Palpable Nonsense


The RCN's knee-jerk reaction to a speech by Jeremy Hunt demonstrates how deluded the trade unions can be at times. 

Because the greets health scandal of modern times, the premature deaths of up to 1200 patients and intolerable standards of care at Mid Staffordshire Hospital, occurred at a time when NHS resources were increasing significantly, year on year.

So the RCN's argument that mistakes and errors are down to 'understaffing' is completely laughable, if you ask me and Dr Peter Carter should be ashamed of himself for peddling such palpable nonsense.   

NHS errors costing billions a year - Jeremy Hunt

The Royal College of Nursing says mistakes are the result of understaffed wards

Basic mistakes in hospitals in England cost the NHS up to £2.5bn a year, Health Secretary Jeremy Hunt is to say.

And the NHS could afford to hire more nurses if the errors were cut out, Mr Hunt will claim during a speech in Birmingham on Thursday.

Cost is incurred through problems like medication errors, avoidable infections after surgery, and litigation.

But a spokesman for the Royal College of Nursing said mistakes were the result of understaffed wards.

In his speech Mr Hunt will describe these kind of mistakes as "expensive and wasteful" at a time when hospital trusts are trying to save money.

'Picking up the pieces'

He will say: "I want every director of every hospital trust to understand the impact this harm is having not just on their patients, but also on their finances.

"And I want every nurse in the country to understand that if we work together to make the NHS the safest healthcare organisation in the world, we could potentially release resources for additional nurses, additional training, and additional time to care...

"More resources should be invested in improving patient care rather than wasted on picking up the pieces when things go wrong."
Mr Hunt wants hospital trust directors to understand the financial impact of harm

A recently-published report commissioned by the Department of Health (DoH) described what it termed as "preventable adverse events" rather than mistakes, as costing the NHS "a significant amount of money".

It estimates the cost of such mistakes to be between £1bn and £2.5bn a year.

Last year the NHS spent £1.3bn on payouts after being sued by patients over care errors.

Four areas of poor patient safety highlighted by the DoH include falls and trips, bed ulcers, urinary infections caused by poorly fitted catheters, and deep vein thrombosis, which together cost an estimated £200m a year in extra care.

Mr Hunt's words will mark the start of a poster campaign warning staff about the financial problems basic errors cause.

'Not enough staff'

The health secretary is due to argue that it would be wrong to set targets or "issue a new ministerial decree" in an effort to cut out such problems - instead he favours a "cultural change" to make hospitals safer.

But Dr Peter Carter, chief executive of the Royal College of Nursing, said the government needed to invest in more staff before patient care can be improved.

He said: "Falls and preventable conditions such as pressure ulcers happen when there are not enough staff on a ward to care properly for every patient, not because nurses are unaware that these things should be prevented."

Labour have also argued that under the coalition government nursing numbers had fallen, and billions wasted on reorganising the NHS, which has resulted in care problems becoming more likely.

Patients' Voices (5 June 2014)


Scotland's health minister, Alex Neil, made some sensible proposals the other day about strengthening the voice of patients in the NHS.

Now who could see anything problematic in that, but here's a terribly defensive response from one of the main health unions, the Royal College of Nursing (RCN), which sounds to me as if patients (or their families) say anything critical then the staff and the unions expect to consulted about what happens next.  

Commenting on the announcement from Cabinet Secretary for Health and Wellbeing Alex Neil MSP that he will bring forward proposals for a new system of listening to, and promoting, the patients’ voice RCN Scotland Director Theresa Fyffe said:

If we are to achieve an NHS in Scotland that truly focuses on patients, we need to listen to their concerns and give them the means for their voices to be heard. That’s why we supported the introduction of Patient Opinion into our NHS last year. We believe that all patients should be able to feedback their views on the care they receive, both positive and negative, so health boards and the Government can use this constructively to improve and change how things are done.

“At the same time, staff must also have a voice and be listened to. Patients’ views can affect already demoralised staff, who are trying to do their best under pressure. Health boards must therefore listen to what patients are saying and then listen and support staff to make the necessary changes to improve how care is delivered. Both patients’ and staff’s feedback and concerns are important and must be heard locally and nationally, if our NHS is to become ‘world class’.”


Now this seems like a whole load of baloney to me because the NHS is one of the most highly unionised areas anywhere in the public sector and the staff already have a very strong voice and ability to express their views.

And as events at Mid Staffordshire Hospital have shown there have been terrible cases of neglect and poor standards of care within the NHS, so the problems are not always about staff working under pressure.

To my mind it's complete humbug to argue that "patients' views can affect already demoralised staff, who are trying to do their best under pressure" because what that sounds like to me is people getting their excuses ready without even listening to what patients and their families have to say.      

Here's what Alex Neil had to say about his own proposals by the way and it doesn't seem to me that there's 

“But let me be clear – there is absolutely no complacency and we will go on striving for improvement while staying true to the founding principles of our NHS.

“That is why we must do more to listen to, and promote, the voices of those we care for. We need the voices of our patients, those receiving care and their families, to be heard in a much clearer and stronger way. The introduction of Patient Opinion has provided a new and vital way to gather views.

“However, we will not stop there. That is why I will be bringing forward proposals for a new system of listening to, and promoting, the patients’ voice. I have tasked Healthcare Improvement Scotland and the Scottish Health Council to develop these new proposals. 

