, Regional Health Authorities etc.
    A similar story to the labourshambles of the FSA/Treasury/Bank of England farce which resulted in exactly who losing their job?
    Strange how Isabel and her pals on the BBC and now even Sky fail to see the similarities with incompetent structures being put in place by Labour.
    Even today Sky have Labour shadow health condemning the government for not acting and not a word about what the Food Standards Authority were doing during their 13 years in office!
    We could have been eating horsemeat for decades without knowing it!

  • HooksLaw

    There will not be any prosecutions because the people who should be prosecuted are the Mrs Miss and Ms Bloggs who mistreated the patients.
    The nurses.
    And OK there are male nurses, but its the image of the nurse which is so sacrosanct.

    As well as ruining the economy Labour ruined the NHS and their parting shot was to promise £20 billion of efficiency savings in their last manifesto.

    The entire labour Party should be prosecuted because they forced political targets on the NHS.
    Thats just one reason why the greatest clear and present danger to this country is the labour party.

    • Russell

      Never a truer word spoken. And yet not one newspaper or tv channel is mentioning the fact that this NHS ‘shambles’ is almost entirely down to Labour governments 1997 to 2010..

    • richard williams

      NO. As Mr. Pickering below points out succinctly ” Some nurses are terrible cows, that’s always been true, but they should be kept in check by management.”
      True now always has been true

  • James Strong

    The NHS is failing, and in my opinion it is incurable.
    It should be abolished, medical care should be privatised and sorm form of individual insurance would need to be introduced.
    In the world of private businerss the *only* way to succeed is to provide something that the customer is willing to pay for.
    That is not the case with the NHS; and ,in any case, the customer is too often seen to be the government rather than the patient.
    But abolishing the NHS is a huge, huge task and probably impossible given the irrational attachment to it and the fact that asking questions about it leads to hysterical opposition.
    Nevertheless, a barave government would start sowing the seeds of the idea of abolition of the NHS now, even though it is not achievable for years.

    • Theodoxia

      But the Mid Staffordshire scandal (and reportedly other scandals on a greater scale in the process of being revealed) provide the opportunity to capitalise on disillusionment with the statist, monolithic monster and encourage popular demand for real reforms. It’s perfectly possible that a generation from now the majority will think it just as strange to suppose that the government should run hospitals, as at present think it absurd that the government should make cars and trucks or dig coal out of the ground.

    • HooksLaw

      The NHS is not failing – its working very hard and your notion of switching us from our present system is absurd and cause massive upheaval. Not least when faced with all our current economic problems. We already have an insurance system; NI. All health services in the developed world are facing cost problems.

      There may be a case to do something different if we are rich enough to do it but hardly now and getting a consensus is likely to be harder than pulling hens teeth.

      • James Strong

        1) It doesn’t matter how hard it is working; what matters is how effective it is.
        2) Of course switching would cause upheaval, and getting consensus would be difficult, as I acknowledged. But it’s certainly not absurd.
        3) NI is not a proper insurance system because it doesn’t reflect individual risk.

        • Fergus Pickering

          Would you explain (3) please? Of course it is not a ‘prper insurance system’. It is supposed to protect everybody, including poor people and chronically sick people. But you are a bigot. Yes you are. Look it up.

          • James Strong

            Explanation of 3)

            Proper insurance reflects the risk that the insured persons bring to the pool of insurance.

            Imagine that I am 20-25kg overweight, I smoke 35-40 cigarettes a day, drink roughly a bottle of wine or 5 pints of strong lager a night, topped off with a treble whisky immediately before bed.

            Although I am past 50 my new hobby is Alpine skiing. I’ve only just started and am struggling to master it, I fall over a lot.

            I take no specific cardio-vascular exercise and although I do not deliberately defy healthy lfestyle guidelines, because that would be silly teenage rebellion, I just completely ignore them and do whatever I want.

            Do you think I should pay the same health insurance premium as an average person?

            I think a private insurance system would more adquately reflect the risks, don’t you?

            As for poor people, I don’t deny this is a problem to be addressed. One early step is to reduce taxation and leave people with more money to spend on themselves. I do take it as axiomatic that a lot of spending from taxation is inefficient.

            Chronic illnesses are indeed another problem. One early step would be to make it illegal to deny cover for chronic illnesses that were not present when the very first insurance was taken out.

            The standard of the NHS is a big problem, and I’ve just given you a rational response.

            I’m neither unreasonably intolerant or prejudiced (Concise Oxford Didtionary) and you, Mr. Pickering, can’t win an argument, or advance us closer to solving the problems of the NHS, by name-calling.

