The NHS wins when its patients die (U.K. National Health Service)

The Telegraph (U.K.) ^ | October 13, 2007 | Charles Moore

[Stoat]

The NHS wins when its patients die

By Charles Moore
 

Last Updated: 12:01am BST 13/10/2007

 

 

Florence Nightingale's famous Notes on Nursing, published in 1859, state that "the greater part of nursing consists in cleanliness". In my edition, the foreword points out that much of Miss Nightingale's writing, excellent though it is, is now out of date. In particular, the need for cleanliness is well understood. That foreword was written in 1946.

Now it is 2007, and we learn that nurses in the hospitals run by the Maidstone and Tunbridge Wells NHS Trust told patients suffering from diarrhoea to "go in their beds". Between 2004 and 2006, 90 patients treated in those hospitals died from Clostridium difficile, and the disease was a factor in the death of a further 241.

Were it not for bad nursing, bad medical attention and bad administration, none of these patients need have died. Indeed, they would not have contracted C. difficile at all unless they had gone into hospital. So, after 150 years' advance of education, technology, prosperity and science, we have lost what Florence Nightingale taught.

It was the distressing subject of diarrhoea, indeed, that provoked Miss Nightingale to one of her most trenchant footnotes. She gave the example of how, if a bedpan with a lid were changed only once a day ("As well might you have a sewer under the room"), by a maid rather than a nurse, the problem might go undetected. he bedpan must be changed frequently, inspected, and all of it, including its lid, properly cleaned.

I notice that the Healthcare Commission's report on Maidstone says that stool charts, i.e. recorded inspections of the diarrhoea, were made in fewer than 15 per cent of cases.

Florence Nightingale adds: "If a nurse declines to do these kinds of things for her patient, 'because it is not her business', I should say that nursing is not her calling." It is a "waste of power", she says, for nurses to do things such as scouring floors, but if it needs doing, they must do it: "the true nurse-calling" puts "the good of their sick first, and second only the consideration what is their 'place'?".

The testimony of the families from the Maidstone area is that their relations who died were often humiliated, left in filth, and ignored. The weakest — the old — were treated the worst. It was a failure of systems, yes, but also of individual professionals and of common humanity.

Every year, as a journalist, I go to party conferences and hear politicians of all parties make speeches about how wonderful the National Health Service is. Gordon Brown got all weepy this year about how it saved one of his eyes.

Last year, David Cameron said that where Tony Blair had spoken of three words — "Education, education, education" — he would emphasise three letters — "N-H-S".

The point our leaders are constantly making is not medical, but moral. It is that the NHS embodies organised altruism. It proves that we, as a nation, care for one another. It makes us "the envy of the world", and it makes us good.

One naturally wants to agree. We all like to think that matters of life and death are well looked after. And most of us will have direct experience of NHS nurses and doctors who have treated us with great kindness, care and skill.

Nevertheless, the basic proposition is not true. The National Health Service is not, morally, or in any other way, the best system of healthcare in the world. Indeed, it is morally defective at its very root, because it does not — cannot — put the sick first. Until this is recognised, it cannot be reformed.

The NHS is, with our state school system, the last major survival in this country of the idea of the 1940s that government can decide what is best for us and make sure that it is done. Aneurin Bevan, who invented the thing, once said that not a bed-pan (that object again) should fall to the ground without the minister knowing about it.

A colleague of mine, who investigated alternative healthcare systems when the extreme dirtiness of many British hospitals first became an issue, went to France to compare. In hospital after hospital, he found floors so clean that you could have eaten your lunch off them. Did the Health Minister order them to clean them, he asked an administrator.

He was met with a look of incredulity. "Of course not. We run ourselves. Patients have a choice of hospital. If they do not choose us, we get no money. No hospital can survive if it is not clean."

Two weeks ago in Bournemouth, Gordon Brown was on to the subject of C. difficile, babbling about ordering "deep clean" and more than doubling the number of hospital matrons to 5,000.

