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Neglect of the weak was not invented with the National Health Service Neglect of the weak was not invented with the National Health Service
(6 months later)
We all know the routine. The inquiry into a grim episode in our national life reports, offering a list of recommendations. The government responds, vowing to learn the lessons and to ensure nothing like it ever happens again.We all know the routine. The inquiry into a grim episode in our national life reports, offering a list of recommendations. The government responds, vowing to learn the lessons and to ensure nothing like it ever happens again.
This week it was Jeremy Hunt's turn, the health secretary giving the government's initial reaction to the second of two Francis reports relating to the scandal at Stafford hospital – and the fifth such investigation into the appalling neglect and abuse of patients that occurred there. Both Hunt and the report's author, Robert Francis QC, spoke of the need to change "the culture of the NHS", the politician promising a culture of "zero harm".This week it was Jeremy Hunt's turn, the health secretary giving the government's initial reaction to the second of two Francis reports relating to the scandal at Stafford hospital – and the fifth such investigation into the appalling neglect and abuse of patients that occurred there. Both Hunt and the report's author, Robert Francis QC, spoke of the need to change "the culture of the NHS", the politician promising a culture of "zero harm".
But what if the horror of Staffordshire revealed a malaise not only in that hospital and the health service, but something altogether deeper? What if it is not just NHS culture – important though that is – that has been exposed, but a larger, more enduring human weakness?But what if the horror of Staffordshire revealed a malaise not only in that hospital and the health service, but something altogether deeper? What if it is not just NHS culture – important though that is – that has been exposed, but a larger, more enduring human weakness?
The thought came as I stood listening, the day after Hunt's Commons statement, to Julie Bailey, whose mother, Bella, died in Stafford hospital in 2007. Between 2005 and 2008 as many as 1,200 more deaths occurred in the hospital than would ordinarily have been expected – and Bella Bailey's was one of them. Then 86, she had gone into Stafford after a routine operation left her struggling to take fluids; she needed to be hydrated. She spent two months on a ward and never came out.The thought came as I stood listening, the day after Hunt's Commons statement, to Julie Bailey, whose mother, Bella, died in Stafford hospital in 2007. Between 2005 and 2008 as many as 1,200 more deaths occurred in the hospital than would ordinarily have been expected – and Bella Bailey's was one of them. Then 86, she had gone into Stafford after a routine operation left her struggling to take fluids; she needed to be hydrated. She spent two months on a ward and never came out.
In a quiet voice – even now, six years on, the voice of a bereaved daughter – Julie, who went on to found the Cure the NHS campaign group, described what she saw. "The conditions themselves were very unclean – there was dressings on the floor, blood-spattered dressings. The main toilet didn't have a door on it, so the confused patients would use the toilet with everybody [able] to see, coming down the corridor. The nurses sitting next to the toilet door could see them exposed.In a quiet voice – even now, six years on, the voice of a bereaved daughter – Julie, who went on to found the Cure the NHS campaign group, described what she saw. "The conditions themselves were very unclean – there was dressings on the floor, blood-spattered dressings. The main toilet didn't have a door on it, so the confused patients would use the toilet with everybody [able] to see, coming down the corridor. The nurses sitting next to the toilet door could see them exposed.
"Patients were just basically neglected. The food would be left at the bottom of the bed and you would see patients just crying out for their food. They'd try to scramble down to the bottom of the bed, they'd try kicking it with their feet, just trying to get at the food, whatever way they could. When they did get at the food, they'd just be eating it with their fingers, just ramming it into their mouths, their hands were just covered in faeces."Patients were just basically neglected. The food would be left at the bottom of the bed and you would see patients just crying out for their food. They'd try to scramble down to the bottom of the bed, they'd try kicking it with their feet, just trying to get at the food, whatever way they could. When they did get at the food, they'd just be eating it with their fingers, just ramming it into their mouths, their hands were just covered in faeces.
"It was just dreadful. They would fall on to the floor and just be left there. The last two weeks of mum's life she just clung to me like a baby – whereas we were able to help the other patients before, for the last two weeks we just couldn't get to them, so you'd just hear the cries of 'Help! Help!'. You'd hear a thud as they fell on to the floor, and the doors would be shut so you'd just presume they'd fallen on to the floor, and you'd just have to leave them crying out 'Help! Help!'. Then they'd go quiet.""It was just dreadful. They would fall on to the floor and just be left there. The last two weeks of mum's life she just clung to me like a baby – whereas we were able to help the other patients before, for the last two weeks we just couldn't get to them, so you'd just hear the cries of 'Help! Help!'. You'd hear a thud as they fell on to the floor, and the doors would be shut so you'd just presume they'd fallen on to the floor, and you'd just have to leave them crying out 'Help! Help!'. Then they'd go quiet."
