Damning Criticism ? Nothing new

News of the NHS Ombudsman’s report that hospitals widely and disgracefully fail to provide appropriate care for elderly patients does not surprise me. My own experience and much anecdotal evidence tells me this has been the case for some years: a serious and growing problem. What is most disturbing about this ‘news’ is that the wheels of the NHS will grind slowly, even if its managers can be made to take any remedial action. Indeed, I have my doubts that this can ever be done.

First, because of the nature of the beast. The NHS is such a bureaucratic behemoth that delicate changes in its practice will be vanishingly hard to impose with any consistency. Even when one head of this Hydra can be cut off, two more will rapidly be growing to replace it.

Secondly, because the NHS system has for years devoted itself to excellence in brushing off complaints. Its management personnel (and that includes nurses) have become past-masters in the process of closing ranks; skilled in the art of letting the private individual’s efforts to complain become ‘lost’ - by a process of automatic denial and delay - in the NHS’s conveniently huge bureaucracy. The Ombudsman will not want to admit it, but I suspect the NHS has become incapable of reformation, even if some of its own people say they desire it.


And, as I say, I know something of this not merely from the accounts given by others, but also from my own experience. A while ago, concerned at the way a patient was being treated, I ventured to ask, discreetly, the nurse who seemed to be in charge of proceedings, whether things were quite as perhaps they ought to be. Her response was staggering. Altogether ignoring my attempt to ask discreetly, in an un-embarrassing way, she almost shouted at me - in such a way that half the patients in the area as well as all the staff could hear all she said. My attempt to ask politely was made to sound as if I had asked something outrageous. And what she said did nothing to contradict that impression: in this hospital nurses were in charge of these procedures; she was a highly qualified person and though I had no right to ask (I hadn’t asked) she would tell me she even had a degree. And who did I think I was questioning what they were doing etc.. Alarmed and unhappy, and determined not to distress the patient any more than the nurse’s disgraceful and unnecessary outburst had already done, I simply said goodbye and left. The next day I had occasion to return. None of the staff spoke much to me; it was an edgy kind of atmosphere. And it was interesting to find that the nurse in question, she of the deeply unprofessional outburst, was not anywhere to be found. Maybe she was just not at work that day; but I suspect she had been discreetly and temporarily moved elsewhere. Hmm. Methought she had protested just a bit too publicly, too quickly and too much...... After all, as it emerged, I had been right in my concern: the hospital had taken that patient in, specifically to avoid a certain problem, and proceeded to treat the patient in such a way as to create that very problem...

Much longer ago, I remember writing to ask why hospital staff had managed to treat one of our children inappropriately. The letter which eventually arrived in response from the relevant highly paid executive in charge of excuses, simply dismissed all my concerns out of hand. The staff, it said, had done everything in their usual way and recorded no problems. (Well, it might have been the case that they recorded nothing! But they should have: for it was not true that 'nothing' had been amiss - I was there and I saw and heard). Moreover, it went on, even if things had been amiss, there was nothing further to be done, for the doctor concerned had (strangely) now left the trust’s employ and probably could no longer be contacted... !! Well, well.

Believe me, unless you have clear evidence and can involve the police to investigate, chasing complaints about NHS misdemeanours can string out for years. Hospitals waste money (which could go on healthcare) on entire departments devoted to answering the complaints they receive: so many are the problems and issues. Most of us, of course, give up in disgust at their endless delays and evasions. So the behemoth escape criticism, and staff are seldom actually held to account. Sadly it is not an unusual problem in our very intricate society.

Where a solution lies, I am not at all sure.
There is much talk of the need for resources, but I suspect it may also be found in teaching nurses somewhere outside the things that pass for universities these days: in Wards where they may acquire hands-on training for specifically nursing qualifications. And teaching nurses that their work is to keep wards clean, do the messy physical care of patients, and get their hands dirty. (And if they don't like that, to find another job: for their predecessors could manage it). I suspect it may also lie in breaking up the gigantic structures of the NHS, so that everyone can work with human scale units, not industrial strength ones.

The NHS ought indeed to be run in a business-like manner; but it is not a 'business' and it seems folly to try and ‘manage’ it as if it were. The management ethos and methods of commerce (suspect even in commerce!) have never been appropriate to healthcare. But I fear it will take more than the Ombudsman to change things for the better.