Nurses should blow the whistle on poor quality care, says Health boss
Nurses who witness sub-standard care should turn whistleblower and report their colleagues to the medical authorities, according to Andrew Lansley, the Health Secretary.
Mr Lansley said a “tick box culture” had developed in the NHS which needed to be replaced with a system which was more direct about tackling problems.
His comments came in the aftermath of a damning report from the Care Quality Commission which warned that elderly patients in half of NHS hospitals were not being properly cared for because of a lack of “kindness and compassion”, which required some people to be prescribed water.
Mr Lansley said: “It is unacceptable for some of these essential standards of dignity and support for people’s food and drink not to be met.” He added: “Staff across the NHS, if they see examples of poor care [it is important] that they blow the whistle. “When things go wrong there should be a means by which we learn to put these things right in future.”
Mr Lansley also said that patients’ families should be more willing to complain if they are not being treated properly.
He said the new local HealthWatch groups would be able to carry out inspections and hold trusts to account which would assist the improvements.
The CQC’s report says that too often staff pay more attention to paperwork than those they are looking after.
Unacceptable care has become standard in some trusts, with doctors and nurses talking down to patients, ignoring their calls for assistance and failing to help them eat, drink or wash.
After carrying out spot checks at geriatric wards in 100 hospitals, the commission found that 35 needed to make improvements, 18 were failing to meet legal standards and there were “major concerns” at two trusts.
Its report is the latest to conclude that pensioners, who account for almost half of in-patients, are routinely denied the most basic care because of a culture of neglect among staff.
In some places, elderly patients were left rattling their bed rails or hitting water jugs on tables to attract nurses’ attention.
Dame Jo Williams, the chairman of the CQC, said: “The fact that over half of hospitals were falling short to some degree in the basic care they provided to elderly people is truly alarming, and deeply disappointing.
“Too often, our inspectors saw the delivery of care treated as a task that needed to be completed. Those responsible for the training and development of staff, particularly in nursing, need to look long and hard at why the focus has become the unit of work, rather than the person who needs to be looked after, and how this can be changed.
“Task-focused care is not person-centred care. Often, what is needed is kindness and compassion, which cost nothing.”
Last December the commission was asked by the Government to investigate whether or not hospitals were meeting legal requirements on treating elderly patients with dignity and meeting their nutritional needs.
Backing up ministers’ fears, the Health Service Ombudsman found in February that hospitals were failing to meet “even the most basic standards of care” for the over-65s, with many left hungry, unwashed or given the wrong medication because of the “casual indifference of staff”.
Research has suggested that 15,000 pensioners die prematurely every year because of late diagnoses and because they are less likely to be operated on than younger patients.
Of the 100 NHS acute hospitals it assessed, the commission concludes in today’s report that 60 were “fully compliant” with standards on respect, while 28 needed to make improvements and 12 were failing.
Fifty-one were meeting patients’ food and drink needs, 32 needed to make minor improvements, 15 were failing and two “were a cause of major concern” and “put people at unacceptable risk of harm”.
These were Alexandra Hospital in Worcestershire, and Sandwell General Hospital in West Bromwich, where an incontinent patient was left unwashed for 90 minutes despite asking staff for help.
James Paget University Hospital in Norfolk was given a warning that it could face closure or prosecution if it continued to let patients go hungry and thirsty.
Inspectors found that, in many wards, patients were not given privacy, with curtains around their beds left open while they were being care for; call bells were left out of reach or ignored; and staff spoke in a “condescending or dismissive way” about those in their care.
Michelle Mitchell, Age UK’s charity director, said the reported highlighted “shocking complacency on the part of those hospitals towards an essential part of good health care”.
Katherine Murphy, the chief executive of the Patients Association, said: “How many reports do we have to look at and how many times do the public need to hear about this before the right action is taken?”
Are we returning to a postcode lottery? NHS waiting times for hospital treatment soar by 50% in one year under Coalition
One in three of NHS trusts are breaching waiting times for treating patients – almost four times the number this time last year, according to the latest figures.
Data for England reveals 45 primary care trusts (PCTs) did not hit the target in August for treating patients within 18 weeks of referral by their GP.
In August 2010, just 12 PCTS breached the waiting times target.
The NHS as a whole is still meeting a national target for 90 per cent of patients to be seen within 18 weeks, but only because some PCTs are performing much better than others.
