Friday, 1 November 2013

NHS scandals: they'll always be there somewhere

This weeks' official government report on National Health Service complaints makes for grim and depressing reading in places. It's long been time to face a fact that's been staring us in the face: some parts of Britain's NHS can be nasty, brutish, unfeeling and downright cruel. Lots of elderly patients end up herded around, while no-one really knows what to do with them. Lots of people are treated with unfeeling brusqueness, rudeness, nastiness and even malice. No-one can read the case studies from Mid-Staffordshire without shaking their head sadly at the injustice of it all.

Now there are lots of reasons for this. For one thing, cash-starved local authorities don't want to deal with ever-rising numbers of old people, leaving hospitals and doctors scratching their heads as to what to do with them. Hospitals are hardly the place for them, as there's often nothing physically wrong with them, at least acutely: but where are they to go?

The most important insight historians can lend to all this is that we've been here before. Again and again and again. We've had scandal after scandal - and revelation after revelation of poor treatment. Ely Hospital in 1967. South Ockendon in 1972, and Normansfield Hospital in 1976. All of the subsequent inquiries revealed that patients who could be ignored often were, relegated to backrooms and hidden wards, well out of sight of hospital and long-stay authorities who basically didn't want to hear about any problems. 

What were the results? New governmental machinery. In the early- to mid-1970s, a Health Service Ombudsman, still there to this day - who could only look into the administrative side of these questions. New complaints mechanisms, forcing hospitals to take patients' views seriously. New legal rights. Citizens' and Patients' Charters. Commissions and Councils and Boards and 'Champions'. And so on - you can read about it all here, if you've a mind to track through an academic article about it. Where has it got us? Well, care is undoubtedly better overall now - partly because of much higher spending, and partly because NHS professionals have gradually got softer, friendlier and more patient-friendly over the years. 

But none of the formal and governmental changes have eradicated poor treatment. Because they can't.  It's a category error, like a visitor to Oxford asking where the university is while the buildings of its Colleges are all around him.

Only a cultural shift on the ground and in the wards can do that, along with many of the practical and admirable changes to training, treatment, complaints at institutional level, local management and constant vigilence that the Clwyd Report recommends. And an acceptance that, in such a huge organisation, poor treatment and downright nastiness will always be there somewhere. It can be driven down and into the corners, but it can't be eliminated altogether.

That's what the history of these scandals tells us - an insight that might make us worry about the very complex and impossible-to-manage NHS that is being born right now, under which no-one is quite sure who is responsible for exactly what. Will the future really be less risky than the past? No-one seems to know. More patients' rights, and some hard-headed practical reforms, say 'yes'; deep, grey and fuzzy administrative confusion says 'no'.

Watch this space.

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