It has been 64 years since Aneurin Bevan established the NHS, which given my age, is the healthcare system I have only ever known and which if I’m honest I take for granted. It was set up: to meet the needs of everyone; to be free at the point of delivery; and based on clinical need, not ability to pay. These are sound principles, but could do with a slight amendment to include the words ‘safe’ and ‘quality’. Surely without these tenets ‘free healthcare’ isn’t quite so appealing!
People all over the world supposedly envy and admire the UK health service, even look to replicate it – I read this week of South Africa’s plans to provide Afrikaans with a social health care system and are introducing National Health Insurance to begin to breakdown its healthcare inequalities. During my travels I am always quick to jump to the NHS’ defence when friends in the US mock it in favour of their insurance-based system ….but, given some recent news reports I have been reading of late, I have to admit I am struggling to defend it.
I’m not referring to the battle we have dealing with HCAIs (healthcare associated infections), nor waiting times or even the financial mess. No, I’m referring to the shocking story I read on the BBC news website of a 22 year old man who died of dehydration. The patient who had also received lifesaving treatment the year prior for a brain tumour, I’m sure had co-morbidities, which surely heightened reasons for his admittance in to hospital.
Aghast at this news, I jumped to the conclusion that it would be down to poor management or due to their not being enough nurses. But it appears that there were in fact too many staff involved – 24 in over three days! The patient given his intensive history, had vast notes which his mother observed never seemed to be looked at in any great detail and given the patients aggression and confusion (a known symptom apparently of dehydration and his condition) was labelled a ‘difficult patient’. This story culminated in the patient calling the police, in order to obtain treatment! According to his mother’s report, he had access to water it was the quantity that was not being managed and timely delivery of his medication. Sadly, treatment came too late for this young man and he died…just 22 years of age….in a UK hospital!
I know the pressures so many hospitals are under with staff cuts and patients in beds that shouldn’t be there due to lack of community services or care homes, but there is no excuse for what has happened in this situation. I’d like to flippantly remark at this point “it’s sad but it’s a one off” and “these things happen” but I can’t – this happens far too frequently – basic care not being delivered which has devastating consequences – first and foremost to the poor affected victims and their families, but to be crass the consequences also amount to more than £1billon negligence payments (and rising) the NHS pays out on an annual basis – most of which is down to basic care mistakes which could have been avoided.
And, here is the indefensible evidence (for the UK):
– 1:300 admissions leads to avoidable death
– 850,000 adverse events occur
– 23,000 avoidable cardiac arrests
– 20,000 avoidable ICU admissions
– 10,000 avoidable deaths from VTE
The issue in the case of the 22 year old was not “human error as a consequence of a medical procedure” it was the result of poor communication between staff. So, has the time come when we need to consider replacing staff with robots to automate care, and remove human error or maybe the time has come that we should move to a private healthcare model? No, of course we don’t want robots, patients need “care”: human contact, human instinct, skill and most importantly good communication. This is what will aid their recovery, but to have some automated support for staff to aid vital communication and to give them that extra pair of eyes, so they can concentrate on delivering ‘basic care’, surely is what’s needed!
Impressive, easy to use ward-based systems do exist to help support staff and aid the patient safety mission that hospitals rate high on their agendas – but their use has yet to be widespread. Hospitals such as Western Sussex, Fife and Central Manchester are using a system called Patientrack. This is an electronic point-of-care data capture system which is enabling more timely and accurate interpretation of vital signs. It leads to the earlier recognition of the deteriorating patient so that the appropriate escalation to medical staff can occur as a result of its track and trigger/alert algorithm.
A clever piece of software I’m sure but when it comes down to it – it’s an important system to enhance communication, will give our busy hospital staff an extra pair of eyes and provide junior medical staff with the evidence to escalate to their superiors without fear or criticism.
Although the case of the 22 year old was not solely resulting from lack of water, I did read a year or so ago about a nurse at Milton Keynes Hospital coming up with the simple, non-technical innovation of a ‘red jug’! Each patient at risk of dehydration /requiring regular fluids was issued with a red jug rather than the standard grey/cream version. This was a useful communication device to all staff to ‘check and refill’ on a regular basis and didn’t rely on messages being passed at staff handover meetings. Simple but so effective!
So, I appeal to UK hospitals, patient safety systems exist which pay for themselves the minute an avoidable death is prevented! Please bring down the startling statistics I referred to earlier…ideally to zero – the clue is in how they are all referred ‘avoidable’. The NHS is an institution I’d like my grandchildren to have access to and although I am ashamed to read about the case of the 22 year old, I still have faith and I am proud in the most part of our National Health Service.
I know it won’t solve all the issues but automated vital signs capture – track and trigger systems are surely a no-brainer! If not now, then at least a few red jugs!
There….business case written!