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Quality Care Commission.

Posted: Fri Nov 27, 2009 4:57 pm
by sejintenej
In reply to the recent thread on OFSTED, and as a follow-up to the Elf & Satety Gorn Mad thread (to both of which readers are referred)


Today's newspapers comment on a Quality Care Commission inspection of Basildon Hospital. Let me start by declaring an interest; I was and am a patient there (and despite the newspapers (and probably the wishes of readers) I am still alive).

Apparently the A & E is filthy, older / incapacitated patiens are starved ...... and in all the place is a shambles. I arrived one evening in A & E, was seen immediately and within minutes (?seconds) I was on a bed being checked over after which I was promptly and effectively treated. The place appeared very clean (no bloodflecked curtains as the newspapers mention) and although it was not necessary in my case every few minutes a member of staff looked in to check on me. Everything was clearly explained, I had ample opportunity to ask questions and eventually they decided to admit me. (I consider that in the circumstances that was a 50:50 decision which accords with what the doctor said)
The next morning I wake up to a spotless ward (there was one cleaner working full time (and did she work!) on one ward.) I was given a simple choice - either I went "over there" to wash or they would bring a bowl of water to me. and so it continued.

I stiil go there at least semi-annually - I was there on 11/11 and was happy with what I saw. I have been an in-patient in many hospitals and that was a close second to Southampton Chest Hospital!)

Nearby, and my normal "local" hospital is somewhat different. I was in and out of wards for about 6 weeks. The cleaner was more than willing but the flesh was weak - to say she was aged is understatement - I doubt if she is still alive. The washing facilities were filthy and for the staff to suggest to patients that they wash was (as the ward sister succunctly put it) against the patients' human rights. I never never saw a bowl of water taken to a patient's bed despite the fact that the population was a mix of those suffering fractures and cancer (at least one died whilst I was there without even the curtains being drawn). Of course medicines prescribed were not always given and on at least one occasion the wrong medicine was handed out, being handled with bare hands. I complained and the head of one involved department answered in writing that the complaint should be ignored because the complainant has not properly respected the medical staff. Yes, there were two Macmillan nurses between the three hospitals. They even had a telephone number but without an answering machine and nobody to accept calls. The Ombudsman had a staff member in that hospital (the first time ever apparently) for 2 years and there were some improvements. It is still regarded as being terrible despite new premises.

In respect of that second hospital I needed to go to to the A & E of another hospital in that Trust. On the second instance they refused to look at my paralysed daughter because it was their policy not to treat sports injuries (an injury she received as a resulkt of school gymnastics). This was a repeat of an answer given 12 months previously to a virtually identical injury so it was NHS policy, not a stupid doctor. (Yes, someone has told me that that decision was illegal but it is more illegal to argue with a doctor of a certain race)
The third occasion was when I had a very severe cut. Bleeding like a pig I had to park 1/2 a mile away (I forgot to take money) and after treatment I passed out. This was "inconvenient" to the hospital so Security arranged for me to be "removed" from the premises though they didn't take me to my car. Dr Scott of CH, were he still alive, could tell the result; I was still bleeding 9 days later.

I think one of the problems (and I hope the moderators will allow this quote) is the staff. A ward sister, asked about staff commented that "look at the sort of people who live around here and where we have to get our staff". Both hospitals are in the same sort of areas and we have all seen the "Essex Girl" jokes

If the newspapers are to castigate hospitals can they please get their priorities right?

Re: Quality Care Commission.

Posted: Fri Nov 27, 2009 5:08 pm
by J.R.
David - I'm with you 100% on this.

It's not the doctors, nurses and medical staff that's ruining our wonderful N.H.S.

Its the Government, hospital Managers and admin jobsworths that are doing it !

Re: Quality Care Commission.

Posted: Fri Nov 27, 2009 6:53 pm
by sejintenej
J.R. wrote:David - I'm with you 100% on this.

It's not the doctors, nurses and medical staff that's ruining our wonderful N.H.S.

Its the Government, hospital Managers and admin jobsworths that are doing it !

No, no and no again.
It's so-called human rights plus the loss of common sense (my post yesterday). If a staff member doesn't pull their weight they destroy the edifice and there is nothing legal that can be done to stop them. Bring back matrons who can sack them without notice if they don't toe the line.

Re: Quality Care Commission.