“Their task is straightforward – develop a system that means we do more to truly hear the voice of patients.”

Nothing in that to get worked up or all defensive about if you ask me, but the RCN have form in this area as you can read below.

Voice For Service Users (5 March 2013)

Trade unions are experts at lots of things - especially at telling other people what to do and how to do it.

But in my experience trade unions are seldom keen to accept any critical assessment of their own performance or the kind of independent scrutiny - which operates routinely in many other areas of public life.

I wrote a post last month about the lack of leadership from the trade unions during the care scandal at Mid Staffordshire NHS Trust - in particular the largest nurses union, the RCN.

Here's what the independent Francis Report into Mid Staffs had to say about the RCN:

Royal College of Nursing

1.98 At Stafford, the RCN was ineffective both as a professional representative organisation and as a trade union. Little was done to uphild professional standards among nursing staff or to address concerns and problems being faced by its members.

1.99 A prime reason for this was a lack of effective representation from elected officers on site. Further, the support avaialable from RCN officials at a regional and national level was limited.

1.100 The RCN is not, of course, a regulator but a combination of a professional representative body and a trade union. However, it does represent a group of qualified professionals and seeks, as it should, to promote high standards of service and conduct. The evidence reviewed in this report suggest that the RCN has not been heard as might have been expected in pursuing professional concerns about the standard of care.

1.101 It appears there is a concerning potential for conflict of intersst between the RCN's professional role of promoting high quality standards in nursing, and its union role of negotiating terms and conditions and defending members' material and other narrow interests.

Ouch! - was probably the intitial reaction of the RCN to such devastating criticism of its role at Mid Staffs - and I suspect that the other NHS trade unions behaved in a similar fashion.

The lesson to learn is that NHS trade unions cannot champion the cause of services users and their families - who need a strong voice of their own to balance the many vested interests which control the NHS.

What's needed in the NHS and elsewhere in the public services is more People Power - and less control by the senior managers and bureaucrats who run the show at the moment - sometimes for their own selfish ends.

Hospital Trip Advisor (4 February 2013)

I am beginning to think that Dr Peter Carter - the chief executive of Royal College of Nursing (RCN) - is losing the plot.

The leader of the country's largest nursing union was in the papers at the weekend - making some rather extraordinary claims about poor standards of care in the NHS - and here's what Dr Carter had to say:

“Will there be another Mid Staffs? Yes, sadly there will be. There are 1.2 million people employed in the NHS and there is a hospital in every town. It would be foolish to say everything in the garden is roses.

Mid Staffs cannot be an isolated incident. The fact is, the service is under huge strain. Trusts are not thinking intelligently about how they deliver care and are simply cutting the numbers of frontline staff. Our members have a personal and professional responsibility to raise concerns.

The vast majority of patients still get good care, but that is no consolation to those who don’t. Mid Staffs has got this massive profile now, but there have been many others like it . . . Bristol Royal Infirmary, Basildon, Alder Hey. The report into Maidstone and Tunbridge Wells [where hundreds of patients died after an outbreak of the superbug C-difficile] is painful to read. On the wards there were beds that were eight inches apart ... what the hell were the managers doing, but also what was going on with the nursing culture? There was a culture of bullying and intimidation.

If the board had spent time walking the wards, talking to patients and staff, just doing their jobs, they may have saved hundreds of lives.

You wouldn’t expect staff at Kwik-Fit to get by with a bit of TLC and a bit of common sense. These are old people ... their bones are like porcelain, their skin is like tissue paper. They need highly skilled specialist care. The idea that four or five unskilled staff can take care of 30 elderly patients is nonsense.”

Now these comments come in advance of the report on Mid Staffordshire NHS Trust - where poor standards of care said to have caused up to 1,200 unnecessary deaths between 2005 and 2008.

So the first point to be made is that the scandal of Mid Staffs happened at a time of plenty for the NHS - which means that, broadly speaking, resources and money were not any part of the problem.

The second point I would make is that the NHS is one of the most highly unionised industries in the UK - and the RCN is one of the largest, most influential trade unions - with lots of RCN members in senior management and leadership positions.

In which case I fail to see how it can sensibly be argued that Trust's board members were somehow responsible for saving hundreds of lives - when there were all these staff around who were paid, some of them very generously as well, to look after patients.

I happen to think it would be a good for NHS board members to interact more with patients and their families - but surely this would be much more practical if the regulatory bodies in the UK made more unannounced inspection visits - and actually asked patients and families for their views on the standard of care received.

My mother died five years ago after and before she passed away my mum was a frequent visitor to her local hospital where - I think it's fair to say - that some of the care she received was very poor.

But no one asked my mum what she thought of her care - nor any of her family - which strikes me as very odd in this day and age - because feedback from patients and families is the obvious way to highlight underlying problems.

To paraphrase Dr Carter's own analogy - I think I receive much better customer care from Kwik-Fit than my dear old mum did at times - from her local NHS hospital.

A former health secretary in the last Labour government - Alan Milburn - came up with an interesting idea recently with his suggestion that the NHS needs an equivalent of Trip Advisor- so that patients and their families can provide useful feedback after a hospital visit.

People power meets patient power - now that really ought to be part of the answer. 

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