Sunday, 3 August 2014

A Demolition of Trust - Jos Bell

Firstly – a short questionnaire…

How is it possible to trust a hospital trust board who deliberately sets out to bar members of the public from a public meeting; how is it possible to trust a board who prevents disabled people from gaining access; how is it possible to trust a board who blocks an elected MP from accessing said meeting until he appears on live radio to tell the nation he has been locked out? How is possible to trust a board who sit with their backs to an audience as they trot out nonsensical and half baked responses to searching questions?
Trust can be hard won or it can be easily offered. Trust can be nurtured and kept or it can be callously taken away. Trust broken is difficult or even impossible to repair.
Trust in the medical profession has been having a rocky ride of late courtesy of the government’s bash-the-NHS tactics, yet it would be safe to say that trust in Jeremy Hunt and David Cameron would consistently fall well below the public’s overall trust in nurses, doctors and paramedics.
Hospital managers largely tend to be wrapped in a bin bag of disdain in the public’s imaginings, yet the best hospitals have the best managers. The decision in 1991 to designate hospital managing boards as NHS Trusts at the same time as bringing in the now notorious purchaser provider split must have been thought to have had at least a symbolic resonance with the patient/doctor ‘ in whom we trust’ relationship, when really in Major world, as with PFI, it was more about following the money.
As we know, humans vary in their capacity for trustworthiness and in the case of hospital trusts, there is a wide variation in standards. The Trust-worthiness scale sits with the successful – or not, application of those running a Trust to their duty of care to the patients and population for whom they are responsible. The question is – are they worthy of trust, let alone mandatory Trust status.
Over the past few years London’s hospital trusts have been in the brink of instigating radical changes in a search for the best means of catering for the capital’s unique health economy, also complicated by the change in funding balance with the littering of CCGs onto the scene. Latterly, in all but one case, there has been a rain check on pressures from Dept of Health/NHS England to take out emergency and acute services on a fast track basis to supposedly create a safer environment/save more lives. An oxymoron if ever there was one. Especially at a time of crisis in capacity.

Not all change is bad, but badly managed change is very bad indeed.
We know (roughly) what took place in the Mid Staffs NHS Trust when managers decided to put funding before patient wellbeing. We all know that despite radical improvements in the intervening years, that much maligned hospital is being closed as a matter of political expediency. Protesters have now resorted to camping out to highlight their plight.
In London the closure of Chase Farm emergency care has resulted in both the tragic death of a toddler whose parents believed, due to lack of clear information, that Chase Farm A&E was still operational - and the inevitable intolerable pressure being put upon Barnet Hospital ( a very senior member of NHS England – go on stretch your imagination just a tad - told me that he had warned Hunt that this would occur).  

Abject lessons to be learned from both situations. But sadly not, it seems, by everyone.
‘Why are you ploughing onwards when there is an A&E capacity crisis across the country, with targets missed on every single week of the past year and services in London completely overstretched?’ ‘Because Jeremy Hunt told us to’. Sorry, Hammersmith & Fulham CCG - Jeremy is not in charge of you – you are in charge of you. The Health & Social Care Act tells us so. Also please tell us do, why you chose to sit yourselves in reprise of the Last Supper in front of images of the Crucifixion while you mishandled this news?
‘Why are you saying you are changing hospital services when you are closing them?’ asks Patrick Barron , local resident and patient ‘Because people told us it would sound too frightening to say they are closing. We have made party packs!’ ( that from a Saatchi and Saatchi consultant lent for a mere snip at £55,000 quid).
‘Where will the 22,000 patients from Hammersmith go, given you have recently declared that St Mary’s is full up?’ asked Community Matron Ann Drinkell. ‘We have a contingency’. ‘What is that contingency?’ ‘It ummmm involves increasing capacity elsewhere.’ ‘Where?’ ‘Ummmmm at Charing Cross… temporarily’. What will happen when you start to demolish Charing Cross and parts of St Mary’s? Grimace.

In the midst of this tangle it’s very clear that affluent areas will be replete with services whereas patients in low income areas will have to travel further afield to services which are already overloaded – wait at least a year until you make your final decisions about Charing Cross, one audience member sensibly urged.
Just a week later, it was over to Hammersmith Hospital to meet Imperial College Healthcare NHS Trust…..and hear the 10 minute agenda item allocated to the demolition plans for Charing Cross.
Admittance having been gained by the MP following the national news outing, others are then gradually admitted on a one by one basis over a period of an hour and a half despite empty seats – a wheelchair user is refused entry. Trust reputation duly tarnished. Said ’Imperious’ Trust spends two and half hours describing a strategy which contains some surprise elements which trounce even the CCG’s Monty Pythonesque efforts of the week before…

‘Their announcement about Charing Cross is different and even more radical than previously stated – they are about to take out even more of the site and give it over to developers.’ This is clearly a different business plan' said Una of the Save our Hospitals Campaign. 'Where, then, is the consultation?'

According to the Board it is not closure, but a ‘strategy’. However the Board presentation specifically says that for the plans on Hammersmith( and Central Middlesex ) to work there is a need for 'optimal service adjacencies'
- these A&E services close on September 10th. 6 whole weeks to put something 'optimal' in place in their stead?
‘How will you cover the shortfall in services due to the closures in Walk In Centres, risk to GP services and lack of community provision’ Francis Prideaux puts a detailed question listing a wide range of community impacts, to warm applause from the audience. He receives a diminutive reply. ‘ 'We are looking at that…’
The area has a rapidly expanding population. 'How will you cater for all of those people who will move into the thousands of new properties which are being built in W London?' It seems they have yet to decide… or perhaps they had forgotten that bit.
‘You keep talking about stroke and cardiac care – but what of those patients who need fast track access to more general medical emergencies such as meningitis, peritonitis, placenta previa and respiratory failure and your hard to access St Mary’s is all full up?’ Trotting out the improvements in trauma care will not help these patients when there is nowhere for them to go.
If you don’t know what’s going ahead on the site – you need to say so..’ said Andy Slaughter
The litany of errors went on – take a Trust chair who openly laughs at questions from patients relaying life threatening conditions and calls their questions ‘ridiculous’ ; take a Trust chair who bizarrely tries to justify the closure of the country’s best stroke unit by citing the treatment of a high profile journalist whose life had been saved in said unit; take a Trust board who sits with their backs to the public while the answering as few of their questions as possible; take a group of people who have taken decisions which will cost lives and yet are content for it to be that way.
‘Why are you talking out of the back of your head Tracey?’ No response from the CEO with the hacker reputation and self-evident disdain for patient welfare.
Sometimes there are grey areas of uncertainty where accusations of cynicism can be levelled at those who query the direction of travel. On other occasions the evidence is not just blindingly obvious, but compounded by actions which are nothing short of self harming brick bats which ricochet collateral damage across a wide trajectory.
The How-Not-To-Communicate Giant Turkey Awards now have what must surely be an unrivalled contender.

Trust broken. Trust shattered. Trust them. Not.

 SHA Website
Jos Bell 1.8.14.

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