Posted: Fri Nov 27, 2009 10:45 pm
by Jo
Well..... it's a while since I worked in a NHS trust, though I still work for the NHS. It's far too simplistic to blame any one (or more) group of people. There are dedicated and conscientious managers and there are lazy doctors and nurses - good and bad in every group. A lot of managers are ex-nurses - they don't suddenly turn into bad people when they take management jobs (you've been watching too much Casualty <spit>). I was a senior manager at the trust (though not on the clinical side) and I take exception to just being written off by people who should know better as "ruining our wonderful NHS" (oh please!!!!). Nor was I one good apple in a rotten barrel - I was privileged to work alongside some very gifted and hardworking colleagues (as well as some mediocre people, as you would expect in any team).

When my father was in and out of hospital in his final years, it differed from ward to ward. I suppose you could say that senior management should be ensuring high standards are maintained throughout, but in one ward I had to get very assertive to make sure they even did the basics like write up a proper care plan. In another (fortunately the one in which he spent his last weeks) the staff were lovely and it was clearly a well-run ward.

As it happens I've also been a patient in Basildon Hospital, though it was nearly 12 years ago and I'm sure things have improved since then, but I wasn't impressed by hygiene standards at the time. It was interesting seeing the other side of a hospital that I used to visit regularly for meetings.

And, with respect, it's not true to say that nothing legal can be done about a staff member who doesn't pull their weight. I've run more Disciplinary courses than I care to remember and it is a problem that can be tackled. But not without notice - sometimes people don't even realise they're not doing the job properly until it's pointed out to them and they're given chance to improve.

There's a lot wrong with the NHS; it's too massive an organisation to function perfectly. But if the solution was simple, it would have been implemented by now. It's much more complex than pointing the finger at specific groups. I could go on but it would still only be scratching the surface......

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 8:16 am
by sejintenej
Jo wrote:Well..... it's a while since I worked in a NHS trust, though I still work for the NHS. It's far too simplistic to blame any one (or more) group of people. There are dedicated and conscientious managers and there are lazy doctors and nurses - good and bad in every group. A lot of managers are ex-nurses - they don't suddenly turn into bad people when they take management jobs (you've been watching too much Casualty <spit>). I was a senior manager at the trust (though not on the clinical side) and I take exception to just being written off by people who should know better as "ruining our wonderful NHS" (oh please!!!!). Nor was I one good apple in a rotten barrel - I was privileged to work alongside some very gifted and hardworking colleagues (as well as some mediocre people, as you would expect in any team).

...
Jo,
I am not arguing with you. As I see it there are a number of basic problems:
- too many resources being directed towards government form filling, statistics etc (ISTR that over 50% of NHS staff have nothing to do with patient care)
- too little control of what happens in wards. This should be up to ward sisters and matrons who should know what is good and what is bad and ensure that standards are good
- poor staff control. We had a case where in a huge hospital there was just one person on duty qualified to give injectioons. She forgot and next day a report was handed in. That forgetful sister was the person responsible for collecting such reports and you can guess what came out at the enquiry. She kept her job and was not disciplined.
- gross stupidity. Brand new hospital, regional centre of excellence in some cancers and they couldn't give radiotherapy because a) they didn't apply for a licence, they didn't have lead lined walls in any room and about 4 other failings!!!! Oh, but they did have a beautiful reception area!

Yes, there are good staff and I won't argue that. We just need all of them to be up to that standard. As for dsiciplinary hearings - the staff seem to have been so supported by unions and law that they have to commit something really major to be out after 12 months enquiry. What do they get for not giving someone the right medicine? for taking patients' food home ......?
My beef was that the paper was concentrating on one hospital whilst a far far worse one closeby was ignored.

I don't watch Casualty nor any similar (or any other) soaps for that matter.

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 9:31 am
by Jo
The quote I took exception to was actually made by JR rather than by you, David. I think you have hit on some of the problems. The unions do have too much power in some trusts, though where I worked we had a constructive partnership and we got them signed up to management policies on Sickness Absence, Disciplinaries, etc. This meant that maverick staff were much more out on a limb and less likely to be unconditionally supported by their union when they tried to take the p*ss.

Some of the difficulties are just caused by the fact that the working environment generally has become less strict and hierarchical - not just in the public sector, but everywhere. There are more part-time staff - the NHS wouldn't function without them, but it does make continuity of care more difficult. There have been other similar developments in the workplace that I think the NHS hasn't really come to terms with but it's impossible to revert to how things were before.

