7th July 2016

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Sir Andrew Dillon
Boss of NICE, in conversation with Roy Lilley
Why keep doing it?
News and Comment from Roy Lilley
There is a really grim story in the news.
The full details are here.  In short a patient lay dead in a London A&E for 'hours' before they were discovered.  We might be talking about 4 hrs.
I have no idea; if this poor soul had been discovered earlier, a death might have been prevented or the patient was very sick and would have died anyway.
Hourly nurse rounds might have reduced the time to discovery at worst to 61 minutes.  I don't know if that is any better...
What I do know is; dying in A&E, a thin curtain dividing life and death, comes nowhere near what any of us would want for our family. 
The machines that go beep, the trolleys that go crash, the doors that go bang.  The relentless gaze of fluorescent lights.  Not the issue... 
It's the hand that was never held, the voice that was never heard.  The lonely, solitary, beginning of a desolate journey each of us will undertake but few of us will wish to embark upon, without an aurevoir.
How did it happen?
It's not a mystery.  There were not enough people looking after more than enough patients.  No rocket science required.
This particular unit sees 500 patients a day.  That's over 180,000 a year.  During the course of last year there were 22 serious incidents.  Maybe one a fortnight.
No failing is acceptable and our only mission can be the pursuit of excellence.  But, to be frank; I think it is a miracle there are not more serious problems.
The numbers spell it out; the nurse patient ratio should have been 1:4 but was 1:10.  Up to 20 patients being treated in the corridor... on trolleys.
Rightly, the hospital is working on its problems and has apologised.  It can only be the hollow apology we are all too familiar with, when institutions express corporate regret.  It is utterly meaningless, offers no solace, ameliorates nothing.
We need an new transparency, a new honesty.  What they should be saying is; conditions are such that we cannot run a safe hospital.  The system is being destroyed by demand, not by poor management. 
The chair of the board should say; we cannot guarantee we can hire enough nurses.  Competition for a shrinking workforce, caps on agency fees, poor workforce planning and housing costs are making it increasingly less likely we will be able to.
The Trust should be frank about junior doctors. 
The reorganisation of foundation training; replacing the 'firm' with a bureaucratic merry-go-round of placements, has killed-off not just the informal social support system but also flexible clinical support.
This leaves junior doctors isolated, disconnected with the aims and ambitions of the organisation and in many ways, at the heart of the mistrust that blights relationships today.
Boards should speak out about the constant threats from regulators creating a chilling effect that is felt from the board room to the bedside.  People too terrified to speak out, part of this problem.
Trust NEDs should listen and discover why speaking out comes with too great a risk.  How these events, rightly condemned, have conspired to make the Trust an even less attractive place to work.  Compounding the problems.
These are system failures and underline why dependency on inspectors, giving us reports that are months old, will never give us safe hospitals.
When will we learn; protecting the front-line, funding it properly is our vital mission.
When will we recognise; staff want to do the right thing and if you show them what good looks like they will get on and do it... better.
By what method will we know; how we are doing today, without technology, dashboards, bench-marking for success and comparing our performance to track down the finest that can be achieved?
Failure is not always incompetence and to pretend it is, is lazy.
This hospital is a component in an interconnection of primary, community and social care; reconfiguration, realignment, amalgamation, coalescence and system-wide recruitment are the only survival choices. 
Shortcomings stem from fragmentation, lack of vision and the barriers to adapting new ways, across the whole local health system.  A legacy of the Lansley reforms, we must scrape off our boots.
If services are not to shrink, become risky and driven to exhaustion, Boards, the CQC and system leaders should be the siren voices.  Leveraging their influence  with policymakers. 

And, stop and think what this is doing to the very people we depend on, rely on, lean on and need to be on our side. 
We know what we can't do.  Why do we keep doing it?   
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18th July - King's Fund - 5.30pm
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