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How cost cutting costs lives

New Labour health secretary Alan Johnson’s claim that the unnecessary deaths and abysmal standards of care at Mid-Staffordshire NHS Foundation Trust are not being repeated at other hospitals is based on wishful thinking rather than facts because the same target-driven, cost-cutting approach exposed in an official report is at work throughout the health service.

In one of the most critical reports of NHS treatment ever, the Health Commission found that up to 1,200 people could have died at the hospital as a result of what it described as “appalling standards of care”. The Commission denounced the trust’s disastrous failure to look after patients entrusted to its care.

Reducing waiting times took priority over the need to look after the seriously ill while cost cutting, management targets, gaining foundation trust status and public relations marketing came way ahead of patient care. The Commission concluded that staff believed care of patients had become secondary to government-imposed targets and there was a “reluctance to acknowledge or even consider that the care of patients was poor”.

A survey found that two thirds of doctors would not be happy to have a family member treated at the hospital. Patients described conditions in one ward as a “war zone”. People in A&E were left covered in blood and without pain relief, food or water, even those with serious injuries.

But no need to worry too much. Mid-Stafford is simply one bad apple in the barrel, according to Johnson. “I can give a reassurance that what happened in Stafford is an aberration, it is not indicative of what is happening in other hospitals,” the health secretary said.

But how does this explain that Johnson’s own office ignored repeated warnings by bereaved patients’ relatives? Julie Bailey, daughter of a patient who died at the hospital as long ago as December 2007 wrote to Johnson about patient concerns on 5 January 2008. Bailey, who founded a group to campaign about deaths and poor care at the hospital, simply received a reply from the health minister’s office referring her back to the hospital.

Worse still, Johnson’s office was not the only official body to ignore warnings about the failings at the trust. The Healthcare Commission itself rated the trust’s quality of care as “fair” between 2005 and 2007, before it applied for foundation status which was granted in February 2008. In other words, it was granted “flagship status” exactly at a time when patients were suffering and dying needlessly because financial and marketing priorities were put ahead of patient care.

Those who failed to spot (or ignored) the debacle in Staffordshire are still in charge of leading NHS bodies. The manager in charge of the West Midlands Strategic Health Authority from 2006, Cynthia Bower, is about to head the health super-regulator, the Care Quality Commission. Her predecessor at the authority’s forerunner is now chief executive of the NHS. The same Trust is said to have “fobbed off” NHS investigators who reported high mortality rates in 2007, saying they were statistical errors. This delayed further investigation.

It is not only individual NHS executives who are responsible for what is going on in Britain’s hospitals. It is the entire ethos fostered for years by New Labour whose priority has been to introduce capitalist market techniques into healthcare. In the end, the trust was run like any other corporation, driving down costs while maximising output.

A different approach in which the needs of the patients come first is desperately needed. That means reshaping the NHS so that it is managed by doctors, nurses and other staff working in it, alongside patients and community groups. The pharmaceutical corporations, equipment suppliers, cleaning, catering, maintenance and construction companies must all be owned and run in a similar way.

Corinna Lotz
A World to Win secretary
18 March 2009

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