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Proletarian issue 52 (February 2013)
NHS: death by a thousand cuts
The cracks in the Foundations are on full show in Mid Staffordshire.
For those who might still entertain hopes that the NHS isn’t being brutally dismembered and rendered incapable of delivering anything but fat profits to the bloated parasites that are feasting on it, the reported carnage in mid-Staffordshire must surely be helping to remove the last scales from their eyes.

Parasites feeding off the NHS

The NHS’s parasites come in many forms. Besides the drugs companies, there are building corporations which continue to rake in huge sums as a result of PFI contracts, along with a plethora of consultative companies that sell their ‘expertise’ to health authorities. And, or course, there are the thousands of private healthcare companies, many of which use NHS facilities and NHS-trained staff to deliver ‘care’ to those patients who can pay to jump the queue-j- a queue, incidentally, that is solely caused by the fact that public resources are being diverted on a grand scale away from the provision of health care to the feeding of parasites.

And, playing a crucial role lower down the financial scale, there are the career managers – executives whose ‘experience’ is in delivering whatever their masters require at the expense of workers (and, in the case of the NHS, at the expense of patients, too), rather than individuals with any particular knowledge of or interest in health provision.

For these ‘managerial’ parasites the ‘National Health Service’ is a jamboree – a non-stop merry-go-round of rich pickings for those who are prepared to help implement service cuts and privatisation measures at the top end, while at the other end overstretched staff struggle to give a service to patients who are increasingly being put at risk as a result of the corner-cutting demanded by profit-seeking contractors and budget-cutting bosses.

Labour, Tory, same old story

Although the current trend is to pin the blame for all service cuts onto the ConDem government, it is important for workers to understand that privatisation is a ruling class agenda that has been being implemented consistently in the NHS by both Labour and Tory governments – both of whom are equally loyal to their capitalist masters – since the 1980s. (For a detailed analysis of NHS privatisation, see ‘End in sight for National Health Service’, Proletarian, August 2006.)

We are occasionally accused of “banging on about run-down services” and ignoring the great job the staff in our NHS hospitals do. Anyone who knows anything of the NHS understands that frontline staff do usually manage to hold things together, in spite of, and not because of, the ongoing privatisation measures. But, as heroically as these staff members have struggled, there comes a tipping point when any service to patients goes totally out of the window and carnage follows. This is the reality of the Stafford Hospital situation, where somewhere between 400-1,200 patients are estimated to have died needlessly over a four-year period.

These deaths came as a direct result of the Labour government’s ‘Foundation’ scheme, whereby hospitals could, by meeting certain government targets, become eligible for ‘Foundation’ status. One incentive for managers to chase after this particular step in the privatisation process was that Foundation status brought with it the right to increase executive pay to whatever was felt suitable by a hospital’s newly-established Foundation Trust.

Public inquiry

A public inquiry into the deaths at Stafford has pointed the finger of blame at executives in both the local health authority and the senior hospital management, whose preoccupation with achieving ‘Foundation’ status led them to implement measures that were the cause of more than a thousand unnecessary deaths – and to a harrowing catalogue of further patient neglect.

Of course, in blaming these career-driven managers, the inquiry has neatly sidestepped the issue of the policies that these managers were carrying out. The crimes of these greedy individuals, who are being presented as a few ‘rotten apples’, are being laid bare, even while the main cause of all our ills (quite literally), capitalism, escapes any real investigation.

The inquiry, chaired by Robert Francis QC, lasted for two years and heard from 290 witnesses. Stafford Hospital’s wards were described as “full of people who lay starving, thirsty and in soiled bedclothes”, as too few nurses rushed around trying but never catching up, or just giving up the unequal daily struggle. Witnesses also told of buzzers that seemed to drone endlessly and of cries for help being routinely ignored.

Tales were recounted of patients receiving the wrong medication or none at all. Surviving patients, and relatives of those who were not so lucky, described how patients were left so dehydrated that some even began drinking from flower vases. This testimony revealed how an institution which was supposed to care for the most vulnerable instead became a very dangerous place to be.

One family lost four members in 18 months at the hospital. Kelsey Lintern, 39, tragically lost first her six-day-old daughter Nyah, and then her 37-year-old sister, Laurie Gethin. These deaths were followed by that of her uncle, Tom Warriner, who was 48, and of her grandmother, Lillian Wood-Latta, who was 80.

The inquiry heard how the baby, Nyah, had to be delivered by Mrs Lintern’s mother because no midwife was in attendance. Another midwife, Mrs Lintern reported, had earlier tried to give her a painkiller to which her notes said she was allergic, and which could possibly have killed her as well if she had taken it.

The baby was born not breathing and had to be resuscitated. She was discharged after just two days, in spite of the family’s belief that she was seriously ill. Four days later, she died. The post-mortem found her to have four holes in her heart. The family are convinced that the hospital should at least have realised there was a problem.

