Fear and loathing in the NHS: exploring quality of care

Old newsPoor hospital care is not new. In 1863, Florence Nightingale declared that ‘…the first requirement in a hospital is that it should do the sick no harm’ (Nightingale, 1863). Moving ahead 150 years, the depressing recent Francis report outlined the results of the public inquiry into the Mid Staffordshire NHS Foundation Trust’s serious mishandling of patient care. This second report into the care at Mid Staffordshire (Mid Staffordshire NHS Foundation Trust Enquiry, 2013) highlighted appalling standards of care, such as patients left for long periods in soiled bedding, patients left without help for eating, patients not assisted in toileting, despite several requests, and patients treated callously and indifferently.In a century and a half, perhaps the most disheartening aspect of this Report to the majority of health professionals is that patients were denied the most basic aspects of care.Sadly, this Inquiry is not the first of its kind. In 2001, the Bristol Royal Infirmary (BRI) Inquiry was undertaken following the abnormally high death rate of several children requiring complex paediatric surgery at the BRI. This Inquiry revealed ‘flawed behaviour’ among staff, and that, while the report concluded that the surgical teams were advancing the boundaries of paediatric cardiac care, there were long periods of financial constraints (Bristol Royal Infirmary Enquiry, 2001). This resulted in a shortage of paediatric cardiologists and nurses, and a lack of capital funding for buildings and equipment in the Trust. Two cardiac surgeons were subsequently dismissed and conditions applied to a third by the General Medical Council (GMC).‘These recent Inquiries and reports of appalling health care are difficult for the vast majority of caring and hard working health care staff to understand’The National Institute for Clinical Excellence (NICE) (now the National Institute for Health and Clinical Excellence) was established as a direct result of the BRI Inquiry, which made almost 200 recommendations. The recommendations focused on the competence of the clinicians, and the importance of hospital consultants in maintaining an up-to-date skill set and training, in addition to undergoing regular appraisals, CPD and revalidation for the roles.

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