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Who’s sorry now?

July 25, 2014

On Twitter, I’ve never been a big fan of those twee little sayings some people like so much. You know the sort of thing: ‘Live out your imagination, not your history’ or ‘One machine can do the work of fifty ordinary men. No machine can do the work of one extraordinary man’. Something did catch my eye the other day though. It said ‘If you want to identify the truly powerful, just ask who cannot be criticised’ – or words to that effect. It had a ring of truth about it, and it made me wonder who, by that reckoning, are the stand-out candidates for the title of Most Powerful People in Britain? Could it be the government? Nope. The Royal Family? Uh-uh. The BBC? Don’t think so. The Established Church? Are you having a laugh? The Square Mile? Oh stop it! No. The group of people that no one these days is allowed to say a single word against is: NHS patients.

This was brought home to me more forcefully a couple of weekends ago when I read a comment from Patient Opinion that was doing the rounds on Twitter. The story told by the commenter was one of being transferred as an emergency to a major hospital and undergoing what sounded like life-saving surgery. A happy ending? Not really. There were no words of gratitude or appreciation for care received. Instead, the commenter had contacted Patient Opinion to complain that the hospital had not yet got around to installing Wi-Fi – and that as a result, the short post-operative recovery period had been rather boring.

So here’s Twitter, a-bristle with righteous indignation on the commenter’s behalf. The commenter further alleges that the hospital selfishly got its own operational network up and running while patients were left high and dry and drops dark hints about double standards. The hospital repeats its apology, confirms that patients’ Wi-Fi is now installed and admits that in retrospect it could have ‘set a different priority for this service’. I alone, or so it feels like, am impotently yelling at the screen “Nooo! You’re not the London Palladium! Your priority is safe care! Never change that!”

OK. If I’m totally honest, I did have sympathy with the commenter. Boredom can be depressing, may delay recovery, and staff should always strive to alleviate it. On the other hand, a couple of days spent twiddling your thumbs seems a small price to pay for a return to health. NHS patients have every right to expect the highest quality treatment and care. Whether they also have the right to be provided with on-tap free entertainment is, I think, a question of a different order – but the fact that a complaint was made about its absence suggests that at least some service-users see it as a perfectly reasonable demand.

In the aftermath of last year’s Francis Report, the expected demeanour of anyone professionally connected to the NHS seems to be one of abject – and highly visible – contrition. This was underlined again a couple of weeks ago when the Health Service Journal reported that under proposed rules relating to the new Duty of Candour ‘patients will have to be informed when an incident occurs that ‘could’ have led to severe or moderate harm or death. Previously, the duty was expected to apply only when incidents had led to harm or death…When such an incident takes place, NHS organisations will have to write to patients and include an apology’. Comments on the article were despairing – a bureaucratic nightmare and a field-day for the lawyers were the widely predicted results.

The motivation behind this move is – one assumes – twofold. Firstly, the patient’s right to know – in this case, the right to know every hypothetical that could have affected the outcome of their admission; and secondly, the openness and transparency that is now supposed to characterise all NHS dealings with the public. But it has to be asked whether an attitude that now amounts to one of ‘institutional contrition’ towards patients on the part of nurses and other NHS workers is really conducive to honest interaction. Am I the only one to feel that it has become harder to, for example, challenge patients about inappropriate behaviour or mistaken beliefs? Is this the hallmark of a open and mutually respectful culture?

A shift of power away from professionals and towards service-users in the NHS was and is entirely necessary. But it would wrong to conclude that once it has been achieved, there will be no more problems. Excessive focus on staff error may trigger a number of psychological responses: defensiveness and resentment in some, timidity and excessive caution in others. None of these seems conducive to the establishment of healthy relationships.

