Is there more patient abuse in the NHS today than there was, say, thirty years ago, or are we just better at exposing it? Dr No does not know for certain. He chose a thirty year comparator because it was about that time ago that he was a medical student, and then a junior doctor, and so frequently exposed to different wards and hospitals. His recollections from that time are more of starched white sheets, and of course the starched but very beguiling nurses who smoothed them out, than of beds doubling up as commodes. He does recall once seeing a cockroach on the polished wooden floor of a ward, but it was a one-off sighting of a very lonely cockroach. Today, it seems, the cockroaches have grown in both size and number, many now standing on two legs as they mishandle and maltreat the patients on their ward. Has it come to pass that the once occasional failing has now become normal practice?
Searching in the BMJ, on the grounds that its news coverage would pick up on reports of patient abuse, Dr No found surprisingly little. Top of the hit list was a 1905 report on abuse, not of, but by patients, of the out-patient (then acting much as A&E does now) department – nothing new under the sun there, then. The second hit was a 2003 report not of doctors abusing patients, but patients abusing doctors. Thus far, the trend seemed to be more of the boot being on the other side’s foot. Third up, however, was a report, from November 2000, of an NHS Trust that had ‘condoned abuse of elderly patients’. The boot was back on the medical foot.
But the next seven hits all came from the late 1800s – that’s right, 1800s, all over a century ago – and again were about patients abusing the system. Overall, reports on patient as victims of abuse were rare. One from 1990 covered abuse by carers, but outside hospital, and so not in or by the NHS. A 2005 report, ‘Blind eye to complaints allowed psychiatrists to abuse patients’, did cover the Haslam and Kerr scandal, but, generally speaking, on the basis of contemporary BMJ reports, there wasn’t a lot of it about. What was about, rather strikingly, was a lot of still familiar themes. Page 883 from a 1894 issue of the Journal takes in: (in)competent GPs, medical fees, the threat posed by madwives, and the hazards of artificial feeding on the [incapacitous] insane, all topics very much alive today.
Be that as it may, if there was patient abuse going on, the BMJ clearly wasn’t, at least via its search facility, saying much about it. So Dr No widened his search, to scandals and other sources. To cut a long story short – Dr No wont trouble you with the details – he did find this 2002 BMJ paper, which reports that the number of NHS scandal inquiries has risen sharply in recent decades, from one in the 1960s, to two in the 1970s, five in the 1980s, and over fifty between 1990 to 2001. At least one other significant inquiry, covering seven hospitals, but not included in the 2002 paper, was published in 1968, while a BMJ editorial from 1999 alluded to several others.
So, by the barometer of pressure of significant inquiries, we certainly have seen an exponential increase in patient abuse by NHS staff. But we still don’t know whether that increase reflects an true increase in underlying abuse, or is instead an apparent increase caused by a greater will to expose and investigate abuse, which has itself remained at relatively constant underlying levels.
That said, Dr No does suspect, based entirely on his own direct personal experience, and notwithstanding the loose nature of his present proxy-dependant research, that the rise in inquiries does reflect at least in significant part a true rise in underlying levels of patient abuse in the NHS. He also notes that this rise appears to have risen most sharply over the last two decades, following the introduction in the mid to late 1980s of general management and market forces to the NHS. Could it be that managers, now playing their market and management games in the once consensual NHS, have wrought the most dreadful changes on what was once, bar occasional failings, generally a decent service? If there is even a grain of truth to that chilling proposition, then it is management blowback on a monumental scale.
13 thoughts on “Patient Abuse – A Bad Case of Management Blowback?”
“Why would anyone want to design such experiments on their fellow human beings in the first place” – front what I’ve read it seems both Milgram’s & Zimbardo’s research was driven (primarily) by a single question; why, in certain circumstances (Abu Ghraib, Auschwitz), are ‘ordinary’ people complicit, or even responsible for terrible acts?
Dr No has a copy of Milgram’s Obedience to Authority (bought when he was a medical student – £2.50 hardback!). The Nazis crop up on page one in paragraph one and repeatedly thereafter – and there is little doubt that the main purpose of the experiments was to understand better how and why ‘ordinary’ people commit awful acts. Milgram also makes the point that the ‘dangers of obedience’ are not limited to Nazidom. In the epilogue he discusses My Lai and Vietnam, pointing out that these events happened under the control of a democratically elected government. Authority is authority, however it got there.
