Andreas Whittam Smith: Tales of bullying from the frontline of the NHS

The Inquiry into Mid Staffs made me think of Abu Ghraib in Baghdad
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The Independent Online

I have been delving more deeply into the 800-page report on the Mid Staffordshire NHS Foundation Trust, which, through mismanagement and poor practice, caused some hundreds of avoidable deaths between 2005 and 2008. I came across this verbatim account of what the daughter of a 96-year-old patient saw when she went to visit her mother in Stafford Hospital:

"We got there about 10 o'clock and I could not believe my eyes. The door was wide open. There were people walking past. Mum was in bed with the cot sides up and she hadn't got a stitch of clothing on. I mean, she would have been horrified. She was completely naked and if I said covered in faeces, she was. It was everywhere. It was in her hair, her eyes, her nails, her hands and on all the cot side, so she had obviously been trying to lift her herself up or move about, because the bed was covered and it was literally everywhere and it was dried. It would have been there a long time, it wasn't new."

Believe it or not, this severe physical and psychological abuse of a defenceless old lady made me think of the notorious Abu Ghraib prison in Baghdad where the American guards deliberately maltreated and humiliated their prisoners.

Is this comparison so far fetched? Admittedly the ghastly treatment of the old lady described above was the result of neglect and not deliberate action. Yet if the neglect is systemic, then intention is playing a role. For this wasn't an isolated example.

One of the advantages of the inquiry conducted by Robert Francis QC is that he lets former patients and their families tell their stories. He shows with example after example that patients had to struggle to care for themselves. This led to injury and a loss of dignity, often in the final days of their lives. "The impact of this on them and their families is almost unimaginable. Taken individually, many of the accounts I received indicated a standard of care which was totally unacceptable."

Moreover one of the themes of the inquiry that does recall Abu Ghraib is a culture of bullying. Bullying is not just an alleged character defect of the present Prime Minister that can be believed or not according to taste. On the contrary, it permeates much of the public sector.

The 2000 NHS plan was the moment when senior politicians got involved in the direct management of the health service. Ministers didn't think that the public sector managers of the time had the abilities to make the required changes. So they set numerical targets and enforced them ruthlessly. In 2001, 20 per cent of NHS chief executives either resigned or were sacked. Reports of bullying began to surface.

Now turn to the executives managing the Stafford and Cannock Chase hospitals. Pressure to comply with targets came from the Department of Health, from the strategic health authorities and from the primary care trusts. Mr Francis found that that the process generated fears that failure to meet targets could lead to the sack.

However, bullying is a fault that is often passed on. So now look in on a nurses meeting. One staff member recounted: "The nurses would go into that meeting and they were told in the meeting that if there were any breaches of the four-hour rule in Accident & Emergency they would be in danger of losing their jobs. On a regular basis, and I mean a number of times per week, when I was on day shifts, I would see nurses coming out of that meeting crying."

Now finally visit the wards and observe this. The nurses passed on to their patients the bullying they had received. When asked to describe the nursing culture on Ward 11, one witness said: "They were bullies. They bullied... the other staff and they bullied the patients. There was no word for it... particularly during the two weeks that Mum was dying, they were calling out for the toilet and they would just walk by them."

Another witness recounted what happened to the gentleman in the opposite bed. "I think he ended up soiling the bed linen, and he was very, very distressed. Obviously I overheard and I said I was going to complain. He got very, very agitated and distressed saying, 'don't say anything, don't say anything, they will take it out on me'."

The truth is that bullying stretches all the way from Whitehall to the wards of a mediocre hospital in Staffordshire.