"Bring back matron" has become a party conference cry, like "Bring back the rope" used to be. But matron will be only a name so long as Mr Brown (or whoever is Prime Minister) ultimately decides who should have what where.

We all know that a Minister for Industry could not possibly decide how many computers we produce or how many investment banks we should have. We all know that a Minister for Food could not wisely decree what vegetables should be sold in which shops.

But we cling to the idea that a single organisation employing 1.4 million people, with the GDP of an entire Scandinavian country, run by politicians, can meet our health needs.

Suppose Sainsbury's cold meat counter was found to have helped kill more than 300 people, would the company survive? Yet the NHS sails on, dealing death. According to a report four years ago by Professor Karol Sikora, we could save 10,000 deaths a year from cancer, just by hitting the European average; but we don't, and nobody takes the blame.

The boyfriend of the chief executive of the death-dealing Maidstone trust tells the press: "No way is she going to talk to you. Why should she?" The trust has arranged her severance pay of £250,000.

We all complain about the "target culture" that made administrators in Maidstone ignore actual human suffering before their eyes. But if you have a top-down system of healthcare, targets are the inevitable response to whatever is the latest disaster.

In this case, one of the targets was to cut waiting times in Accident and Emergency to four hours (four hours! You wouldn't put up with that to buy a cinema ticket, yet we have been brainwashed into thinking that it's not too bad for your child with a broken arm). In this world without choice, each claim of need jostles against another: either faster A&E, or cleaner bed-pans, but not both.

This is all, morally, wrong. It turns the patient from being the entity for which the service exists into a nuisance. Each new patient is just an added cost and each dead patient is an administrative convenience.

Under systems of social insurance, such as exist in Germany, Belgium or France, many problems remain, but this most basic one disappears. Money goes with each patient, who can choose who treats him. Therefore every doctor, hospital and nurse wants patients.

Our system also turns the nurse and doctor away from their duty, and therefore attacks their moral sense. It tells them to ignore "the habit of observation", which, said Florence Nightingale, was the key skill of nursing, in favour of through-put or targets or — for human nature reasserts its worse side when badly led — sneaking off home exhausted and disillusioned.

The NHS is run from top to bottom, and therefore, from top to bottom, it is bad.

[Stoat]

Coming to America if HillaryCare is allowed to gain a foothold.

[lilylangtree]

National health care is a b*tch, just like the hildebeast.

[okie01]

How is it that people can actually wish for something like the NHS?

It's not "fair" -- in the sense that everybody gets the same poor service. You can bet that Gordon Brown and Tony Blair did not go to Maidstone for their treatment.

It's not "effective" -- for the very reason that the reporter identifies: each new patient is a cost, each death an administrative convenience.

Nonetheless, it is damnably expensive. Even though it is "free"...

[Gritty]

[Stoat]

How is it that people can actually wish for something like the NHS?

Because they aren't aware of the reality of what it truly is.

It's not "fair" -- in the sense that everybody gets the same poor service. You can bet that Gordon Brown and Tony Blair did not go to Maidstone for their treatment.

It's not "effective" -- for the very reason that the reporter identifies: each new patient is a cost, each death an administrative convenience.

Nonetheless, it is damnably expensive. Even though it is "free"...

And although of course Britons can choose to gain care outside of the NHS system, the mere fact that it exists at all raises their costs exponentially....people pay once via their taxes and then again if they want to go outside the system and actually gain quality care.

How is it that people can actually wish for something like the NHS?

Because they aren't aware of the reality of what it truly is.

It's not "fair" -- in the sense that everybody gets the same poor service. You can bet that Gordon Brown and Tony Blair did not go to Maidstone for their treatment.

It's not "effective" -- for the very reason that the reporter identifies: each new patient is a cost, each death an administrative convenience.

Nonetheless, it is damnably expensive. Even though it is "free"...

[AZLiberty]

Medicare is in the same position. The quicker people die, the better it is for Medicare, financially.

