Another ‘Mid Staffs’-like scandal – and a scandalous ending?

I need to tell you about a situation that I’ve come across which could fill you with horror. If you’ve been appalled by the Mid Staffs scandal, then you need to know about this. I’m almost certain that this story is not currently being covered by any of the mainstream media.

This article concerns a nurse with responsibility for a large, busy ward in which she tended many severely ill patients, with many terrible outcomes. Death rates under her care were at a level that no one should accept in a modern hospital.

I’m so sure of the facts I’m about to tell you that I’m even prepared to name the nurse: Kate Arriens. That so many British patients died under this Dutch nurse will surely appall.

Arriens failed to maintain sterile procedure in her ‘care’ of her patients. Infections were rife, and some even lost limbs because of them. Some were left so desperate for water that they even drank from their toilet. Others died in fear and agony, with only the rudiments of care provided to them and without even being able to talk to a priest or minister. Arriens often left her patients completely, often only returning an hour or more later, and didn’t offer pain relief to most of the suffering patients in her charge.

In the relatively short period she was in charge of her single-sex ward, an astonishing number of patients died, yet no one blew the whistle. Even though the chain of command and responsibility was absolutely clear, the people in charge of her hospital took no action against her, and completely failed to improve conditions.

Who is responsible for this astonishing cover-up? You’re probably outraged and wondering what happened to the woman responsible for this terrible episode.

If so, you’ll be even more outraged to know that, not only was she not punished, but she was rewarded for her performance.

With a medal.

The “Most Excellent Order of the British Empire“, to be precise.

Kate Arriens – better known by her married name of Kate ter Horst – was a Dutch woman who lived in Arnhem in 1944. Her house became the ‘hospital’ for hundreds of British paratroopers wounded in the attempt to take Arnhem Bridge – the ‘bridge too far’.

Ter Horst’s house was surrounded by German forces and she was forced to bind wounds with strips torn from sheets. After the water pipes were ruptured, she would often leave her patients to find water at great risk to herself and, in extremis, even gave them water from the toilet to ease their thirst.

With no anaesthetic, blood supply or antibiotics, often all she could do was read to her patients from the bible and hold their hand until they died. In spite of the dirt, stink, screams, deaths and unimaginable suffering, Kate ter Horst was remembered by those who survived as

the Angel of Arnhem.

You see, context is everything.

Something might seem, out of context, to be the most appalling neglect – even callous irresponsibility or outright cruelty. But in their properly-understood context, the very same facts can portray courage, nobility – even heroism.

What might, in ideal circumstances, seem like the most intolerable misdeeds can in fact be an almost-superhuman effort of compassion, diligence and self-sacrifice – if the context is one of lack of sufficient resources, support and personnel to have even the remotest chance of offering ideal care.

The events at Mid Staffs NHS have been portrayed as typifying callousness, neglect, laziness – the very opposite of the compassion we expect from our doctors, nurses and healthcare assistants.

But strip away the misleading headlines and misunderstood (or deliberately twisted) statistics and replace them with a correct understanding of what happened at Mid Staffs – or even a dispassionate, objective reading of Robert Francis QC’s official report, which emphatically does not say ‘hundreds died’ – and the ‘poor care’ at Mid Staffs takes on a completely different significance.

Consider these three key facts:

  1. The Francis report was clear that the immediate cause of poor care was drastic understaffing.
  2. Far from there being ‘hundreds of needless deaths’ at Stafford Hospital, the real Hospital Standardised Mortality Ratio statistics demonstrated one clear fact: the death rate was below the national average.
  3. The vast majority of patients at Mid Staffs during the crucial period reported good care and remained supportive of the Hospital and its staff.

The government and the media have painted a picture of a hospital where staff didn’t care and where patients were wantonly ignored in their mess and suffering.

But in view of the severe understaffing and the lower than average death rate, a radically-different picture emerges – one of hard-pressed, over-stretched, harried staff who couldn’t possibly deliver good basic care to everyone all the time, but who still managed to make sure that the severe shortages did not cause more people to die than would have died anyway.

