The Crisis in Caring
'We can treat. But we are losing the ability to care'
It has been hard for those of us who have spent our working lives doing our best for patients, and seeing our colleagues do the same, to acknowledge that we are in danger of losing compassion, caring and simple kindness. But the evidence cannot - and should not - be ignored.
Every year there are more scandals and we are promised: ‘lessons will be learnt’. Lessons are not learnt. The next year – and the next − there are yet more scandals: scandals that often share the same features. It is less than ten years since we learnt from the Kennedy Report that between 30 and 35 very ill babies had died needlessly in a Bristol hospital. Others were left brain damaged. The nation was outraged, and was right to be so. Lessons would be learnt, we were told.
Since then we have had Mid-Staffordshire, where official reports say between 400 and 1,200 people died needlessly, by way of Maidstone and Tunbridge Wells (90) and Basildon and Thurrock (‘at least’ 70).
In October 2010 we have seen in − one week − two disturbing inquest reports. The first concerned a profoundly disabled nine-year old who died because a feeding tube became dislodged, leading to food leaking into the abdomen and causing infection. Doctors dismissed his mother’s concerns and, in the days before his death, twice failed to investigate the reason for this child’s pain. Elsewhere a teenage girl with meningococcal septicaemia was “lost” by a hospital when an electronic bed management system instructed she should be moved to a different ward. She died shortly afterwards. The coroner identified seven separate failings in her care.
Just a couple of weeks earlier, another inquest had heard how nurses were 'too busy' to read a patient’s notes and so did not give her the insulin injections she needed daily to treat her diabetes. The patient collapsed into a diabetic coma and died after only two days. These are failings by individual clinicians, teams and the system.
It is not only needless deaths. According to the Francis Report, poor care at Mid-Staffordshire caused: 'unimaginable distress and suffering'. Patients had been left for hours in soiled beds and neglect had left some so thirsty they were reduced to drinking the water from flower vases. Nor are these isolated instances. They happen all too regularly and all too commonly.
No-one goes into medicine, nursing or NHS management wanting to harm patients. So what has gone wrong? It is true that mistakes always have been made and always will be made. It is true that there will always be a few individuals who are careless or neglectful or cruel. But these examples weren’t the result of a few individuals behaving badly. These were needless deaths and cruelty in NHS hospitals on an almost industrial scale. That is shameful – and we cannot be sure there are no more scandals to emerge.
Not so very long ago, it would have been impossible. Clinicians would not have allowed it. Systems would not have allowed it. Peer pressure would have made sure standards were maintained. What can we do to put this right?
The first – perhaps the most important solution – is to renew the sense of vocation and service that has always driven those who care for the sick. Systems and the top decision makers must make it clear both that patients are at the heart of healthcare and that they respect and value the health professionals who deliver it.
Technological medicine and advances in science have brought with them huge benefits. We are able to treat successfully today people who fifty years ago - even ten years ago – would have died. But we are losing the ability to care for them.
Industrialised medicine has given us the factory conveyor belt syndrome, where patients and professionals alike are little more than objects. We have to turn our back on that downside while retaining the best that science and technology have to offer. We must recognise that patients and the public are our partners, not passive recipients of our wisdom and instruction. There can be no more powerful alliance than patients and professionals. Together, we can create a renaissance in medicine.