The Office of Management and Budget (OMB) did a study a few years ago to determine whether Medicare should implement newer techniques for chronic disease management. The conclusion was that the new techniques would probably allow people to lead longer, healthier lives, but people would eventually die of something else, probably cancer, whose treatment is much more expensive than having people die of heart disease. The cost to Medicare would have been huge.

[Cacique]

btt

[Stoat]

Medicare is in the same position. The quicker people die, the better it is for Medicare, financially.

Very sad, and it 'should' serve as a lesson to all on the necessity of implementing Capitalist reforms in Medicare.

Such reforms, thankfully, are at least being discussed.  Hopefully the siren song of "free healthcare"  will not sway too many voters, but I worry that far too many are simply too stupid to understand what it is that they are actually voting for.

[skinkinthegrass]

The NHS wins when its patients die (U.K. National Health Service)....

Of course, they do.....Death is so much cheaper, too (and w/ no legal liability's...they still keep the $$$$/taxes) and you can still blame the mean 'ol republicans, for not having if sooner...and still not very good for the patient....the rationing.

[Popocatapetl]

Remember that to leftists, nationalized health care is an article of faith, no different than Holy Communion is to a Christian.

Leftists don’t care if a national health care system is 100% lethal for every patient who walks through the door. It isn’t important if it kills or makes sick instead of healing, or if it is filthier than a stable. It doesn’t matter if its doctors and nurses are fakes and butchers.

They will still insist not just that it is better, but that it MUST BE better. They will also say that ANY problems are because of sabotage and not enough money. Even if all the money in the world is not enough money. Like Tinkerbell, they think that medicine is not based in science, but in faith. And if all the children clap their hands, then socialized medicine will work.

As I said, it is an article of faith with them. They will argue forever in its behalf as if it was their religion, because it *is* their religion. Logic and reason mean nothing compared to their faith. Suffering and death mean nothing compared to their faith.

That is why health care should never be under their sway, for their faith is a foolish and murderous creed, always has been, and always will be.

[Peter Libra]

A superb essay. I myself was a patient under the new NHS in 1952 and 1954. Pleurisy and then a cartilage removal. I complained then, but it was duck soup because I walked away healthy. I knew something radically wrong was afoot. A young man of 19 yrs was so full of outrage at his plight, that of since 2 yrs of age, he has recurrences of T/B. In and out of hospitals. (Stanmore Middx Orthopaedic Hospital). He was allowed to blow a trumpet at night. His tune never varied- it was "O Papa" from the three penny opera.

I complained and the sister blasted me with both barrels. She told me I was only 21 yrs and would be soon out into the world. A world of dances, girls and freedom.

I never could put my finger on it then. Now I can. The old order of discipline and having rights with obligations was going. I notice Florence Nightingale is referred to. As bad as any system is, when order goes, it is on it's way to disaster.

Millions of persons in my own native country are on welfare. Strong as an ox. The potential for even four hours a week service in just cleaning and doing something useful is there. It would not fix it, but an untapped source of simple labour is available.

Yeah,I know "forced labour" just like Hitler etc.

[Stoat]

A superb essay.

I'm delighted that you like it.  :-)

 I myself was a patient under the new NHS in 1952 and 1954.

I'm very sorry to hear of your health troubles, but happily you remain with us today, fighting the good fight   :-)

If you had absolute authority and power to change anything at all pertaining to the points you made, what would you do?  How would you change things to make them better?

[britemp]

‘And although of course Britons can choose to gain care outside of the NHS system, the mere fact that it exists at all raises their costs exponentially....people pay once via their taxes and then again if they want to go outside the system and actually gain quality care.’

True, though I now pay slightly less per year living in England for both NHS and private healthcare than I used to pay for my private healthcare when I lived in America. This of course is nothing to do with any inherent efficiency present in the NHS and everything to do with the appallingly inflated prices for healthcare in the US.

[Peter Libra]

I am going to answer your question in a somewhat unusual way. As to being still with us as I am, I am so blessed with health. (growls from imaginary audience- 'e don't deserve it. My spouse, though a liberal is the cause.

