Stafford and the NHS

It is an old story, but it has been given new prominence by the Francis Report into what went on at the Stafford Hospital.

In a report by the Healthcare Commission last March, Sir Ian Kennedy, the commission's chairman, said, "There is no doubt that patients will have suffered and some of them will have died as a result. The investigation found there were too few doctors and nurses, vital equipment was not available when needed, patients did not receive the care they deserved and the trust had no system in place to spot when things were going wrong."

Among the most serious failings were filthy wards, with blood and excrement encrusted on surfaces; nurses with inadequate training were unable to operate cardiac monitors or intravenous pumps, which meant patients were not receiving the correct medication or the right dose of fluids.

Furthermore patients were "dumped" for hours and even days at a time in smaller units without a dedicated nurse to care for them. There were too few consultants in A&E to provide adequate cover and often there was no experienced surgeon in the hospital after 9pm.

Appalling standards of care put many patients at risk, and between 400 and 1,200 more people died than would have been expected in a three-year period from 2005 to 2008, the commission found.

The Commission stated: "An analysis of the trust's board meetings from April 2005 to 2008 found discussions were dominated by finance, target and achieving foundation trust status.

"There is little evidence that poor standards of nursing care were identified and discussed. The investigation found that poor results of surveys of patients or staff were not discussed in public. It found that a doubling of C. difficile infection in the early months of 2006 was not released to the board nor the public."

Inquiry chairman, Robert Francis QC, made 18 recommendations for both the trust and the government in his final report after hearing evidence from more than 900 patients and families. Mr Francis also identified a chronic shortage of staff, particularly nurses, as being largely responsible for the sub-standard care give to patients. He also said that while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion to patients.

Requests for assistance to use a bedpan or to get to and from the toilet were not responded to. "Patients were often left on commodes or in the toilet for far too long. They were also often left in sheets soiled with urine and feces for considerable periods of time, which was especially distressing for those whose incontinence was caused by Clostridium difficile. Considerable suffering, distress and embarrassment were caused to patients as a result. The inquiry also found that the attitude of some nurses "left much to be desired". It added: "Some families felt obliged or were left to take soiled sheets home to wash or to change beds when this should have been undertaken by the hospital and its staff. Some staff were dismissive of the needs of patients and their families."

It seems that the management of the hospital were more concerned with meeting government financial targets than caring for patients. Managers made nurses redundant to save money, but wasted over a million pounds in redundancy payments. At the same time they awarded themselves huge bonuses. The report can be viewed here.

How far should the disgraceful behavior at Stafford be seen as typical of the NHS? Is this what you get with 'socialized medicine'?

By definition this was not typical. Stafford was picked up because it was an outlier - by far the worst hospital in Britain. It is no more typical of the NHS than Harold Shipman was of GPs.

However, it does expose a risk when there is a monopoly provider in a particular area and the rigors of competition are removed. Where there is a state monopoly, institutions become too big to fail. Too big to fail is also a problem with other huge employers - take General Motors, Chryslers, and the Royal Bank of Scotland for example. To my mind it is a mistake to prop up failing enterprises. We must learn to manage failure. When a big company fails there will always be someone who can step in and buy what is valuable about the business - just as Barclays did with Lehman Bros. If there is a need for a service, a business will step in and fill it. When the British-owned car industry collapsed, the country didn't get out its bicycles; Nissan, Toyota and Honda stepped in and built factories. BMW, VW and Peugeot all stepped in and bought the profitable bits.

Although Stafford was the worst hospital in the NHS its problems were indicative of what can happen when government gets involved in healthcare. Because the taxpayer is footing the bill, there is a constant drive to cut down costs without concern for the individual circumstances of an area. Do you have more old people than normal? Your costs will be higher. Are house prices high in your area? You will have to pay more for adequate staff.

But we shouldn't lose sight of what is good about the NHS. Contrary to what people assume, there is a thriving insurance based system in the UK. But only 20% of the population chose to join it because the taxpayer-funded system is good enough for them. You might think it's because they don't want to pay twice, but in the US people pay twice: once in their taxes for Medicare, Medicaid, VA hospitals, the NIH, and County hospital ERs; and once for their insurance. And the proportion of the GDP spent on provided for government run services is much higher than the proportion of the (much smaller) British GDP spent on the NHS.