It seems to Dr No that ‘bad apples’ are an unfortunate combination of red herring and scapegoat – a rotten stinking alliance at the best of times. It seems much more likely that these atrocities arise out of a variant of group-think, a variant in which acceptable social norms (and conscience) collapse under the weight of the in-built, all too common, and at times necessary (which complicates matters further) human need to conform to the herd, and to authority, even when to do so clearly violates what is good.
The problem, Dr No suggests, is not ‘bad apples’: it is the bad trees, even bad orchards, that allow them to grow.
I think its pretty shocking that Health Care Assistants are the ones to bear the brunt of hospital cross infection problems. The argument is usually and predictably “they didn’t follow the protocol.”
Interestingly, I had lunch today with a friend who out of the blue brought this into the conversation:
He was rather incandescent about this recent report regarding Mid Staffordshire NHS Trust.
He found it difficult to believe that, after the outcry a couple of years ago and the present on-going inquiry, those now in charge of the place didn’t have the wit to realise that they’d need to damn well get their act together and make sure staffing levels in the A and E Department were safe at all times.
But he questioned another aspect: why were the public, local, and national press not making more of a fuss about the number of avoidable deaths that had taken place in the A and E Dept there. He compared this numerically with other deaths that resulted in huge public outcry eg Baby P, Harold Shipman, soldiers killed in Afghanistan etc. He made the point that these un-necessary deaths occurred (I quote) “in a hospital for heavens sake – where large numbers of people are supposed to be protected by caring staff.” He wanted to know why there was not the same outcry as there was when a baby died from child abuse, elderly patients were killed by a serial murderer who also was a doctor, or soldiers bodies were brought home from the battlefield.
We came to various conclusions but I’m not sure if they were the right ones.
“What are the circumstances that make ordinary people complicit, or even responsible for such terrible acts?”
The key word that may well justify these experiments shrouded in dodgy ethics is “circumstances.” But is society any further on in identifying the bad trees or orchards or even the bad weather that causes bad apples? And if society has identified the circumstances what are they doing about it?
So, the question My Black Cat is asking me is: “Has Milgram’s and Zimbardo’s research benefited society?”
Hmmm, for many years I have had the same discussion/argument with my brother-in-law/ego-driven university lecturer that morality/ethics were on a continuous sink, an ever continuous (and unstoppable?) decline where we think and consider less of others and more of ourselves. For many years he laughed at me, yet now agrees with me and has thrown his socialism out of the window as political beliefs do not equate to reality.
Whether we (care to) admit it or not, society is being gradually dumbed down for that is how governments gain control of the minds of the people, we are malleable yet at the same time, this ease to which we are manipulated has detrimental effects on society as we can be manipulated by all.
We have (for the most part) become a nation of sheep in that we follow the diktats of unions, governments and so on – even though we may not realise that we do. Yet there is the herd mentality where we conform to fit in and are capable of the unspeakable
Why was there not an outcry over avoidable deaths at A&E at Staffs? Baby P was a baby and therefore vulnerable, Harold Shipman was a murderer (and therefore of great interest – how did he get away with it for so long?) and the soldiers, the dear soldiers are still regarded as unfortunate victims/cannon fodder in world politics. A&E does not afford a similar emotion.
Why did the management not have the wit to learn from the lessons of two years ago, because they are remote from it – pure and simple. What happens in A&E, on the shop floor is as distant from management as is the moon. Unless you feel it and taste it, it is meaningless and that is what is wrong with the NHS today, once ‘management’ was removed from the medical profession, so was understanding.
“What are the circumstances that make ordinary people complicit, or even responsible for such acts?”
It is a sad fact that if we are not a ‘bad apple’ the potential is definitely there for us to become one. If the circumstances are right, just right and we cannot extricate ourselves from them (for whatever reason) we will be slowly worn down and conform, we will conform to survive.
Let’s all get behind a huge contributing factor towards poor nusing care in the UK. If you care …then sign.
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