            • fantasy_island

              I should look up the spelling of dictionary if I were you.

              • James Strong

                Don’t be silly.
                It’s a typo, look where ‘c’ and ‘d’ are on the keyboard.
                Now, I invite you address my points.

    • Fergus Pickering

      Whee do you live? And are you planning to abolish state school while you are about it? Do you think there is the remotest chance of your policies being put into practice?

  • Ron Todd

    Last nights ‘Question Time’ on the BBC first question something like ‘are the appalling conditions at Staffordshire hospital a sign of things to come with austerity?’

    On ‘Newsnight’ the day the report was released the present conservative government was mentioned 6 times before there was any mention of the party in power during the scandal, and that was to introduce a Labour party ex minister who was given a chance to defend labour party health policy and attack previous Conservative policy. The Conservative spokesman was then constantly interrupted and hectored. The panel discussion started with ‘How do we know this is still not happening under this Conservative Government’

    The left will not stop pushing the idea that any problems with the NHS are down to the Tories and ‘the cuts’ . Doctors and nurses managed to treat patients with compassion when the health budget was a fraction of what it is now. The NHS bosses get what they want by pleasing the government bnot the patients. The manager get an easy life by appeasing the public sector unions not looking after patients. The doctors and nurses risk their careers by ignoring liberal/PC sensitivities (like any hints of christianity) not by ignoring patients.

    • James Strong

      Your second paragraph is good; thank you for some cold facts about the way it was reported. Direct quotes would still be welcome.
      Your first paragraph is less convincing. The question about austerity is certainly loaded, but it’s a question and as such it gives the panellists an opportunity to refute the assumption behind it. A politician who wants to do that should be able to.
      But, ‘How do we know this is still not happening under this Conservative Government?’ makes it clear that it is recognised that it was happening under a Labour government.

      • Ron Todd

        Dimbelby is always going to go first to somebody who agrees with the anti Tory attitude.

    • Colonel Mustard

      I noticed also on QT that the SNP spokesman was allowed to get away with the cart before horse comment that he didn’t ‘think’ that “austerity was to blame for Mid-Staffs” without challenge or correction by Dimbleby or the Conservative spokeswoman. In fact I thought the wording of the question in the light of what the report had revealed was not just tenuous but probably contrived.

      • James Strong

        Don’t blame Dimbleby; blame the Conservative spokeswoman. There is no reason to expect the chairman to do a panellist’s job for her.

        • HooksLaw

          Of course you have to blame Dimbleby and the BBC. They are blatantly bigoted.

        • Colonel Mustard

          No, I blame Dimbleby as well because he is very quick to challenge Conservative panellists on any semantic error. In fact one thing I have noticed on this programme is that any Conservative panellist very rarely gets a chance to speak without interruption by Dimbleby whereas Labour panellists are permitted to hold the floor for lengthy periods uninterrupted.

          You seem very intent on defending the impartiality of the BBC. May I ask, do you have a vested interest in doing so?

          • James Strong

            No, I’ve got no vested interest in defending the BBC and I’d be pleased to see evidence to convince me that it is biased. But I haven’t been presented with that; instead I get claims of bias from people who are themselves biased.
            I don’t watch Question Time so I haven’t seen Dimbleby do what you say he does, but if he does it is provable by timings and quotes.

            I’ve looked at Biased BBC and been very disappointed with it, not that they’d care, of course.

            As for websites, there are whole websites dedicated to the theory that the US Administration was behind 9/11. The existence of websites isn’t evidence.

            I’ve seen the Today programme attacked for robust interviwing techniques with Conservative ministers, but to me that is just the interviewers doing their job by taking up a contrary position. And I am glad they do it. John Humphrys should not be interviewing in the style of Terry Wogan.

            Imagine you are a neutral between rugby and soccer and I say ‘it’s common knowlege’ and ‘every man and his dog knows’ that crowds at.big rugby union matches are better behaved than crowds at big soccer matches. Would you accept that assertion as it stands?

            You shouldn’t.
            I would still like to see dispassionate, factual evidence of BBC bias, not assertions.
            And I’m not going to go and look for it because the burden of proof is on those who make the claim; I am making no claim.

            • fantasy_island

              Looks like the Colonel hit a nerve.

            • Colonel Mustard

              “Imagine you are a neutral between rugby and soccer and I say ‘it’s common knowlege’ and ‘every man and his dog knows’ that crowds at.big rugby union matches are better behaved than crowds at big soccer matches. Would you accept that assertion as it stands?”

