Sunday 10 February 2013

“You are no Longer a Human Being.”


In 1946 George Orwell published How the Poor Die, an horrific account of his experience in a French public hospital in the late 1920s.  In this he drew the following conclusion;
In the public wards of hospitals you see horrors that you don't seem to meet with among people who manage to die in their own homes, as though certain diseases only attacked people at the lower income levels. But it is a fact that you would not in any English hospitals see some of the things I saw in the Hôpital X. This business of dying like animals, for instance, with nobody interested, the death not even noticed till the morning—this happened more than once.
Orwell! thou should’st be living at this hour: England hath need of thee; her hospitals are fens of stagnant waters.  OK, my apologies to Wordsworth for my free adaptation of one of his most memorable poems.  But what I say is true: English hospitals, it’s coming to light, are stagnant fens, places were healthy people go to die, at least if the the example of Stafford Hospital can be taken as a benchmark. 
I’ll say more on this dreadful case in a  moment, but first a word on our National Health Service (NHS), the great sacred cow that politicians criticise at their peril.  We have here a system of socialised medicine set up in the immediate post-war period by the then Labour government of Clement Atlee. 
Orwell, a self-defined socialist, though of a unique kind, was a supporter.  What would he have made of the dream if he had been alive now?  Here we are, seventy years on, and English hospitals are reproducing some of the things he witnessed in France all those years ago, yes, including the business of dying with nobody interested.  The horror here is almost impossible to imagine. 
It has been calculated that between 2005 and 2009, a mere four year period, some 1200 patients at Stafford Hospital in central England died needlessly.  Last week an inquiry headed by Robert Francis, a senior lawyer, published its report, the second into the hospital’s failings.  And the failings are truly appalling, a complete abdication of all duty of care, examples of incompetence, negligence and outright brutality, in some ways worse than anything Orwell witnessed in his foreign charity ward. 

Patients were left lying in their own urine and excrement for days.  Those in desperate thirst were forced to drink water from vases.  People were sent home with life-threatening conditions.  One old man suffering from dementia and Parkinson’s disease was pulled from a lavatory in a state of undress, the nurse screaming at him “You are no longer a human being but an animal.  I hate you.”  Not only were the patients unwashed, in some cases for up to month, but wards were shockingly unhygienic, covered in blood, used dressings and bloody needles. 
One woman arrived 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.”  Another was so concerned about the welfare of her mother, who said she was frightened of the staff, that she mounted a 24-hour vigil by her bedside.  She was horrified by the things she witnessed;
Patients were screaming out in pain because they could not get pain relief. Patients would fall out of bed and we would have to go hunting for staff.  It was like a Third World country hospital.  Things were so bad on the ward that I started feeding, watering and taking all the other patients to the lavatory. It felt like it was not just my mum I watched dying, but all the others as well.
Those who complained were dismissed with contempt by senior management.  A twenty-year-old man was sent home with painkillers after a serious fall from his bike.  Doctors completely failed to diagnose a spleen injury.  He bled to death at home in agony.  The hospital’s chief executive, later reacting to complaints from his mother and family, wrote to them, saying that they should “put the matter behind them and move on.”  
Well, now we have moved on; now we know exactly what was involved, a culture of turnarounds, tick boxes and statistics, all encouraged by the government of Tony Blair, a culture of quick fixes and negligence, encouraged by those who trumpeted the endless virtues of our ‘much-loved’ NHS. 
Charles Moore, writing in the Telegraph, rightly said if negligence on this scale had been discovered in the private sector the management would be sacked and criminal charges would quickly follow.  But with the ‘much loved’ NHS a different culture prevails.  What happens?  Why, nothing, merely reports that take years to produce and end by blaming nobody.  The latest instalment effectively concludes, after much pious hand-wringing, that those in charge should stay in charge.  It was all a ‘cultural failure’, you see, not a question of individual responsibility .  That must be a great comfort to the relatives of the dead.

No sooner was the latest tome published than Sir David Nicholson, the chief executive of the NHS, was interviewed by the BBC.  This man in a previous life was head of the West Midlands Strategic Health Authority between 2005 and 2006, and thus the senior figure responsible for the Stafford Hospital.  In a previous life he was also a member of the Communist Party.  He was “shocked,” he is “sorry” for past ‘cultural failures.’ No matter; he is staying, backed by the present Health Secretary and David Cameron, the Prime Minister. 
In a public statement launching his report, Mr Francis began by saying: “Many will find it difficult to believe that all this could occur in an NHS hospital.”  No, quite frankly, I don’t.  Stafford may be an extreme case but it is by no means an atypical feature of our rationed, managerial-conscious and patient-negligent ‘much loved’ NHS.
The point is, as Moore also says, this dreadful bureaucratic monster was never about patient care; it was about taking charge of delivery by centralised diktat.  It was for people who produced the service, not those who received it.  The truly shocking thing is we now see that those like Nicholson, effectively responsible for the death of hundreds of people, can escape blame for fear of ‘scapegoating.’  Could this happen in any country that is not called Cuba or North Korea?  It has happened in England.  It must be of some benefit to have a former communist in charge. 