There was a film made for propaganda purposes in WW2. Most will never see it. NINE MEN . The crux of the message for men doomed was not to give up. They were alone in the Western Desert. It was to remember personal pride in themselves. This coupled with the fact, that they were comrades.

A bit far off I know but..... As human beings we have to recognize that the one of the ultimate things to be desired- is human dignity. My friends mother was 92 years old. She loved casino gaming. From Canada at the Michigan border, she took a nasty turn at the Upper Penninsula's Bay Mills casino.

They got her to War Memorial Hospital in Sault Ste Marie, Michigan. Ah, like royalty the elderly lady was treated. She almost made it to 100 yrs. She missed the Queens message. Expensive? Yes. Worth it? You bet.

We heard later, she would have been treated for the nasty turn anyway. To have not paid would have been downright rotten. The system has to have renumeration.

Bit of a screed. Liked telling it.

[Peter Libra]

One more point I failed to bring up was the incidence of over usuage by the general public both in Canada and the Uk of the system. 6% of the users in Newfoundland use 24% of the services. I have been in "murgency" and observed the absolute chatter and chuckling of emergency seekers.

Another province suggested a 10 dollar fee each time. Shot down by the do good Johnnies. Persons who are indigent in Canada are said to spend a third of disposable income on fast food, lottery tickets and creature comforts. Ergo.

Insist people pay a fee.

[VOA]

“Suppose Sainsbury’s cold meat counter was found to have helped kill
more than 300 people, would the company survive? Yet the NHS sails
on, dealing death.”

In the USA, if your product (POSSIBLY, and likely in the Topps case)
made some people sick, the company dies.

The company is ultimately responsible for the product and damages...
but there have been some mumbled proposals about the government health
inspectors being “faster” in reporting health-endangering results of
inspections to companies.

Beef Recall Forces Topps to Shut Down
http://ap.google.com/article/ALeqM5igYUJVjgwiiOrvpL9-faEYHGJ4DAD8S3JN680

[Interesting Times]

Beautiful article that cuts to the heart of the matter: socialized medicine can’t work because socialism doesn’t work.

[Jacquerie]

. . . 6% of the users in Newfoundland use 24% of the services . . .

Few in the US have any idea how socialized health care will bring out the hypochondriacs.

As the perceived cost approaches zero, demand will approach infinity. The only "solution" is rationing of the product.

[businessprofessor]

I agree that few realize the workings of socialized health care. I am not sure that people in countries having socialized medicine understand it either. Until you are sick, the system seems fine. The problem is that treatment is rationed when you need it. You do not find out until it is too late.

I am not sure that experience with socialized medicine in other countries will be a good predictor of the experience here. In the short run, everyone will be happy here. Slowly, the dam will leak leading to price controls, rationing, and blame seeking. In the long run, our experience will be much worse than other countries for the following reasons:

- Litigation lottery
- Proportion of dollars spent on elderly health care is much larger than other countries
- Illegal alien health care

If the dims have enough votes to pass universal health care, they will have enough votes to pass an amnesty. The next amnesty will be tantamount to open borders. The health care system, even the current one, will be overwhelmed when open borders takes effect. The system may be self correcting to a degree in that people with means will seek health care elsewhere.

[Stoat]

Beautiful article that cuts to the heart of the matter: socialized medicine can’t work because socialism doesn’t work.

I'm happy that you liked it, and you're right of course.  I fear that far too many here in the USA are ignorantly enamored with 'anything European' as being 'more sophisticated' than the way things are done here.  This comes from generations of listening to condescending Leftists and Socialists tell us how evil we are because we embrace Evil Capitalism and so of course we care nothing for the common man, yadda yadda yadda YAWN.  Never mind that our economy runs rings around theirs on the worst days and those in Socialist countries who can will flock to our healthcare system in droves, given half a chance.   All of this is lost on the Oprah listeners who look at 'anything European' in starry-eyed wonder.

There is a lot of work to be done over the next year in educating people on the truths of what you say..