The figures for August show that the total number of people who waited 18 weeks or more for treatment reached 28,919, compared to 19,547 in August 2010. A total of 759 patients waited more than a year, compared with 286 in the previous year. The number still in the system who have not yet been treated stood at 2.61 million in August, down from 2.65 million in the previous year.
Shadow health secretary Andy Burnham, said: ‘The figures published today are yet more evidence that David Cameron has put our NHS in the danger zone.
‘After years of improvement under Labour, more patients have had to wait longer for treatment since David Cameron came to power. ‘It is particularly alarming that 45 trusts are now missing the target for 90 per cent of patients treated within 18 weeks. A return to the postcode lottery – taking the N out of the NHS.
‘Month after month, it is becoming increasingly clear that you can’t trust the Tories with our NHS.’
The Department of Health spokesman said more people overall were treated in August, even if they had to wait more than 18 weeks. The figures show 301,245 people completed treatment in August 2011, up from 288,244 in August 2010. He said: ‘Patients should be treated as quickly as possible, but those who have already waited over 18 weeks must not be forgotten.
‘The NHS is treating more people who have waited over 18 weeks – which shows the effort that is being put into getting treatment to those who have waited longer. ‘But where the NHS can improve, it should improve – and already more PCTs are meeting this standard compared to March 2011.’
Big British U-turn: Nuclear power is vital to our future, says Green/Leftist minister
Energy Secretary Chris Huhne yesterday completed a dramatic personal U-turn and declared: ‘We need nuclear.’ Mr Huhne said the technology was vital in ensuring Britain could keep the lights on while tackling climate change. But he pledged that energy firms would have to deal with contaminated waste themselves – the huge cost of which has previously landed on the taxpayer.
Despite widespread opposition from his Liberal Democrat colleagues, he confirmed plans to press ahead with eight new nuclear power stations as all but one of the UK’s current reactors will be decommissioned by 2023.
In the most pro-nuclear speech by a Cabinet minister for years, Mr Huhne, who campaigned against nuclear power before taking office, told the Royal Society: ‘Nuclear energy has risks, but we face the greater risk of accelerating climate change if we do not embark on another generation of nuclear power. Time is running out. ‘Nuclear can be a vital and affordable means of providing low-carbon electricity. I believe nuclear electricity can and should play a part in our energy future, provided that new nuclear is built without public subsidy.’
Mr Huhne’s new gung-ho approach leaves him open to charges of hypocrisy.
Before last year’s election the Lib Dems’ manifesto pledged to veto the proposals for a new generation of nuclear power. And just last month the Lib Dem conference voted to impose a windfall tax on companies that are operating the UK’s existing nuclear power stations.
Mr Huhne was previously one of the fiercest critics of the industry. In 2007 he wrote: ‘Nuclear is a tried, tested and failed technology, and the Government must stop putting time, effort and subsidies into reviving this out-dated industry.’
He has since claimed these comments were ‘misunderstood’ and that he was not opposed to nuclear power provided it did not involve large state subsidies.
In his speech, Mr Huhne insisted ministers had learned from ‘past mistakes’ on nuclear, and that energy companies would be required to set aside cash to pay for dealing with nuclear waste, which currently costs his department £2billion a year.
Paul Steedman, of Friends of the Earth, said Mr Huhne appeared to have been seduced by the ‘fantasy economics’ of the nuclear industry.
Hateful British prosecutors lose one
I deserved all I got, says the burglar beaten by his victim: Case against father thrown out when criminal refuses to testify
When businessman Steve Coupland fought off a violent burglar breaking into his van, the Crown Prosecution Service insisted he should be charged. But after a 12-month fight to clear his name, the case has collapsed – because career criminal Matthew Higgins refused to give evidence against him, saying he ‘got what he deserved’.
Mr Coupland, who has never previously been in trouble with the police, had seen his van targeted by thieves on 13 occasions – including the two nights before the incident – and tackled the burglar only after he was attacked with a crowbar.
Higgins, 43, who has an appalling history of violence, ended up being badly beaten by Mr Coupland and both men were arrested by police. Prosecutors refused to accept that Mr Coupland, 54, was lawfully defending himself and his property.
But the CPS has been forced into a humiliating climbdown by Higgins’s refusal to testify against him. Mr Coupland was cleared after no evidence was offered against him on the day of his scheduled trial at Hull Crown Court.
The father of three, who runs a cleaning company, had been so convinced a jury would see sense that he not only denied grievous bodily harm with intent but also ignored legal advice by refusing to plead guilty to a lesser charge.
