Wednesday, 6 March 2013

How to get away with murder

Castlebeck, the company at the centre of a BBC-exposed scandal into physical abuse and neglect at one of its care homes, has gone into administration.

Eleven care workers admitted a total of 38 charges last year after they were secretly filmed abusing patients at Winterbourne View near Bristol.

There were two lessons to be learned from this morning's news:

1. If you're a low-paid worker, and you want to abuse old people, join the NHS.

2. If you're a manager, and you want to insulate yourself from risks and responsibility, join the NHS.

How else can we interpret the discrepancy between the handling of events at Winterbourne View and Mid Staffs.

If you work for a private company, and you callously neglect vulnerable patients in your care or knowingly inflict suffering, there's a good chance you will go to jail. And rightly so.

If you work for the NHS, even fatal neglect will go unpunished.

Charles Moore reminds us what 'care' was like at Stafford Hospital:

[The Francis Report] is a great disappointment. It is woolly and over-long, full of jargon and euphemisms and forgettable recommendations. It is a waste of two years. But if you go back to Mr Francis’s first report, in 2010, you are sharply reminded of exactly what all this is about. It has 13 pages on “continence and bladder and bowel care” alone. These include stories about an old man forced to stay on a commode for 55 minutes wearing only a pyjama top, about a woman whose legs were “red raw” because of the effect of her uncleaned faeces, about piles of soiled sheets left at the end of beds, and of bowls full of vomit ditto. A woman arrived at 10am to find her 96-year-old mother-in-law “completely naked… and covered with faeces… It was in her hair, her nails, her hands and on all the cot sides… it was literally everywhere and it was dried.” One nice bureaucratic touch: another woman who found her mother with faeces under her nails asked for them to be cut, but was told that it was “not in the nurses’ remit to cut patients’ nails”.

That treatment alone warrants jail time, but at Stafford Hospital neglect turned fatal:

Statistics show there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008.

Today we learned that Castlebeck, a private company responsible for 214 residents across 20 UK sites will go into administration. Neglect at just one of their sites, Winterbourne View, proved fatal to their reputation.

In a statement, Daniel Smith, one of the company's partners, said the Winterbourne View home had been immediately closed after the abuse was revealed, with the company "promptly undertaking a root and branch internal review of its operations".

He said: "Whilst the board has focused on quality care provision and restoring confidence in the Castlebeck operations, the impact of two further unit closures in 2011 and reducing occupancy has significantly diluted Castlebeck's subsequent trading capabilities."

In the free market, failure is punished. In the NHS bureaucracy, it is rewarded.

Sir David Nicholson was Chief Executive of the Shropshire and Staffordshire "Strategic Health Authority" at the time of the fatal neglect at Stafford hospital. Today he is Chief Executive of the English NHS. Even after the latest report into the mistreatment, Nicholson refused to step down. Our Coalition Overlords seem quite happy for him to stay in his post. Charles Moore explains:

In retaining his power, Sir David, who is a former member of the Communist Party of Great Britain, had already been endorsed by our political leaders. Jeremy Hunt, the Health Secretary, publicly backed him. David Cameron, in the House of Commons, expressed every confidence in the great man. The political calculation, reinforced by the close relationship between Sir David and the omnipresent Cabinet Secretary, Sir Jeremy Heywood, is that only Sir David can exercise the financial control and manipulation of waiting times required to prevent the NHS exploding politically at the next election. All the deaths at Stafford Hospital occurred under a Labour government, but the Conservatives are being curiously prim about pointing this out. It is in the interests of both parties to play down the lessons of Mid Staffs.

Regular readers may remember Sir Jeremy from my post about him last year. And how appropriate that Sir David was a Communist. A Guardian article from 2006 notes that he was a member of the Communist Party of Great Britain until 1983:

Nicholson has been with the NHS for 29 years. He joined as a graduate trainee in the same year he joined the Communist party, which he then saw as the best vehicle to take forward his passionate support for the anti-apartheid struggle. He says he was not a Eurocommunist: he was among the Tankies who did not see an ideological need to distance themselves from Moscow. During the interview, the working-class lad who has reached the top pokes fun at himself by asking how much of this early baggage needs to appear on the civil service security vetting form that is sitting on his desk awaiting his attention. Perhaps former Communist John Reid, Patricia Hewitt's predecessor as health secretary, might be in the best position to advise?

Whatever might have drawn a Communist to the NHS? I'll leave the conclusion to Charles Moore:

The creation of the NHS in 1948 was not a scheme for making medicine better for patients. It was a way of taking charge of its delivery by centralised bureaucratic diktat, something which happens in no other country today except Cuba, North Korea and (oddly) Canada. It was therefore designed for the people who produced the service rather than for those who received it. Each extra patient was, from the producer’s point of view, a nuisance rather than a benefit. The NHS’s proud boast is that it is free at the point of use, but this is delivered in a variety of much more responsive ways in, for example, Australia, France, the Netherlands, Germany and Spain. Only in this country is the punishment of those whose actions or neglect have killed hundreds of people seen as “scapegoating”.
The truth is the exact opposite of what we keep telling ourselves. The NHS is the least caring and most selfishly run important institution in this country. Until we recognise this, there will be plenty more Staffords.

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