              Yes, actually. And whether I shouldn’t or not is beside the point. We are not making a court case against the BBC, who by their own admission adopt a “cultural liberal” stance. I agree that the existence of websites is not evidence (and never asserted it was) but I don’t see that I am compellable to cite their evidence here to convince you. That is for you to explore. My own perception from watching the BBC on many occasions is that it is hideously biased towards left-liberal prejudices and preferences but probably more biased against theTories. My comments reflect that and I’m entitled to make them. I am not in a court of law giving evidence and this is not a debating society.

              But let me request some evidence from you. Can you name a well known comedian appearing on the BBC who adopts a right of centre posture and makes jokes at the expense of the Labour Party? Their absence is evidence by itself and yet the BBC’s comedy programmes are full of snide attacks against the Tories, just as their drama programmes include subliminal political correctness and left-liberal morality peddling. Stephen Fry, grand matron of the BBC, is quite overt in his political leanings and several of their “personalities” have openly boasted of membership of the Labour Party on QT. Hardly appropriate from a supposedly impartial broadcaster.

              And then there is the Balen Report…

              • James Strong

                I will google the Balen report.
                No I can’t name a well-known comedian who adopts a right of centre posture, I don’t watch BBC comedians.
                Nevertheless I would expect comedians to make their jokes predominantly against those in power, like Private Eye does. At the moment the power is in a coaltion where the Conservatives are the biggest part.
                What did those comedians do from 1997 to 2010?

                • Ron Todd

                  From 1997 to 2010 the BBC’s stable of right on millionair left wing comedians mostly attacked the Tories, Ever listen to the ‘one show’?

    • Chris lancashire

      There’s an easy answer to this, stop watching QT. I did ages ago and don’t miss the weekly bias. Good to see the audience figures steadily declining.

      • Ron Todd

        I can’t help myself I gave up after the first question.

  • Jimmy R

    I wonder if the same “Stay Calm and Don’t Panic” attitude would have been taken if the same thing had happened with a Private Hospital? Sorting out how the situation arose and who amongst the management was negligent in not preventing it is not looking for scapegoats and neither is punishing them in an appropriate manner. A scapegoat is somebody towards the bottom of the pecking order who is thrown to the wolves by those above in order to distract blame from themselves and to protect their own posteriors.

    What happened at Stafford was gross negligence starting right at the top and trying to sweep the issue away as if nothing had happened is simply not acceptable. People died in their hundreds and those responsible for presiding over that must be punished exactly as they would be in any other organisation.

    If deaths through negligence on that scale had been occurring in an industrial organisation there would be cries for charges of Corporate Manslaughter, and rightly so. I, as most sensible people will do, accept that it is inevitable that people can die as a result of their medical condition, that is the nature of things and is inevitable at some time for all living beings. But that is obvioulsy not what happened at Stafford.
    People whose deaths should, and could have been prevented, dies as a result of massive and persistent failings and glossing over that fact is not only unacceptable but is, in effect, condoning the behaviour of those responsible and conniving with their gross negligence. To do that would be unforgivable and must never be allowed to happen.

    • Russell

      Nurses leaving patients in their own pools of urine or soiled sheets, unwashed and not fed or given water should be sacked and/or prosecuted for neglect of their duty of care. The tiers of management put in by labour, full of grossly overpaid so called executives should suffer the same consequences, as should the Ministers of Health who were responsible for setting up this chaotic and expensive jobs for the boys management structure.

  • 2trueblue

    Who is in charge? From the top down it seems that those in charge today appear never to have walked through the hospitals they are supposed to be in charge of. What then were they doing? Where is the line of management? It is not good enough for anyone to be overlooking hospitals without understanding who else is involved and this is the problem.
    Nurses today go to university and this seems an odd place to start training for a role that is very ‘hands on’ in all senses of the word. Maybe that is where the whole process needs to go back to. Ward managers? Again the same question. Go through the whole chain and it begs the question: what do these people do and are they sufficiently engaged in what goes on in the whole process of actually caring for the patients, in every sense. That is what it is about. There are too many people hanging around who are not actually interacting with the patients, when what we need is the reverse. When Matrons, ward sisters, staff nurses were in charge the care was better. The facilities may not have been so new but relatives did not worry whether their loved ones were in safe hands.
    When hospitals are being ‘visited or inspected’ they are actually given notice that this is going to happen, WHY?
    And yes, heads should roll, this is peoples lives we are talking about.

  • Daniel Maris

    Well I don’t believe it’s so sacrosant that “Sir David Nicholson” can’t be sacked. He was in charge at the time. He more or less admits he never toured the wards. In my mind, given what was going on, that is an admission of negligence. How many big hospitals were under his charge? How long does it take to walk around them? 2 days? 4 days? 10 days? Out of maybe 1000 days or more. He has no excuse.