‘I’m over the moon it’s finally over,’ he said. ‘This case has wasted a lot of time and money. ‘I have worked hard all my life and have never done anything wrong. I was just protecting my property.
‘I was facing years in prison, but I was determined to fight it. They said I had gone over the top, but I had to do what I had to do to stop that happening to me. The system is weighted in favour of the criminal – they would have preferred me to bring him in for a cup of tea and hand over my wallet.’
Just hours before the incident, Mr Coupland had spoken to police about attempted break-ins on his van the previous two nights in September last year.
The van, which contained nothing of value, was parked outside Mr Coupland’s house in Hessle, Hull. At 10pm he was alerted by the noise of Higgins trying to force open the van with a crowbar. He shouted at the thief and went outside to confront him.
But Higgins hit him on the arm with the crowbar and Mr Coupland – who, at 5ft 3in tall, is ‘at least six inches’ shorter than the thief – fought back with all his strength. ‘Both of us ended up on the floor,’ said Mr Coupland. ‘I was hitting him and trying to get the crowbar off him, which I managed to do. My blood was boiling.’
Higgins lost part of his ear in the fight and Mr Coupland believes this happened when he threw the thief against a pillar. Eventually he was able to restrain Higgins until police – called by his wife and a neighbour – arrived at the scene.
Mr Coupland was locked in police cells overnight and lawyers decided to press charges because of the extent of Higgins’s injuries.
‘The police were brilliant,’ said Mr Coupland. ‘They didn’t want me to get prosecuted as they are sick and tired of druggies breaking into vans and then being given community service. ‘I had acted in self-defence and was not going to admit doing anything wrong.’
Higgins has since been jailed for 21 months for drugs, blackmail and weapon offences. He was also given a three-month suspended sentence for attempting to break into Mr Coupland’s van.
He has been in and out of custody since he was a teenager and has 71 previous convictions, including a 14-year prison sentence in 1989 for stabbing a solicitor during an armed robbery.
Mr Coupland said: ‘I had no idea I was taking on such a dangerous man, but I don’t regret what I did and would do the same again. I won’t let these people ruin my life.’
A spokesman for the CPS said: ‘We have discontinued the case after the victim refused to give evidence.’
We don’t need experts to teach us how to be civil
A new British report calls on officialdom to ‘nudge’ the masses towards civilised behaviour. It isn’t only a patronising idea, but a dangerous one
It appears that some sections of the British establishment are suffering from selective amnesia in relation to the riots in England in August. The rioting is now treated like an embarrassing episode that one should not discuss in good company.
In such circumstances, anything that reminds us of the truth that these riots were not an aberrant moment in an otherwise civic society, but rather spoke to some profound underlying social problems, is welcome. A new report published by the Young Foundation, titled Charm Offensive: Cultivating Civility in 21st Century Britain, grapples with the question of how to tackle the feeble levels of civility in English communities today.
The report successfully establishes one crucial point that is often overlooked in debates about community life and anti-social behaviour: it notes that civility should not be confused with other forms of behaviour related to public activities and formal institutions. Rather, civility is a taken-for-granted form of behaviour, through which people express their own and recognise other people’s humanity. As the report notes, civility ‘can, as an unspoken language for interaction, provide the basis for achieving a “good society”, through an emphasis on qualities such as respect, empathy and compassion’.
So civility is very much a pre-political accomplishment; it flourishes in the pre-political areas of people’s lives – in their everyday conversations and interactions. Today, as in the past, civility becomes tangible through social engagement, through taken-for-granted behaviours and the rituals of everyday life.
How civility works, and how it mediates human interaction, is influenced by both social factors and cultural ones. Unfortunately, however, contemporary political thought and policymaking has lost confidence in its ability to engage with social and cultural issues. Instead, it prefers to focus policy on the alleged moral deficits of the individual, and it is more interested in discovering new techniques to manage behaviour than it is in addressing social problems. The clearest expression of this trend is policymakers’ promiscuous use and abuse of brain research, where people’s alleged mental failings become the all-purpose explanation for every social ill, from poor educational attainment to a disposition towards criminal behaviour.
Sadly, Charm Offensive also falls under the spell of this brain-obsessed outlook. It informs us that civil behaviour makes people happy. How do we know this? Apparently, MRI scans have shown that civil actions stimulate the same areas of the brain that are stimulated by experiences such as falling in love or holding a baby. So what we need in order to sort out today’s crisis of civility is a bit of ‘neurological reflexivity’.
