Saturday, 12 November 2011

Health matters

Many years ago, when I first came to work in London it was as a Nurse.  I didn't last long, for lots of reasons which I may return to another time.   Fast-forward 25 years and that Nursing background informs my day to day work so that I would never consider those years wasted.   I take no satisfaction in reading about the latest 'crisis in nursing care' report but equally I'm not surprised by those reports.   NHS hospitals in particular have become adept at providing treatment, without care.    

Care matters.  I would actually disagree that it is unskilled work.  During my training, it was a cardinal rule that physical care allowed you to observe and assess the whole patient; to consider their hydration status, mobility issues, level of consciousness and orientation and to detect any changes which might be significant so that treatment would be adjusted as appropriate.   

When I started my Law degree and others learned that I used to be a Nurse, I became used to comments about how it must be a relief not to have to do bed baths or wipe bottoms or whatever.   Again, I would say that it takes considerable skill and sensitivity to engage with another human being in such an intimate way and yet allow them to retain their dignity whilst maintaining a degree of professional detachment.    If close personal care is delegated away from trained Nurses without maintaining close supervision, Nurses lose their ability to know their patients and then what are they?   Drugs administrators?   

I fear that the growing number of stories in the media will be as nothing compared to the storm to be unleashed with the publication of Robert Francis' QC's Report following the Public Inquiry into the Mid-Staffs Hospital scandal, due in Spring 2012.  

And why is this likely to be a major scandal and possibly lead to the next big institutional crisis (after Banks and MPs expenses )?  Well because it was a Foundation Trust.  There was a rush to convert to FT status by lots of Trusts and it is emerging that the quality standards monitors appointed to check that they were fit to manage themselves as FTs, each thought that the others were checking.  Classic.

Before I returned to the big City to work, I would have said that I was pretty well informed generally but the meaning of Foundation Trust had sort of passed me by.  Turns out they are almost like a privatised part of the NHS or to put it another way, FT status allows the Trust to BORROW.  Yes, read it and weep.  

In order to re-build our hospitals nationwide, the last government (and the Tories didn't object at the time) created these entities, so that their borrowing would be off-balance sheet essentially.  

The Health Service Journal estimates that about 30% of these FTs are so indebted that they cannot make their loan repayments...but they are too big to be allowed to fail.  

Enter Circle and their acquisition or management contract for Hitchingbrooke Hospital.   In the clamour by Labour MPS over the past couple of days to condemn this move, where I wonder was Andy Burnham MP, who presided over the unseemly rush to convert as many Trusts as possible to FTs in the dying days of the Labour government?  

The hard reality is that it was either Circle takeover or closure.  We had better hope it works, because it's unlikely to be the last and if it doesn't work, what then?  Another massive bailout?

I feel tired.


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