Another damning and distressing report from the Health Service Ombudsman thumps onto the desks of NHS managers today. Again, in numerous case studies, the neglect and inhumanity of the care offered, in all our names, to old and vulnerable patients is laid bare in its horrible, incomprehensible reality. As has been said repeatedly this morning, there is of course much more good care, many more consummately professional and humane nurses and doctors, than there is of the disgracefully callous lack of care depicted in this report. But it has also been acknowledged that we are not dealing here with one or two outrageous cases which serve only to point up the excellence of care generally: there is something going on here which is much more systemic, more widely distributed, and more unforgivable than that.
John Humphrys, in his telling interview with ombudsman Ann Abraham, put it very succinctly. This is not about professional incompetence. It is about inhumanity, lack of compassion, and the most basic failure of respect for other people. And as he also pointed out, this is not news. We’ve been here before. So often some hapless NHS manager has been wheeled out to express their shock, their horror, their incredulity. And then their determination to put it right, their insistence that this is a tiny minority of cases, their assurance that weaknesses will be addressed.
What is going so terribly wrong? Why does it seem so impossible to put right whatever it is that is going so terribly wrong? There will be claims that it is a lack of resources; an obsession with targets rather than patient care; a deficit in the training and supervision of staff. None of it will wash. Because this appalling drama is played out not in reports, nor in policies, nor in budgets, nor in training. It is played out in the human interactions between individual staff and individual patients. It is the result of the innumerable discrete choices that staff make not to care, not to be moved, not to notice.
If that is the “what” of the problem, can we say anything about the “why”? I think we can. I do not pretend that what follows is in some sense a definitive, or all-encompassing explanation. Indeed, many will find it outrageous and offensive, and reject it out of hand. But I offer it nonetheless, knowing that it is in itself both partial and insufficient. The cruelties and neglects of staff towards patients represent one direction of travel in the staff-patient relationship. There are, too, the attitudes of patients and their families to staff. When my mother-in-law was diagnosed with motor neurone disease, and fell headlong towards ever greater dependency, I was able to observe not only how she was treated by the staff in the hospital, but also how many of the patients treated the staff. To be honest, neither was very attractive.
In London, the great majority of ward staff are from ethnic minorities. Their command of English is not always as secure as it might be. On the other hand, although there are increasing numbers of older people from ethnic minorities in geriatric care, the majority of the patients I witnessed were white. Not surprisingly, they were of course old. Older white people – yes, I know this is a generalisation – are not always as thrilled by immigration or ethnic diversity as perhaps we’d like them to be. The black nurses had to deal with a lot of racism from their patients. A lot. On the other hand, a lot of old people, with less than perfect hearing, were frequently left entirely baffled by what the staff were trying to tell them. Mutual incomprehension often led to mutual irritation, and sometimes mutual hostility. Some of the patients routinely shouted at and abused those charged with looking after them. Too often, the patients’ families were no better.
In a blog it’s not much use to exhort you to “read my lips”. So I’ll use bold italics to do the same job. I am not saying that any of this justifies, or excuses, cruel, inhumane, disrespectful behaviour from staff. You’re clear about that, aren’t you? But in this sorry business, it is exactly the nature and quality of the relationships between staff and patients that is what counts, what determines outcomes. We live in a country where immigrants are routinely denigrated, blamed for all the ills of society; where black people are still confronted with racism every day; and where newspapers such as the Daily Mail seem to make it their particular mission in life to exacerbate rather than diffuse these tensions. It is perhaps not surprising that our hospitals, relying as they do on those very immigrants and black staff, are thus places where those tensions come to the surface most acutely.
It would be stupid to try and suggest that today’s ombudsman’s report, and the horrors it reveals, can all be reduced to this one issue. We do, however, need to face the fact that inhumanity cannot be dealt with by a policy re-think, or a training course, or an increase in expenditure. Something is rotten in the relationships between patients and their carers: all I’m suggesting is that not all the fault, not all of the time, rests with the latter.