The relentless politicisation of neuroscience reveals how influential technocratic and therapeutic policymaking has become. In the outlook of the brain obsessives, social and cultural analysis serves a perfunctory role only, providing a pretext for intervention into the pre-political or informal areas of community life. Having correctly identified civility as something that exists in a pre-political zone, Charm Offensive goes on to call for technocratic intervention into this domain of social experience. By presenting incivility as an individual problem, and by hiding behind advocacy science, the report proposes the politicisation of pre-political areas of life.
The report suggests changing individual behaviour through pedagogic and expert interventions. So, having identified lack of empathy for others as a key marker for incivility, the report’s authors suggest we should teach people how to be empathetic. They call for ‘empathy training’ in schools and in other institutions. In short, the report disassociates personal qualities and forms of behaviour from any wider moral and social context and instead treats them as technical skills that can be taught by trainers. It also reduces the virtue of reciprocity and reciprocal behaviour to a ‘skill’, which can be cultivated by external experts.
It is not surprising that when being civil is looked upon as little more than a skill one can acquire through training, the cultivation of civility comes to be seen as an act of self-interested manipulation. ‘Civility seems to thrive better when it is embedded from the outset as an integral and explicit element of any strategy or new venture’, says Charm Offensive.
The strategic planning and manipulation of behaviour promoted by Charm Offensive are very similar to the Lib-Con government’s policy of nudging. The doctrine of nudge is devoted to remoulding the way people think and act through behaviour modification. Nudging is presented as a benevolent attempt to help people realise what is in their best interests. So Charm Offensive also advocates what the nudge lobby calls ‘choice architecture’, which ‘may help us to make better choices and behave more consistently with our beliefs and aspirations’. In relation to the problem of incivility, the report proposes the adoption of the kind of techniques usually associated with the promotion of government-sanctioned healthy lifestyles. It states: ‘[the] behavioural-change approaches currently being applied to reduce obesity or increase recycling could be applied far more systematically in the promotion of civility.’
As is the case with all forms of paternalistic intervention into our lives, the solution is to ‘send in the experts’. Apparently it is the experts who know how to nudge people to do what is in their best interests. It is experts who can apparently teach otherwise morally illiterate people about the value of empathising with others. And it is experts – with the help of behavioural economics, neuroscience and evolutionary psychology – who can become the architects of civility. This is why the authors of Charm Offensive complain that ‘very little investment’ in expertise has gone into the field of tackling incivility.
The casual manner in which behaviour-management is put forward as the solution to problems in community life reveals a serious loss of focus in modern policymaking. To make matters worse, the advocates of nudging delude themselves into thinking that what they offer is a benevolent alternative to old, more intrusive forms of state intervention. The authors of Charm Offensive contrast their ‘softer, bottom-up interventions’ with old-style ‘punitive top-down policies’. But what is ‘bottom-up’ about campaigns that are drawn up and initiated by experts who work at think tanks and research institutions? What is bottom-up about advocating training programmes in ‘effective empathy’?
It could be argued that one reason English communities have problems of incivility is because so much of their informal life has come under the scrutiny of official and semi-official institutions. If civility is indeed an accomplishment of pre-political interaction, then all this intervention into everyday relations and interactions can only disrupt the process through which people work out what forms of behaviour are appropriate to their circumstances. The attempt to regulate the informal sphere has a very destructive impact, as strikingly exposed by the confusions that surround intergenerational relations. One of the principal legacies of policies designed to protect children from their parents and other adults has been the erosion of adult solidarity. Many modern forms of incivility are the direct outcome of the reluctance of adults to contain the behaviour of children – and more nudge-like intervention into community life can only make this bad situation even worse.
Whatever the problems confronting communities today, the answers will not be found through displacing political deliberation with technocratic policymaking. The very fact that, just a few months after the riots, there is an absence of serious debate on the fundamental questions raised by this violent event should be the very first issue to be confronted and interrogated. Avoiding the big questions by treating incivility as a problem that could be put right through training individuals in neurological reflexivity represents a naive belief in the power of the expert to fix communities. Surely decades of failed community programmes indicate that a hands-off approach would be far better and is long overdue.
Foreign boss fired two British cleaners for being lazy
From what I know of the British, their boss was right
Two cleaners claim to have been sacked for not working as hard as foreigners. Stella Judge and Sarah Pritchard say they were told that Britons were lazy while immigrants were happy to work all hours on the minimum wage.
Yesterday their MP used Parliamentary privilege to raise their plight in the Commons. Henry Smith said the cleaning firm, Jani-King, had questions to answer about the case, which corresponds with widespread fears that home-grown workers are losing out to immigrants.
