Patients on NHS wards can’t afford prevarication over poor care

The shocking revelations emerging from East Kent Hospitals University NHS Foundation Trust​ will make many people pause and ask how could such things happen in an NHS trust – it’s a question being asked all too often.

Police are investigating the latest allegations of an elderly man being forcibly and inappropriately restrained by nurses and carers. Their actions were apparently filmed by security staff who reported the incident to managers. Staff have been suspended and investigations are ongoing.

We will have to wait until those enquiries are completed before we know exactly what happened but at least one member of staff, a whistleblower who spoke to The Independent, was clear that the video was “horrific”.

Across the NHS there are thousands of confused, elderly patients who lack the capacity to make decisions for themselves and this presents real challenges to stretched NHS staff.

Where a patient who cannot consent to treatment needs to be physically restrained, guidance requires doctors and nurses to make sure they act in the patient’s best interests and consider the best approach, which must be proportionate. Restraint can include sedation and should have suitably documented reasons, with an emphasis on doing it calmly with staff the patient may be familiar with.

Patients can be violent and aggressive, sometimes because they are sick and don’t know what they are doing, and managing these patients is probably one of the hardest jobs NHS staff do.

None of this is to excuse poor care. But worryingly the senior East Kent clinician who spoke to The Independent on Friday labelled the trust culture as toxic. In such environments, with the added ingredients of poor staffing levels, undue demands and pressure, poor care can be normalised.

This was evident on the wards at the Mid Staffordshire trust care scandal and almost every other example of elderly care failures.

Staff who are ground down by the fear and oppression of a poor-care culture can make choices they would never have previously considered possible. It’s a melting pot that means safety and quality of care cannot be guaranteed.

The East Kent insider didn’t lambast the chief executive Susan Acott, but instead pointed to an unyielding middle management who were treating each other and their staff badly. They described a culture where staff were shouted down and people had learnt to keep their heads down.

A good organisational culture can be the essential vaccine to the virus of cruelty and poor care. The whistleblower said Acott was saying all the right things but on the ground it wasn’t cutting through.

The challenge for hospital chief executives is to take those brave decisions to tackle the blockages in their middle management that can create the toxic atmosphere that allows poor care to thrive.

The CEO has responsibility to make sure their vision is properly communicated and acted on, and if they can’t, they need to make way for people who can. Patients on the wards can’t afford prevarication.