In my experience, drug errors are taken very seriously. They would almost always result in a disciplinary investigation. What happens to the nurse involved would depend on the individual circumstances (was this a first offence or has it happened before? did the nurse immediately admit the error or did he/she try to conceal it?). Punishments would range from a warning to dismissal, and being struck off the NMC register (a lot of people don't realise that nurses have to be registered the same as doctors, and can be struck off).

But I am always suspicious of media headlines, particularly in the tabloids. I used to have a lot of respect for Roger Cook, until we had an experience with him about 10-12 years ago. He had discovered that one of our psychiatrists was sexually abusing female patients. RC sent in a fake patient with a hidden camera and the doctor was filmed saying things like "no-one will believe you if you complain because you're mentally unstable". It was quite shocking. (It turned out that he had previously been struck off in his home country but the GMC don't have to pass on that information and when we recruited him, he came with references and the appropriate GMC credentials).

What appalled us at the trust was that we only found out about a week before the programme was aired, and our Chief Exec contacted the BBC urgently to get some of the documentary evidence so we could start disciplinary proceedings immediately. No, we were told, basically it would steal some of the programme's thunder if they spilt the beans before it was aired, so we would have to wait, like the rest of the viewing public, and then they might let us have the evidence. I think we suspended the doctor concerned straight away - the knowledge that things were going to be revealed in the programme gave us enough grounds - but the BBC's priority was clearly sensational programme-making rather than patient safety. I have been much more sceptical about media interest in the NHS since then.

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 1:04 pm
by NEILL THE NOTORIOUS
I have been a Director of an NHS Trust and The Blessed Anne was a Senior Sister (SRN trained at Charing Cross and Southampton) who "Ran" Intensive Care in her final years before Retirement (Early --- they wanted her Grade !)
Qualifications noted --- we agree that no two Hospitals are alike, even if , in the same City, and WITHIN Hospitals, there are differences in Ward "Cultures" --- this may be regrettable but is a fact.
I'm afraid that it is MANAGEMENT which is required --- and that means down to the Nurses and Assistants themselvess to have an interest in their Profession. not only the "Suits"

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 1:06 pm
by J.R.
Apparently, the ratio at East Surrey Hospital, Redhill recently was along the lines of...............

ONE MANAGER to every FOUR members of the medical staff !

Sorry, but that beggars belief !

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 1:27 pm
by Jo
Well it depends on what definitions are used. In the NHS the term "medical" is traditionally used to denote doctors, not nurses, so I wouldn't be at all surprised at that ratio as doctors, even at acute hospitals, are not normally in the majority. In addition, nursing staff from ward sisters and upwards have management responsibilities as well as hands-on nursing responsibilities so it depends in which category they were placed.

It's very easy to generate shock horror headlines if you don't bother to examine the facts on which they are based.

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 1:31 pm
by sejintenej
J.R. wrote:Apparently, the ratio at East Surrey Hospital, Redhill recently was along the lines of...............

ONE MANAGER to every FOUR members of the medical staff !

Sorry, but that beggars belief !
Then you certainly will be unable to believe a newspaper report a while back that there were fewer medical staff in the NHS than managers etc. - that is more than one manager for every member of the medical staff. East Surrey Hospital is obviously better than some from the patient's point of view.
Do NHS managers get bonuses?

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 1:45 pm
by Jo
sejintenej wrote:
J.R. wrote:Apparently, the ratio at East Surrey Hospital, Redhill recently was along the lines of...............

ONE MANAGER to every FOUR members of the medical staff !

Sorry, but that beggars belief !
Then you certainly will be unable to believe a newspaper report a while back that there were fewer medical staff in the NHS than managers etc. - that is more than one manager for every member of the medical staff. East Surrey Hospital is obviously better than some from the patient's point of view.
Do NHS managers get bonuses?
I have the impression that bonus schemes are going out of fashion. In both my current and previous jobs in the NHS I started on a bonus scheme, but in both cases the schemes were wound up a few years ago. In fact if there are still any in operation it's probably only for Board level staff, as everyone else is now on a standard national pay scheme.