‘The allegation that two of my constituents have been sacked simply for being British is deeply disturbing,’ said the Tory MP for Crawley. ‘The suggestion is that Britons are lazy and foreign workers are cheaper.
‘Unemployment and immigration are big concerns – with people increasingly worried about being dismissed and replaced with non-British workers. ‘I’m hoping for a fuller explanation of the situation in this case from Jani-King.’
A spokesman for the firm – based in Kingston, Surrey – denied the pair were sacked for being British. ‘Two employees have been dismissed following standard employment procedures,’ she said. ‘The reasons are unrelated to ethnicity. Jani-King has over 1,200 staff in the UK and is an equal opportunities employer.’ The spokesman said she could not reveal what proportion of the staff were foreign because no statistics were kept on nationality.
The two women at the centre of the claims – next-door neighbours in Crawley, West Sussex – said last night that their colleagues came mostly from Mauritius, then more recently Bulgaria.
Miss Judge, a 57-year-old mother of five, has launched a claim for unfair dismissal. She and Miss Pritchard had started full-time work cleaning the Gatwick Travelodge in summer 2010, originally for One Complete Solution. But when that firm lost the contract in April the work passed to Jani-King, which took on the employees. Miss Pritchard, a 30-year-old mother of one, said she and her friend quickly realised their days were numbered.
Miss Judge was sacked at the start of July and Miss Pritchard was made redundant three weeks later. She said: ‘We would work a normal shift from 8.30am, then go home – but the foreign staff would still be there at 10.30 at night. When I went home, they stayed on. ‘They were on the minimum wage, £5.93 an hour at the time. At first most of them were from Mauritius but now they’re generally from Bulgaria where the manager is from. ‘It was obvious we were sacked for being British.’
Mr Smith said Jani-King reacted ‘aggressively’ to his letters which amounted to ‘this is none of your business’ and had threatened legal action.
Speaking as MPs discussed topics for future debates, Mr Smith told the Commons: ‘I have been dealing with a case on behalf of two constituents who were dismissed from their job with a commercial cleaning firm called Jani-King, allegedly for being British.
‘Can we have consideration for a debate on discrimination against British workers in this country?’
Leader of the House Sir George Young urged him to inform ‘the appropriate authorities if anything illegal has taken place’ and said he would contact Work and Pensions Secretary Iain Duncan Smith.
British private schools escape the Leather Lady
A landmark ruling has freed private schools to decide for themselves how they meet their duty to help the poor to justify their status as charities. The ruling by three senior judges frees independent schools – most of which are classed as charities which allows them to enjoy valuable tax breaks – from interference by the Charity Commission.
It marks an end to a long-running dispute between the Independent Schools Council and the state watchdog, which is headed by Labour supporter Dame Suzi Leather.
Under rules which came into effect in 2006, private schools had to prove their ‘wider public benefit’ to keep their charitable status. Labour ministers said the Commission would push schools to advance the cause of social mobility and offer free places to poorer children.
Yesterday judges at the Upper Tribunal (Tax and Chancery) Chamber, a division of the High Court, said it was for the schools themselves and not the Commission to decide how they should meet their legal duty to help the poor.
The ISC, which represents half a million pupils in 1,260 schools, had challenged the right of the regulator to ‘micro-manage’, saying its guidelines were ‘prescriptive and interventionist’.
The judges, Mr Justice Warren, Judge Alison McKenna, and Judge Elizabeth Ovey, said schools could help the poor in a number of ways, including sharing their facilities with state schools, instead of just offering free or subsidised places.
They added that some of the guidelines operated by the Charity Commission are ‘erroneous’ and must be changed.
Once a minimal or threshold level of help for the poor has been offered by a school, ‘what the trustees decide to do in the running of a school is for them’, they said.
Under the judgment, they can also offer teachers to state schools, open their playing fields and swimming pools to state school pupils, and invite state pupils to join classes in subjects their own schools do not offer.
ISC general counsel Matthew Burgess added: ‘The ruling takes public benefit decisions away from the Commission and hands them back to school governors, and for that reason we warmly welcome it.’
The Charity Commission said: ‘We accept of course the tribunal’s conclusion that some parts of our guidance do not explain the law clearly enough.’ But it added: ‘It is a matter for individual charitable independent schools to decide for themselves how to meet the public benefit requirement as long as it gives more than a tokenistic benefit to the poor.’