"Central government strategically enabling and catalysing better services"

The internet disgust for the hypocrisy of a government which can continue to trumpet that "central government [is] strategically enabling and catalysing better services" despite the death toll in Staffordshire General Hospital is mounting. While internet disgust is, per my last post and more to the point David Mitchell's recent blog, a dangerous thing to take seriously at the best of times, the criticism has been surprisingly restrained given that death toll. I'd encourage you to read:

The Ferret Fancier: 'Individual management failures', where he outlines the absurdity of Gordon Brown saying that no reasonable person would deny A&E admissions should be seen within four hours in a week when that precise policy has been shown to kill by obliging Trusts (very intentionally plural) to prioritise the meeting of targets over everything else including patient care in order to get funding.

Dr. Grumble: Mid Staffs Investigation, which links a channel 4 news story and observes that junior doctors were pressurised into taking decisions they knew to be wrong to meet targets.

NHS Blog Doctor: It couldn't happen in Britain: Staffordshire General Hospital, which links the "dirty tricks" campaign used against Rita Pal, who tried to blow the whistle on Midlands hospitals several years ago, to the absence of doctors as whistleblowers

The Witch Doctor: A letter to Mr Brown, Mr Johnson, and Mr Bradshaw, which suggests that despite all the jargon (and although I am again criticising the government and civil servants, God Bless the Local Government Association, at least for today) and management-speak the government and the DoH are producing about leadership and "Leading Beyond Authority", part of the problem in Staffs and generally is that the real leaders in the NHS are being overlooked.

Angus Dei: NHS: Mid Staffordshire NHS Trust: The Killing Fields, observes that Monitor, the body set up by the government at a cost of millions to provide effective regulation of NHS Trusts and better patient care took the decision to award Staffs Foundation Trust status while all this was going on, and observes that this makes them look like a colossal waste of money. He also notes that the Healthcare Commission didn't pick up on any of these problems in their annual healthcheck (that channel 4 news story linked to from Dr. Grumble's post suggests it was an independent medical statistics group in London who highlighted the problem).

The Jobbing Doctor: All together, points out that the supposed figureheads of our profession, the senior figures who have chosen to case their lot in with the government and to support their reforms, have been in post for a decade, and must take some responsibility for permitting the system to be put in place which caused these deaths.

All I have to add is that - as with the MMR scare - the media are part of the problem here: we as a society must learn that beating up on people who are working under conditions outside their control (doctors and managers both) will not solve the problem. These situations arise because the government has set up a system whereby meeting pointless targets is rewarded financially, and conversely if doctors do what they are trained to do, that is treating patients according to the degree of their clinical need, their Trust misses targets and gets its funding cut. Let us be completely clear: the managers are not to blame. The managers do not create the rules of the game - they are employed to meet these targets, and even at Staffordshire they did it well. The government rewarded them for their behaviour. The system put in place rewarded them for meeting their targets, and indeed by the standards the Department of Health has chosen to judge Trusts by, they still are an excellent Trust. The inevitable stripping of their Foundation Status will not change that fact, and while it is probably the right thing to do, all it does in reality is to give them less money to address the problems with.

There is no point trying to demonise the managers (I disagree with Angus Dei here) nor the hospital - that is scapegoating. The system is at fault here, and it must be changed, as indeed must the soi-disant political (Brown, Johnson, Bradshaw) and medical (Donaldson, Carol Black, Paice, Needham) 'leaders' responsible for the state of our health service. Until they and the targets are changed, we - you - are part of a society that continues to incentivise seeing people within four hours because it wins votes over keeping them alive.

Mind you, it is an old political truism that the dead cannot vote, so perhaps the government are just playing the system they are part of perversely well...