  • Loomie

    Isabel’s observation re the NHS being sacrosanct to politicians is spot-on. Until politicians learn that criticising the worst elements of the NHS needn’t imply a blanket of blame over every single healthcare professional, manager or administrator, little constructive remedial action will be taken. Politicians of every party seem scared to say or do anything seriously revolutionary to improve the NHS, for a whole variety of reasons, some bad, some laudable. No nurse can be condemned without carefully pointing out that the others are all saints and angels. Are health ministers (and their bosses) with honourable motivations simply going to continue throwing good money after bad, in the process doing more long-term damage, instead of thinking the unthinkable? We often hear that a major threat to public healthcare in the UK is that the Tories claim to value the NHS, but don’t mean it. Perhaps a bigger threat might be that the current Prime Minister claims to value the NHS, and means it.

    • telemachus

      Cameron’s one and virtually only one virtue is indeed that he loves and values the NHS
      We trust him on this because of the tragic experiences with his son
      He transiently lost us because of political weakness over giving Lansley his head
      Now he has taken charge
      He could have left Hunt to deal with Francis but no he took it himself with devastating effectiveness
      Dare I suggest that here we have the basis of a bipartisan way forward with all dedicated to support value and motivate the dedicated Doctors and Nurses who dedicate their lives in our service
      It is correct not to sack the demoralised individuals whose corporate depression led to the faults at Stafford and elsewhere
      Can we see leadership from Political Medical and Nursing leaders to say. Hey you are highly trained highly skilled professionals, we need you and we thank you for the weekends and nights that you have forsaken your families on our behalf
      We laud your efforts
      We can all better ourselves week on week
      We will support you in your drive to perfection

      • HJ777

        Yes, of course, everybody was “only following orders” and therefore cannot be held to blame for anything.

        They all “dedicate their lives to our service” altruistically in exchange for nothing more than the best pay in Europe and generous pensions.

      • Fergus Pickering

        Nurses and doctors do not ‘dedicate their lives’. They are not saints for Christ’s sake. They do a job for which they should be, and are, paid adequately. Some are nice and some are not so nice. As you well know.

        • Colonel Mustard

          When I was a young man in hospital in the middle part of the last century there were nice nurses and there were not very nice nurses, as well as some terrifying matrons. But one thing was common to them all. Their regime was disciplined and rigorous towards the care and wellbeing of their patients. I remember very well the very early morning cleaning routine and changing of bedclothes, etc., all performed by smartly uniformed nurses. They all worked very hard at patient care, cleanliness and hygiene. The separation of clinical and so-called ‘support’ (cleaning, etc.) services has gone badly wrong. The very ethos of Nightingale has been undermined, not least by the status aspirations and task prejudices of the nurses themselves.

          This is why when I hear lefties boast of “progressive” this and “progressive” that I roll my eyes (rather than swivel them).

          • Fergus Pickering

            Good post, Colonel. But there were nasty nurses even then. I met one from Belfast I would have cheerfully strangled. She was probably married to a terrorist. And there were lazy, useless doctors. Just as there are nasty lawyers (and how) and lazy, useless teachers. Are and were. I think you may be right IN GENERAL. And I have to say that my own experience of the NHS over the last few years has been all good. I’m still alive and I’ve got sight in both eyes. However, London and the South East isn’t bloody Staffordshire. Though the WestMiddlesex Hospital was a bit of a disaster area a quarter of a century ago when my father had the misfortune to spend a couple of months in it.

          • Ron Todd

            One big change in hospitals between the first time I was in one as a boy and the last time was the uniforms. The first time I could tell the nurses from the ward sisters and the ward sisters from the matrons by the uniform. The junior doctors had white coats the senior doctors had suits. The last time I could not tell nurse from cleaner or doctor from somebody who had walked in from the street.

      • 2trueblue


      • Ron Todd

        If this had been the private sector there would have been mass sackings and resignations. People would be in the dock facing charges up to and including corporate man slaughter. Except of course in the private sector a business has to have consideration for the customer not just government tick box targets .

  • Archimedes

    “monolith might be a sensible way of running the free at the point of delivery health service that the British public feels so emotional about”

    The emotional attachment is dying with the generation that remember the reasons for the NHS. This is just another reform. You’ll find that polling will tell you that people tend to be less attached to the NHS, than they are to their life and, given the entwined nature of the two, it would suggest that they probably don’t really value the NHS all that much now, do they. It’s just a means to an end, not an emotional attachment.

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