Bailey spoke in a room overlooking a forlorn London building that, 150 years ago, served as the Strand Union workhouse, many of the windows now boarded up. We were there to record an edition of the Radio 4 programme The Long View, comparing the Stafford scandal with a strikingly similar episode in the 1860s, when Victorian society was rocked by harrowing revelations of neglect and abuse in the workhouse's infirmary. In that very building, and in places like it all over the country, those unlucky enough to be both sick and poor were left to suffer in conditions that shock even now.Bailey spoke in a room overlooking a forlorn London building that, 150 years ago, served as the Strand Union workhouse, many of the windows now boarded up. We were there to record an edition of the Radio 4 programme The Long View, comparing the Stafford scandal with a strikingly similar episode in the 1860s, when Victorian society was rocked by harrowing revelations of neglect and abuse in the workhouse's infirmary. In that very building, and in places like it all over the country, those unlucky enough to be both sick and poor were left to suffer in conditions that shock even now.
So Julie Bailey stood and listened as she heard an 1865 newspaper account of a victim at the St Giles workhouse infirmary, one Richard Gibson. The Times report quoted a police constable: "I never saw a human being in so dreadful a condition; he was delirious; he had a large wound in his back; his brown skin was marked with red spots like marks from itch or vermin; his person was in a filthy condition; his shirt was soiled with excrement, and his sheets were slightly soiled in the same way; there was a most nauseous smell about him; his hair was very much matted."So Julie Bailey stood and listened as she heard an 1865 newspaper account of a victim at the St Giles workhouse infirmary, one Richard Gibson. The Times report quoted a police constable: "I never saw a human being in so dreadful a condition; he was delirious; he had a large wound in his back; his brown skin was marked with red spots like marks from itch or vermin; his person was in a filthy condition; his shirt was soiled with excrement, and his sheets were slightly soiled in the same way; there was a most nauseous smell about him; his hair was very much matted."
Bailey grimaced as she heard that, the memories it evoked not of 1865 but of 2007. It was a rare moment of empathy across the decades, Bailey identifying with a stranger who lived and died in the 19th century. In his story, she heard her mother's.Bailey grimaced as she heard that, the memories it evoked not of 1865 but of 2007. It was a rare moment of empathy across the decades, Bailey identifying with a stranger who lived and died in the 19th century. In his story, she heard her mother's.
But I doubt the experience offered much consolation. In me it prompted several reactions, none of them cheery. First, it provided confirmation that the falsest word in the journalistic vocabulary is "unprecedented". Rare indeed is the situation that genuinely has never arisen before. Instead, problems recur again and again. The details may change, but the fundamentals are often uncannily the same. In this case, the key elements were common to both Stafford and the workhouse: financial pressures, complaints of managerial overlords pinching the pennies, whistleblowers on the inside. When we say "unprecedented", what we usually mean is "for the first time any of us can remember". The troubles are not new; it's just that each generation forgets.But I doubt the experience offered much consolation. In me it prompted several reactions, none of them cheery. First, it provided confirmation that the falsest word in the journalistic vocabulary is "unprecedented". Rare indeed is the situation that genuinely has never arisen before. Instead, problems recur again and again. The details may change, but the fundamentals are often uncannily the same. In this case, the key elements were common to both Stafford and the workhouse: financial pressures, complaints of managerial overlords pinching the pennies, whistleblowers on the inside. When we say "unprecedented", what we usually mean is "for the first time any of us can remember". The troubles are not new; it's just that each generation forgets.
Second, and more basic, was a renewed shock at the Mid Staffs scandal. How stunned would Dickens or Gladstone be to discover that a spectre that had appalled them in the 1860s had not been banished for ever, but still haunts the 21st century? Those confident Victorians believed they were creating a new world. They would be dismayed at the power of the old world to linger on.Second, and more basic, was a renewed shock at the Mid Staffs scandal. How stunned would Dickens or Gladstone be to discover that a spectre that had appalled them in the 1860s had not been banished for ever, but still haunts the 21st century? Those confident Victorians believed they were creating a new world. They would be dismayed at the power of the old world to linger on.
But last is the nagging worry that perhaps such vile conduct persists because it is not simply an NHS problem, as it was never purely a workhouse problem. That it is, instead, a human problem, not wholly eradicable by a restructuring here or a systems tweak there. Awful to contemplate, but perhaps this is what human beings will always do to those who are weak and vulnerable and in their power, unless actively constrained not to.But last is the nagging worry that perhaps such vile conduct persists because it is not simply an NHS problem, as it was never purely a workhouse problem. That it is, instead, a human problem, not wholly eradicable by a restructuring here or a systems tweak there. Awful to contemplate, but perhaps this is what human beings will always do to those who are weak and vulnerable and in their power, unless actively constrained not to.
Maybe it stems from a kind of fear, and therefore loathing, of the sick, for the intimation of mortality they represent. Whatever its origins, it was not invented with the National Health Service and it will not die with it. The danger is within ourselves, and is older than any of us can remember.Maybe it stems from a kind of fear, and therefore loathing, of the sick, for the intimation of mortality they represent. Whatever its origins, it was not invented with the National Health Service and it will not die with it. The danger is within ourselves, and is older than any of us can remember.
The Long View is broadcast on Radio 4 at 9am on 3 AprilThe Long View is broadcast on Radio 4 at 9am on 3 April
Twitter: @j_freedland Twitter: @j_freedland
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