Pleased do not think the Stafford case is an isolated incident.  Other hospitals and other NHS trusts are now under investigation.  It’s estimated that a further 3000 patients have died needlessly elsewhere over the past two years.  Inquiries – more delaying tactics – have been ordered into hospitals where death rates are persistently high.  Solicitors are preparing to act against nine trusts accused of neglecting elderly patients.  You might like to remember all of the above facts in considering the alleged virtues of rationing and socialised medicine.  Come to England; we know how to do it, we know how to deliver health care with dignity and comfort.  There again you might be better advised to go to a charity hospital in France. 
The dread of hospitals probably still survives among the very poor, and in all of us it has only recently disappeared. It is a dark patch not far beneath the surface of our minds. I have said earlier that when I entered the ward at the Hôpital X I was conscious of a strange feeling of familiarity. What the scene reminded me of, of course, was the reeking, pain-filled hospitals of the nineteenth century, which I had never seen but of which I had a traditional knowledge.
Ah, George; the future is not a foreign country; we do things pretty much the same here. 

14 comments:

  1. Here is something I posted on MyT about this issue:

    Medical practice at every level has a strong risk of death and permanent harm to vulnerable people already suffering sickness or injury.

    Conservative estimates published in the Journal of the American Medical Association and the New England Medical Journal based on surveys of US hospitals assessed 100,000 - 120,000 deaths per year in the US from medical mistakes - not including malpractice or deliberate negligence! In addition: 500,000 to 1.5 million injuries inflicted by medics per year.

    In the UK, the numbers are smaller, but still horrific.

    http://www.whale.to/a/dean.html

    If such homicide numbers were attributed to terrorists or criminals or automobiles or personal weapons or any consumer product then governments would collapse and national crusades be launched.

    Somehow, the medical industry has managed to shield itself from accountability better than any other group in society. But by allowing this industry to continue without accountability, we place ourselves at greater personal risk than we would by allowing drunk drivers, terrorists, and criminals all together to run riot.

    Even Murder Inc. has more concern for its clients than the medical and pharmaceutical professions.

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    1. Calvin, yes, the situation is quite horrific.

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  2. I for many years have been warning about the dysfunctional and not fit for purpose NHS which fell on deaf ears of course. Up to 2004 I was of a recipient of medical support under the auspices of the NHS and received treatment from time to time. Sometimes it was excellent especially in the earlier years but as time progressed it became pretty dismal and in the end appalling. In 2004 I moved to France and I came under their healthcare system and what a difference I found and I can only describe it as excellent. The reason for the differences can be explained by how provision and funding is organised. The NHS is virtually totally free and completely state controlled and run the French system is a mixture of private and state provision and funding. The one offers no choice that leads to lack of accountability and to no incentive to give value for money or to be efficient. The French system does the very opposite. Given that the French are as socialist minded as the Brits perhaps more so and rather protectionist and anticompetitive setting up a system that involves competition and an element of self-reliance is quite surprising. However they have perhaps seeing the flaws inherent in the British system, it is not a perfect system by any means but probably the best that can be achieved without it going totally private. In the USA I understand provision is even better but it is not universally available although Obamacare is supposed to see to that. No doubt Obamacare will give universality but it may bankrupt the country in the process as health already accounts for 17% of GDP. The root of all our ills as I have mentioned in a previous comment is socialism it is eating away at our economy, society and democracy. It is not that many of socialist aims are undesirable such as wealth redistribution, equality and justice for all but the manner and fervour that they use to achieving them. Socialism only works when their is sufficient wealth to pay for it something that was exceedingly overlooked by the left. Having for years overburdened the state with socialist policies and practices the state now finds that to maintain the status quo it has to borrow and print and create staggering amounts of debt quite unsustainable of course and we will eventually all pay the price for it and already are but not as badly as what is to come. Under current conditions the sensible thing to do now would be to reduce our public spending to affordable levels by the reduction of the size and functions of the state. The need is to privatise or semi privatise much of the public sector such as the NHS which would have the added advantage that it would improve it immeasurably. To do so however would be political suicide because the left by acting irresponsibly or perhaps even by design have engendered an entitlement culture. Now society is dominated by a section that is state dependent who have a vested interest to maintain the power and size of the state so that the state will continue with the wholesale redistribution of wealth. What we have is a receipt for disaster an unsustainable system that no one will or can address and remedy so in the end it will not be just the NHS that declines beyond redemption but all of society as well.

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    1. Antisthenes, I've been looking at possible alternatives and the French system looks quite promising as does that of Singapore. The English system badly needs reform but - given the various factors you have alluded to - even raising the issue is tantamount to political suicide. People have been frightened away from the alternatives even when they see that the present system is frightful.

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  3. In my previous comment I was perhaps being disingenuous by not referring to Ludwig Von Mises who to some extent I plagiarised as he said this some years ago and I quote “A system in which a majority of the population is dependent on the government [public sector employment and welfare beneficiaries] leads to an unstable political and economic situation, since a majority of the population then has a vested interest in increasing the power of government to redistribute wealth." I apologise for the omission.

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    1. Good quote. Thanks for adding. It's the prefect epigram for Obama's November victory.

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  4. It's staggering. The widespread moral and professional corruption, that not only sustained this "cultural failure" but is also now letting off those who were in charge of it, needs to be absolutely cleaned out of this country.

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    1. It is indeed staggering, Seymour. This country excels in one thing: evasive public inquiries.

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  5. Medical error malpractice is an issue here as well, mistakes, ignorance, indifference, medication issues, from prenatal care to geriatrics.

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    1. Indeed, Anthony, it's an issue everywhere. Where there are doctors there will be serious errors of judgement. There is something different here, though. There is politics.

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    2. The American Medical Association, and the U.S. Food and Drug Administration contain a great deal of politics even though socialized medicine in not universal here in the U.S.

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    3. Yes, there is always politics with a small p. But here the Politics are always writ large.

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    4. The reason that there is so much confusion in the UK is that they have yet to come to the conclusion that they drive on the wrong side of the road.

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    5. The rest of the world, well, most of it, is right which is wrong. :-)

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