Just three months after baby Nyah’s death, Mrs Lintern’s sister, Laurie Gethin died of lung cancer. Despite showing clear symptoms of the disease, it took 18 months for her cancer to be diagnosed –and that was only after a scan at another hospital detected it. Mr Warriner, Kelsey’s uncle, was operated on for bowel cancer but died after his intestine was accidentally pierced. Her grandmother, Mrs Wood-Latta, died hungry and dehydrated after she was admitted following a stroke. Her family complained bitterly that she had not been given enough fluids.

As a result of catastrophically low staffing levels at Stafford, the most basic levels of hygiene and patient care suffered atrociously. According to many witnesses, medication was often given late or missed altogether. Mealtimes were sometimes missed, and those who could not feed themselves or drink without help often went without food even when meals were available as no-one had the time to see to them. The incontinent were left unclean for hours and the infirm were often just left on commodes. It was reported that one woman was left unwashed for the last four weeks of her life.

‘Foundation’ targets

One of the main reasons for this deadly chaos turns out to have been the hospital management’s obsession with meeting the targets set for attaining Foundation Trust status. In particular, the need to discharge patients from A&E within four hours of them having first been seen resulted in some truly abominable practices.

This all-important shibboleth led to senior doctors and experienced nursing staff being pulled away from operations and ward duties, leaving junior doctors in charge of critically-ill patients, operations cancelled, and inexperienced nurses alone on wards, switching off equipment like heart monitors because they did not know how to use it. In some cases where the four-hour casualty treatment deadline loomed and proper medical staff could not be found from elsewhere in the hospital, decisions about which patients to treat were even left to receptionists.

The picture that emerged from the inquiry is of a hospital in which fear was the main driving factor in ‘managing’ the staff. Bullying was rife, and complaints were countered with threats of dismissal by managers.

These constant threats of the sack were very real. The hospital was already massively understaffed as managers attempted to cut costs and meet the government’s ‘efficiency’ targets.

Role of career managers

Of course, while we place the ultimate blame on the political system we live in, which will always put profit before people (even more so now that it is spiralling ever deeper into economic crisis), the greed of these lower parasites is also to blame, as without them there would be nobody to carry out the instructions of the ruling class. But in a system that promotes and rewards greed, the greedy will always rise to positions of power.

In the case of Stafford Hospital, these lower ‘players’ have been named, and they, their job titles and deeds make interesting reading, proving once more that in the modern capitalist state the connections and interconnections made in ‘business’ (and the health service is definitely now a business) are far more important than any educational qualifications. In fact, the connections made and mutual back-scratching carried out are the real qualifications needed for ‘rising through the ranks’.

Martin Yeates was the Chief Executive of Mid Staffordshire NHS Trust for four years. It was he who was the driving force behind the hospital’s cost-cutting programme. In pursuit of the dubious Foundation status ‘goal’, Yeates implemented widespread job cuts, which led to nursing shortages and a reliance on untrained healthcare assistants. When the situation was brought to light, Mr Yeates resigned, walking away in March 2009 with more than £400,000 and a pension valued at £1.27m.

Yeates was never questioned by the inquiry, brazenly refusing to attend on the grounds that he was “suffering from stress and might never be able to work again”. He sold his £600,000 home and left the area saying that “The personal cost to me and my family of being hounded by the press and certain campaign groups is irretrievable; I have lost my family, my career and my health. Nothing that I now say or do will get me back the job I loved.”

Yeates seems to have recovered, however. He is currently chief executive of a charity, Impact Alcohol and Addiction Services, which holds contracts with the NHS. Impact runs an addiction prevention project at the Royal Shrewsbury Hospital and offers information, advice and counselling at GP surgeries.

Mrs Jan Harry was in charge of nursing care at Stafford during a period of job cuts. She is on record as saying that she “had no major concerns about the care provided and that it was not her job to monitor standards on the wards”. This claim was later described as “absurd” by Dr Peter Carter, general secretary of the Royal College of Nursing (RCN).

Staff who were questioned at the inquiry described Mrs Harry’s management style as “draconian”, while the Unison rep Kath Fox and the RCN’s legal officer Adrian Legan both admitted to the public inquiry that staff were too scared to speak out because of her intimidating manner.

Mrs Harry parted company with the trust “by mutual agreement” in June 2006. A year after her departure she was hired by a consortium of hospitals in Dudley to run a cost-cutting programme as they prepared for foundation status. She went on to work at the Salisbury Foundation NHS Trust, providing “management support” between December 2008 and May 2009.

Harry’s nursing career came to an end in 2010 when, as a result of her behaviour at Stafford Hospital, the Nursing Medical Council suspended her from working as a nurse for two years stating that she “could represent a real risk to public safety” and could “put patients at serious risk of harm”. The charges which led to this suspension included a failure in her duty of care, failure to maintain a safe level of practice, poor infection control and prevention, and a lack of governance regarding patient safety and risk management. She retired at this point.

Dr Helen Moss was Jan Harry’s replacement at Mid Staffordshire. She was sharply criticised for not acting quickly enough to tackle the problems that were uncovered at the hospital. She had been made aware of staff shortages shortly after she joined the trust in December 2006, but said that she “had not realised the level of cuts at the hospital in the six to nine months before taking up the position”.

