Death by negligence in the NHS

I read with sadness this morning, Mary Riddell's interview with Ann Clywd for the Telegraph. Ms Clwyd may be at the opposite end of the political spectrum to me, but no one should go through what happened to her and her husband and I whole-heartedly support her campaign to do something about it.

Six weeks ago, Ms Clwyd's husband, Owen died of hospital-induced pneumonia. She descibes him, crushed against the bars of his hospital bed, shivering with cold, his lips cracked from a nearby fan, his eye weeping from an untreated infection. And not a nurse in sight. It is a depressing tale of neglect and callousness and sadly it is all too common.

My own mother died in a not dissimilar fashion. She was 83 with dementia when she found herself in the local hospital with a broken hip. They operated and the following day she was bright and sparky and the best I had seen her for some months. Then something happened. Her cognitive abilities plummeted. I asked the nurses what it was. They were dismissive. I asked if she could be in pain. They were dismissive. Everyday I asked a different nurse to investigate and every day I was fobbed off, and meanwhile my mother became more and more withdrawn.

Then I had a brainwave: maybe she had a urinary tract infection. I knew that could affect her cognitive abilities. So I asked the nurse if they'd tested her urine, adding that she was catheterised and wasn't a routine test standard in those circumstances. The nurse said it was and she was sure it had been done but she'd check. The following day, there was no change. So I asked about the urine test again. It hadn't been done, but the nurse said she would do it as soon as she had a moment.

Two hours later I got a call from the registrar to inform me that my mother had end-stage renal failure. It's pretty clear to me that a simple failure of compassion and a large dose of negligence killed her. The NHS went to great expense to replace her hip, successfully, and then failed to spot the signs of and test for a UTI. I find that stunning.

But what can we do about it? I don't think it's simply about slagging off nurses. The consultant who spoke to Ms Clwyd described her husband's death as a nursing failure and I'm sure my mother's death falls into the same category. But that's too easy.

I think the key lies in the fact that nobody takes responsibility for each patient's care. When you enter a hospital you are, nominally, put under the care of a consultant. In practice, you may never see that consultant and if you do, it will be a quick hello, scan of the chart and onto the next. The sense in which the consultant is responsible for the totality of your care is theoretical. They may wish to. Their Hypocratic oath may even require them to be. But nobody could possibly have personal responsibility for that many sick people.

What would happen, though, if you did make someone truly responsible for each individual patient? It doesn't have to be a consultant, or even a junior doctor. All you need is someone with enough good sense to spot when something isn't right.

Anyone old enough might remember the discussion back before the Japanese showed us how to build cars about the difference between the British way and the Swedish. The Swedes back then were producing cars that, in build-quality terms, were second to none. And they were doing it by having small teams who each had resposibility for building a car from start to finish, whereas we were handing off from one team to the next as the car passed along the production line.

It seems to me that the Volvo method might provide an answer to this particular problem of the NHS. When large numbers of people are all, corporately, responsible for an outcome, it doesn't tent to turn out that well because no one person sees it as their responsibility to do something if someone else migth do it instead. But assign one individual to each patient and make them responsible for that patient's well-being and then see what happens.

It's got to be worth a try hasn't it? Or do we have to wait until more elderly people die ignominiously and unnecessarily?

The NHS's Structural Deficit

Today's Telegraph has a fascinating and deeply depressing little article on the latest outbreak of hooping cough that has now taken 13 little lives. Those deaths are saddening of themselves, but what affected me more was an overwhelming sense that they were avoidable but for a structural deficit within the NHS.

What do I mean? The NHS's aproach to diseases like hooping cough is simple: immunisation. Think about it for a moment. We now routinely immunise out children against hooping cough (that's the P in DTP and stands for pertussis), dyptheria and tetanus, measles, mumps and rubella, meningitus of various alhpabetical types, HPV and tuberculosis. Many of these are given together in cocktails. Several involve boosters. And if, as a parent, you decide not to agree to any of these innoculations, for whatever sensible and cogent reasons, boy, do you get harassed by the local arm of the NHS.

Now many will say this is right. That disease control is all about building up a herd immunity. But is it that simple? Let's take another look at the hooping cough outbreak. Apparently current vaccination levels are high and health experts (whatever they are) say that the outbreak is not due to parents shunning the jab. Even so the NHS is urging women in their third trimester to get vaccinated. Why? Could it be because it's just another way for the NHS to keep tabs on us; to fill out forms, tick boxes, achieve the trigger levels for payment schemes, control our lives?

Hold that thought for a moment and look at the reasons that are being given for the current outbreak. 'Whooping cough cases tend to come in waves as immunity against the disease provided by vaccination wanes over time and allows small outbreaks to occur' the Telegraph reports.  The article then goes onto describe the symptoms in both babies and older children and adults. And that's when it hit me. You see, in older children and adults the disease presents as a prolonged cough, just like the one that was sweeping around Sussex, for example, this summer. My daughter had it. Several of her friends had it. And when they went to the doctors they were all given the same story. Yes, it's a nasty cough, it lasts about 8 weeks and it will go away on its own. At no point did the GP mention hooping cough, or warn them to keep away from babies.

And when you think about it this is typical. One part of the NHS is massively pushing immunisations against a disease that kills babies while the other part of the NHS fails to spot (or doesn't bother to mention) it in older children. And the funny thing is that it's not two parts of the NHS, because the GPs who aren't bothered about hooping cough in older children are the same people who are pushing the vaccines. But then again, there aren't any boxes to be ticked, forms to be filled, payments to be won when someone comes along with a cough, are there?

So is there a structural failure here? I'd say so. And it's deeply disturbing when it leads to the death of so many tiny lives.