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 2:44 pm
by englishangel
Jo wrote:The quote I took exception to was actually made by JR rather than by you, David. I think you have hit on some of the problems. The unions do have too much power in some trusts, though where I worked we had a constructive partnership and we got them signed up to management policies on Sickness Absence, Disciplinaries, etc. This meant that maverick staff were much more out on a limb and less likely to be unconditionally supported by their union when they tried to take the p*ss.

Some of the difficulties are just caused by the fact that the working environment generally has become less strict and hierarchical - not just in the public sector, but everywhere. There are more part-time staff - the NHS wouldn't function without them, but it does make continuity of care more difficult. There have been other similar developments in the workplace that I think the NHS hasn't really come to terms with but it's impossible to revert to how things were before.

In my experience, drug errors are taken very seriously. They would almost always result in a disciplinary investigation. What happens to the nurse involved would depend on the individual circumstances (was this a first offence or has it happened before? did the nurse immediately admit the error or did he/she try to conceal it?). Punishments would range from a warning to dismissal, and being struck off the NMC register (a lot of people don't realise that nurses have to be registered the same as doctors, and can be struck off).

But I am always suspicious of media headlines, particularly in the tabloids. I used to have a lot of respect for Roger Cook, until we had an experience with him about 10-12 years ago. He had discovered that one of our psychiatrists was sexually abusing female patients. RC sent in a fake patient with a hidden camera and the doctor was filmed saying things like "no-one will believe you if you complain because you're mentally unstable". It was quite shocking. (It turned out that he had previously been struck off in his home country but the GMC don't have to pass on that information and when we recruited him, he came with references and the appropriate GMC credentials).

What appalled us at the trust was that we only found out about a week before the programme was aired, and our Chief Exec contacted the BBC urgently to get some of the documentary evidence so we could start disciplinary proceedings immediately. No, we were told, basically it would steal some of the programme's thunder if they spilt the beans before it was aired, so we would have to wait, like the rest of the viewing public, and then they might let us have the evidence. I think we suspended the doctor concerned straight away - the knowledge that things were going to be revealed in the programme gave us enough grounds - but the BBC's priority was clearly sensational programme-making rather than patient safety. I have been much more sceptical about media interest in the NHS since then.
The NMC is much harder on on nurses and midwives than the GMC is on doctors, and even tougher than the law.

However I think it is is much more supportive of staff with addiction and/or mental health problenms if they are made aware of them.

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 4:54 pm
by NEILL THE NOTORIOUS
I had the unpleasant duty of Chairing a Disciplinary Hearing, on a Nurse who had "Struck" a Patient ------- (Given a push with "Get a move on !")
This was an "Instant Dismissal" Charge.
I was amazed to hear from the Accused, that his Union Rep (Unison) had refused to represent him.
What to do ? In retrospect, I should probably have adjourned, and telephoned Unison HQ to ask what the Blazes (Or words to that effect) was going on ?
A Union Rep, or Shop Steward, is responsible for representing the interests of his Member, and, as a Lawyer, this doesn't matter whether he likes him/her or not. the Member has paid their dues and is entitled.

I didn't phone Unison, but I did my best to ask the questions, which should have been asked, by the Rep, as a sort of "Friend of the Accused" --- this, I admit, was quite improper of me, but I felt it had to be done.

He was dismissed -- which was a shame, because he was a good Nurse --- but someone was "Out to get him" and had the evidence.

Re: Quality Care Commission.

Posted: Sat Nov 28, 2009 9:01 pm
by englishangel
Or Unison refused to represent him because he wasn't a good nurse.

Re: Quality Care Commission.

Posted: Sun Nov 29, 2009 10:45 am
by sejintenej
http://www.timesonline.co.uk/tol/commen ... 936385.ece


Given recent newspaper uproar I rather enjoyed:
In the case of Basildon and Thurrock, the Care Quality Commission (CQC), the new independent regulator for all health and social care in England, was the body that inspected the trust and published the dreadful findings. Yet last month it posted on its website a glowing report on the trust, giving it 13 out of 14 for cleanliness and 5 out of 5 for keeping the public healthy. This report, astonishingly, is still there.

Another quote from the same article (somebody might want to copy it to the OFSTED thread)
The Ofsted report last week was deeply depressing for its cautiously expressed findings — failing schools, illiterate children and poor teaching. What’s worse is that Ofsted and its predecessors have been inspecting and reporting fairly cheerfully for decades, while standards have fallen lower and lower.
As if we didn't already distrust these organisations