In 2009, following the Stafford scandal, she moved to East Midlands Strategic Health Authority, on secondment as associate director of training. Her salary of around £100,000 a year was still paid by Mid Staffs. Moss has since gone on to become a management consultant for corporate accountants Ernst and Young, specialising in the health sector.

Cynthia Bower was the head of the West Midlands Strategic Health Authority and ultimately responsible for Stafford Hospital. It was while she was in charge that evidence first emerged regarding the serious problems in patient care at the hospital, but the health authority rejected the high death rates as a “statistical error”. Mrs Bower even claimed that “Stafford wasn’t on my radar!”

She had spent 19 years of her career working in and managing children’s homes prior to moving on to work in senior roles for a variety of NHS organisations in the West Midlands, eventually becoming chief executive of the health authority in 2006.

After the sordid details of the scandal at Stafford Hospital came to light in 2008, Mrs Bower quit the job, moving on to become Chief Executive of the Care Quality Commission on a salary of £203,500. She resigned from this post in February 2012, amid very strong criticism of the regulator’s failure to police hospitals and care homes.

In November 2011, while still chief executive of the CQC, Bower was appointed as non-executive board member of the Skills for Health organisation, which works to improve staff skills in the health sector, a position she still holds.

Ms Toni Brisby was the Chairman of Mid Staffordshire NHS Trust and it was her job to oversee the cost-cutting decisions being taken by Martin Yeates and his board of directors. She is a former law lecturer, antenatal teacher and marriage guidance counsellor and claimed that the trust board was addressing Stafford’s problems when the Healthcare Commission exposed serious failings at the hospital in its 2009 report.

Brisby gave evidence to the inquiry by video link during which she asserted that the only complaint she could recall was from a patient who “didn’t like the amount of sauces being put on her food”. Not surprisingly, she quit her £45,000 for a three-and-a-half day week job with Mid Staffs in March 2009, at the same time as Mr Yeates.

After everything that happened in Stafford Hospital she went on to run a management consultancy which advises on strategy in the healthcare sector, with clients including the Health Education Authority and NHS trusts.

John Newsham was Mid Staffordshire’s finance director for over 10 years, presiding over its attempts to cut costs and the drive towards NHS Foundation status. When questioned at the inquiry, he admitted that the trust’s attempt to save £10m in order to break even could have led to staff shortages. At the time there were more than 208 vacancies, 100 of which were for nurses. He claims to have been assured patient safety would not be compromised by the savings.

However, Newsham admitted he did not realise the impact of the cuts on patients, saying no-one reported problems to him. He took early retirement in 2007, at the age of 53, shortly before the trust gained foundation status.

Karen Morrey was the director of operations at Mid Staffordshire from 2006 until 2009, and she has publicly accepted responsibility for a failure to thoroughly investigate patient complaints. She was put on paid leave in July 2009, before leaving the trust in November that year and founding KMC Futures, a healthcare management consultancy firm, with her partner Mike Court, who had also been the director for improving patient experience at Midd Staffs, on a salary of between £85,000 and £100,000.

Morrey has now returned to the NHS and is employed by Dudley Group of Hospitals as a contractor in a “service development role”. In 2012 she also became a director of Staffordshire Women’s Aid, set up to provide advice and support for women.

These, then, are likely candidates for scapegoat duties, but we are sure they will be well looked after in the long run.

Meanwhile, another name that has come to light is that of a rather bigger fish, Sir David Nicholson. Currently Chief Executive of the NHS, Nicholson was in charge of the health authority with responsibility for Stafford Hospital for a full year in 2005/06. Not only does he not accept any responsibility for the conduct at the hospital that he was supposed to be overseeing, but he told the inquiry that Stafford was a “singular rather than systematic problem in the NHS” – an obvious untruth that will be easily recognised by all who have any knowledge of the NHS.

NHS feeding bankers and multinationals

Every single hospital that ever achieved ‘Foundation’ status did it through staff cuts and a depleted service. And what of the other time bomb that the Labour government left sitting in the NHS (and other services) – PFI?

The scandalous cost of PFI building continues to bleed health authorities dry and will certainly require more job losses and further ward/bed closures in the near future if the mounting bills are to be met. Of course, by then many of the people who currently run our health authorities will have stuffed their pockets with public cash and walked away into new consulting jobs, leaving the problems behind them.

The bourgeoisie is clearly totally shameless in the way it is destroying the service offered by the NHS in order to generate profits for itself. The steps that activists have taken so far to try to defend the service are clearly not enough. No amount of pleading with MPs or Early Day Motions and other such devices beloved of social democrats makes the slightest difference to anything. New and more effective methods of fighting must be sought.

And in the final analysis, we will have to kill the parasite rather than limiting ourselves to trying to treat the ever-worsening symptoms of its infestation of our society. We have to overthrow the capitalist system and replace it with socialism – the rule of the working class, which puts the interests of the working class first.

Save the NHS from capitalist greed!

:: Dismantling the NHS, Proletarian issue 50 (October 2012)
:: Last chance to save the NHS, Proletarian issue 46 (February 2012)
:: Save the NHS from capitalist greed , Leaflet (March 2012)
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