The same mistakes…

primary care training_NHS_The same mistake...

Last week we learned of deaths; maybe hundreds, unexplained, at Liverpool Community Trust.

Who of us didn’t think… Mid-Staffs. Well, who knows…

It is a familiar story that emerges from a period in our history that the NHS cannot be proud of.

In the scramble and pressure to become a Foundation Trust the focus was on balancing the books.

Monitor, the regulator, in those days, wanted sound balance sheets, they weren’t interested in who occupied the bed sheets or how they were cared for. They left that to the CQC… and the two organisations didn’t speak to each other.

The simplest way to balance the books?

Seventy percent of costs are in staffing. The biggest group, nurses. When vacancies occur, don’t fill them. Reduce bank, cut agency. It’s not difficult but for organisations already working at the margins of safety, small, extra cuts are disastrous.

Set ludicrously high departmental savings targets, turn up the management pressure and see what happens.

As a result, quality goes down the pan.

Senior management gets more anxious. Middle management more desperate. They start to manage up and bully down; ‘yes, boss, we’ll deliver’. To the staff; ‘go and deliver and don’t bring me bad news’.

Around this time front-line staff will get anxious. They know they aren’t doing things right. Some will leave and work elsewhere. Creating more vacancies.

Some will try and raise concerns. At first they’ll think they are being listened to. They discover they are not. They’ll try again and be denounced and bullied in pursuit of a policy they didn’t vote for, doing work they know is wrong.

They’ll carry on in the hope things will get better, fulfilling a vocation and for the sake of the fellowship and camaraderie of the people they work with.

Management, right up the line, will know the impact of their decisions. They will be told, shown the numbers but choose not to see, not to hear. Their values distorted by ambition, hubris and fear. They get in too deep to get out.

Regional apparatchiks will visit and pile on pressure. ‘You have to be a foundation trust… we have targets to meet’. Phone calls will be made from the DH to the chief executive and quiet words will be had with the chair; ‘I know you won’t let us down…’

Here, in twelve paragraphs you have the toxic history of the NHS and the three volume Francis report that described the past and still, I wager, predicts the future.

The talk, now, is about regulating senior managers. They will be no better placed than a nurse director, or, for that matter medical director, regulated, yet caught between corporate loyalty, obligations to their professional body and bellicose bullying from above.

When the DH chooses to squeeze organisations to achieve impossible political targets and when there are senior managers who will do their dirty work… no patient is safe.

When regulators pretend their ratings are more important than dealing with the reality of the local health economy and ignore a global shortage of staff… no patient is safe.

We told ourselves Francis would be the last report into catastrophe. Kirkup proved us wrong but we hoped he would be the last. Now we have to wait to see the truth of Liverpool.

Has history repeated itself?

The belief that history repeats itself is self-limiting. It renders us powerless but we are not. History is not an unrelenting cycle of ignorance, it’s a chain of causality that we can command. We are living, now, in our own history.

Mindsets are made up of beliefs and facts. Beliefs aren’t real only facts are.

The belief that history repeats itself is a dangerous mindset. There is no inevitability, the future is not settled by the past. There is no certainty that what happened once, will happen again.

History does not repeat itself. We do. We repeat the same mistakes.

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Reproduced at by kind permission of Roy Lilley.