To return to the HSJ‘s Duty of Candour story, I suppose that under the proposed new regulations, I would have got an apology for my mum’s death. And while I appreciate that many people’s experiences are very, very terrible, have been the cause of enormous and unnecessary suffering and fully deserve investigation and answers, I am speaking here entirely for myself. And my view is that my mother was eighty years old and died in her bed, after a short illness and surrounded by her family. Especially with everything else that’s going on in the world at the moment, why would I need an apology for that? I think I would have found it patronising, as if the hospital’s assumption was that I wouldn’t be able to cope with the loss of a parent.

Minds keener than mine have suggested that the Coalition’s aggressive championing of patients’ rights is being used as a crowd-pleasing distraction from the the deeply unpopular agenda (which, by the way, no one has ever had the right to vote on, as it appeared in neither party’s manifesto at the last election) of opening up the NHS to private health care providers. That their attachment to individual rights in the NHS is down to politically expediency rather than commitment to an ideological constant is plain from the attitude they take towards rights in other areas: the right to benefit payments and to privacy for example, are both under severe threat. To that extent, our love-affair with ‘rights’ is a cynical manipulation that diminishes rather than empowers.

But the rights game is also a risky one. Health care professionals are bound by codes of conduct that balance their rights with responsibilities and hold them to account if they act against patients’ best interests. They are not perfect. But they are something. Patients’ rights, on the other hand. are practically limitless. It would appear that they already extend to the right to be kept entertained. So where next? Well how about this: female patients have the right to be cared for only by female nurses.

I often think that after the Jimmy Savile scandal and last week’s gruesome court case involving Canterbury staff nurse Dale Bolinger, all it would take is a few pages of outrage in the Daily Mail to spark a campaign to ban the delivery of personal care to female patients by male nurses. Insulting? Yes. Costly? Ridiculously. Unworkable? In the current staffing climate, almost certainly. But if the public could be persuaded that it’s what they want, who knows…I really wonder how Jeremy Hunt would handle it?

For the Health Service Journal article on the Duty of Candour (may be paywalled), see:
http://www.hsj.co.uk/news/duty-of-candour-extended-to-cover-wider-set-of-incidents/5072993.article?blocktitle

 

Stop Press: New guidance on Duty of Candour from the Care Quality Commission:http://www.cqc.org.uk/sites/default/files/20140725_nhs_fppr_and_doc_consultation_final.pdf . See pp 23-24 esp para 7.

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2 Comments
  1. Apatient permalink

    So disagree with this blog.

    Patients’ rights in the UK are massively limited. We have a gatekeeping system here – so cannot get secondary care opinions even if we need them unless a GP deigns to refer us.

    We have a boundaries system here so we can’t register at a better GP if we are receiving crap care.

    We don’t have a “right” to a second opinion – we only get one if the GP deigns that this is necessary.

    We don’t have a choice of effective treatment – we get given whatever the doctor thinks is best even though doctors may know less about our diseases than we do.

    It’s hard for us to see our records.

    It’s hard to make complaints – try complaining about bad care when you know you’ll have to go back and see the same doctor because of all the gatekeeping/boundaries restrictions listed above.

    I’ve lived abroad and in other countries – patients have much more say and involvement in their own healthcare.

  2. Thank you for your comments. I think your experiences illustrate the kinds of problem I am talking about where ‘rights’ are concerned. We seem to have got ourselves into a situation where the rights that you feel – quite justifiably – should be your entitlement remain unaddressed while others are free to interpret the concept as ‘getting my own way in everything and abusing with complete impunity any health care worker who tries to stop me’. The outcome is more misunderstanding and suspicion between the two sides – something that helps no one, as I’m sure you’ll agree.
    I’m actually very far from being against patients’ rights, and I hope you can achieve a satisfactory resolution of the problems you are encountering. But I think it’s legitimate to ask whether the hopes we are pinning on ‘rights’ are an illusion. If everyone has the right to whatever they want, how will the NHS cope? These are the questions we are not encouraged to ask – because we wouldn’t like the answers. To that extent, rights, at least as deployed in current political rhetoric, are false gods, giving false hopes. We’re being cheated. But maybe that’s all part of the plan. Are we just being used?

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