This conclusion will win me no friends in some quarters – but the truth is too important to worry about that.

No doubt there were a few poor nurses, carers or doctors at Stafford. Any large organisation, and any profession, has some people who under-perform, no matter how much effort is made to prevent it.

But the majority of staff at Stafford Hospital performed near-heroic feats to keep everything from falling apart, and succeeded not only in preventing deaths but in delivering good care to the majority of patients.

Don’t be deceived by the lazy headlines and attention-grabbing soundbites that leave out the context for the sake of ulterior motives.

Without context, we’re almost certain to get the wrong end of the stick – and if we’re wilfully deprived of the context, we should be questioning the motives of those doing the depriving, rather than falling for the ruse and standing by while the wrong people are attacked.

20 responses to “Another ‘Mid Staffs’-like scandal – and a scandalous ending?

  1. Pingback: Another 'Mid Staffs'-like scandal - and a scandalous ending? | Welfare, Disability, Politics and People's Right's |·

  2. *round of applause* Absolutely brilliant piece! This should be published in the mainstream media, the Independent perhaps, as an antidote to the conspiratorial NHS bashing that is so surely designed to undermine the NHS and make some wiggle room for Jeremy *unt to sell it off. Many, many people need to read this.

  3. Pingback: Another ‘Mid Staffs’-like scandal – and a scandalous ending? | Eye on UK Government·

  4. So grateful I want to cry. With sufficient but not excessive staff look what we are achieving now. I rest your case!

    • 🙂 Glad to be of service! I heard that the original ‘real Mid Staffs’ article was read by most people working at the hospital and cheered everyone up – I hope this will do the same as well as challenging some of the ‘anti’ perceptions.

      I’ll keep chipping away at this, and expect to be posting a big ‘exclusive’ post over the next few days, once I’ve got my head around the new information I’ve got.

      Would love to get down and visit the hospital some time. If ‘Save Stafford Hospital’ take up my offer of help via CCGWatch, I might get my wish!

  5. As a senior medical student sitting my final exams (and starting work as a Junior Doctor in August), I have read your comments/articles with interest. Despite being an EU citizen, I have trained in the UK and I have learned to love the NHS, despite its flaws. However, the government seem to be using it as a political game, and I fear for the healthcare system I may have to work in in the future.

  6. Since the crazy experiment with the market began 39 years ago NHS management costs have ballooned from about 5%to 12%.Nicholsons £20b challenge would be met by returning to status quo ante.

  7. My role in the NHS often involves supporting staff and teams through conflictual situations.Although cumulative resource depletion is a major problem (sweating the assets), a further difficulty comes from the tools and methods used in the surveillance and governance of the Health service.The governance systems employed by organisations such as Monitor and the CQC create in themselves an abundance of difficulties and lead to a preoccupation with fantasy realities of idealised futures which can be achieved through project management. What tends to be avoided is an engagement with how things actually are. Senior managers and their staff increasingly find themselves caught up in a coercive systems approach which dehumanises people and encourages statistical gaming.The consequential power dynamics close down the open communication required for holding the ring of care around vulnerable people as everyone fears for their jobs.We have been blinded with the pseudo science and power issues which sustain the managerialist edifice of performance and ‘evidence based’ outcome with its politically driven stretch target culture.

  8. Hear, Hear! i.e. common sense and listening to the staff has gone out of the window.
    As regards what I was “not amazed” by (last but one comment), it was that since the marketisation of the NHS, management costs have gone up a lot. It’s interesting that we used to have an NHS everyone trusted pre 1974 (date of the first of 17 major re-organisations), based on clinical priorities and producing the world’s best overall whole system health outcomes, available to 100% of the population for 4.8% of GDP (yes probably a bit of sensible investment was then needed). Whatever system you use for producing widgets/cars/cream cakes in society (eg the market) there seems no doubt that a socialised system for health care is the most equitable, accessible, effective and cheap!

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