DR MAX PEMBERTON: Care and kindness beats NHS box ticking

The maternity scandal at the Shrewsbury and Telford Hospital NHS Trust has become one of the worst in the history of the National Health Service. Over two decades, hundreds of babies died or were left brain damaged, with close to 1,500 cases reviewed.

Grieving parents have now hit out at the NHS regulator — the Care Quality Commission (CQC) — for failing to listen to them. It told parents it would not support an independent inquiry into the baby deaths just months before one was ordered.

One mother said she had ‘absolutely no faith’ in her ability to regulate and spot future scandals. I’m afraid I tend to agree.

Dr Max Pemberton says that patient care and kindness needs to be a priority in the NHS and recognised by inspectors

A few years ago, the hospital where I was working was inspected by the CQC and I will witness first-hand how warped and unhelpful the criteria they use to assess a hospital are.

My hospital was by no means perfect, but the staff worked incredibly hard and were unwaveringly dedicated and passionate about their jobs. Everyone really cared about trying to get the best for their patients.

Before experiencing a CQC visit, I had assumed patient care would be their primary concern. Silly me.

Prior to their visit we were warned that, rather than using real-life clinical encounters to assess how good the care was, they would instead focus on odd and trivial things.

For example, the inspectors might ask staff things like ‘do you know the physical location of the infection control policy folder?’

It won’t matter that they’ve undergone training and know the infection control policy inside out. They need to know where the folder with the typed instructions is. If they don’t, that’s a black mark.

At one meeting before the visit, someone realised that the carpet that lay between two rooms was the wrong type of carpet. Apparently it needed to be special carpet that doesn’t attract dust. It was regularly vacuumed by the cleaners, and the rooms were rarely used, but apparently that was irrelevant.

Everyone ran round like headless chickens frantically changing carpets so that we didn’t get marked down.

It’s crystal clear that the people who’ve come up with these ridiculous criteria have absolutely no awareness of what’s really important to patients who are sick in a hospital.

If they did, they’d go round seeing if nurses brought you water when you were thirsty, or held your hand when you were scared, or if a doctor stayed late to explain something to a worried relative — or any other myriad things that actually relate to care and what affects people’s experience of the NHS.

As well as being an NHS doctor, I’ve been a patient, too. I know what mattered to me when I felt unwell and vulnerable.

A few years ago I swallowed an antibiotic that got stuck in my throat and eroded a hole in my gullet. In hospital I had to plead with a phlebotomist to take my blood after she refused, saying she was on her break and I had been sent at the wrong time.

Dr Max Pemberton (pictured) says that he won't forget the nurse who gently took his hand as he was having a scope put down his throat

Dr Max Pemberton (pictured) says that he won’t forget the nurse who gently took his hand as he was having a scope put down his throat

She eventually relented and, tutting, vindictively stabbed me in the arm with her needle. And it wasn’t an isolated incident.

A grumpy receptionist brought me close to tears. A radiologist snapped at me when I turned to answer a question as I was having my chest x-rayed. I was talking about as though I wasn’t there and, worse still, had people discussing their holiday while performing intimate procedures.

If these things can happen to me — a doctor who knows his rights, what to expect and how to assert himself and complain — what must it be like for other people? Imagine being elderly, or confused, or having a learning disability. Or just being scared and in pain and not being treated in a kind, courteous and compassionate manner.

Surely that is important? Not to the CQC it isn’t.

Conversely, there was a kindly volunteer who found me looking lost and took me to the door of the doctor I was supposed to be seeing. I can’t remember what the doctor said, but I’ll never forget the volunteer.

Neither will I forget the nurse who gently took my hand as I was having a scope put down my throat or the porter who went the extra mile to find me a blanket when I was cold.

Small gestures that make the biggest difference.

These are the things that there are no tickboxes for yet, but which, for the patient, are vital. Sick people want care and kindness, not regulation carpets.

If we can’t inspect how patients are treated, what’s the point of doing an inspection at all?

Carrie’s right, words CAN hurt you

Carrie Hope Fletcher (pictured) plays the lead in Andrew Lloyd Webber's Cinderella.  She has spoken about she has been subjected to unpleasant remarks about her appearance

Carrie Hope Fletcher (pictured) plays the lead in Andrew Lloyd Webber’s Cinderella. She has spoken about she has been subjected to unpleasant remarks about her appearance

Carrie Hope Fletcher, who plays the lead in Andrew Lloyd Webber’s Cinderella, has spoken about how playing a character subjected to unpleasant remarks, particularly about her appearance, hasd her confidence. Although directed at Cinders, not her, it goes to show the power of negative comments and how we can’t help but absorb them to some extent.

I often talk to patients about being mindful of negative comments said without thinking. If we aren’t careful, we internalise them and they become part of a story we tell ourselves. We start to believe the comments, regardless of how true they are.

I remember a teacher saying I was bad at maths. I think this came from not being taught times tables at school. She thought I was stupid and I started to believe it. I’d panic when confronted with sums and make daft mistakes — it became a self-fulfilling prophecy. It wasn’t until I did statistics at degree level, and went to Harvard to study health economics, that it occurred to me I wasn’t bad at maths at all.

It’s often assumed private schools give children the best start in life. But researchers at University College London found state schools do not lead to worse mental health or lower levels of ‘satisfaction’ in adulthood. A private education may give children an unfair advantage in life, but they aren’t happier adults.

  • Covid restrictions have left a generation of babies and toddlers struggling to crawl and communicate, according to an Ofsted report last week. They found a host of difficulties, from struggling to make friends and development delays to anxiety around strangers. It goes to show how social humans are. It is fundamental to normal development to be surrounded by people. While I despair at these reports, the thing I hold on to is that children’s brains are still rapidly changing. Though development may be delayed, this doesn’t have to be permanent. The next year will be pivotal to avoid a generation profoundly damaged by Covid. Now more than ever we must help them catch up.

Dr Max prescribes…

Mood-Boost Podcast

In this podcast Ricky Gervais talks to his friend Sam Harris, a neuroscientist and philosopher

In this podcast Ricky Gervais talks to his friend Sam Harris, a neuroscientist and philosopher

In this podcast Ricky Gervais talks to his friend Sam Harris, a neuroscientist and philosopher. It’s fun, but tackles some complex questions such as why do we dream, why do we cry at stories and why do we fear death? A wonderful introduction to the philosophy of the mind.

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