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ss triple helix - Christmas 2011,  Crisis in care?

Crisis in care?

The way of the cross is the answer

The last few months have seen a series of reports from the Care Quality Commission (CQC) (1) and the Equalities and Human Rights Commission (2) showing that care for the elderly in our hospitals, care homes and even in people's own homes is falling far short of even the most basic acceptable standards.

This lack of care takes many forms, from call bells being deliberately placed out of reach, to curtains not being closed properly when patients were on bed pans or having bed baths. Elders being cared for at home were given the option of either getting dressed, washed or having a meal, but not all three!

We have also seen examples of blatant abuse, such as that at Winterbourne View where people with learning disabilities were physically and psychologically abused by staff on a systematic basis. (3)

While the negative aspects of these reports get the public's attention, often overlooking the majority of examples of good care, there is little doubt that there are real problems.

Some are systemic (shortage of staff, a proliferation of providers, increased demand and funding that cannot keep pace). Others are more cultural; a society that does not value the elderly and disabled; a targets driven NHS more concerned with ticked boxes than people, etc. The CQC have also highlighted the failure of leadership at every level from NHS Trust Boards to clinical leadership at the ward level.

While action by government, regulatory and professional bodies is essential to improve these standards, there is also an individual professional responsibility. As CMF member Sarah Howles wrote in a recent piece for the CMF blog: (4)
' I lead that ward round, what am I teaching everyone with me? I'm telling my juniors that we as doctors shouldn't bother with people once we've "fixed" the list of medical problems. I'm showing them that if someone's a bit confused then there's no point in listening to them. I'm saying that if something's not "our job" we shouldn't engage with the problem. And it's not just the doctors who will be watching me; I'm showing the nurses and other ward staff what I think is an acceptable way to look after people. I'm modelling how to protect my own time and not work as a team.'

In the NHS's target driven culture and limited resources it is easier to follow the path of least resistance rather than modelling a more difficult, Christ-like approach to caring. This is the leadership we need in the NHS. As Paul puts it:
'In humility consider others better than yourselves. Each of you should look not only to your own interests but also to the interests of others.' (5)

  1. Dignity and nutrition for older people, Care Quality Commission Report, 13 October 2011, accessed at
  2. Inquiry into home care of older people, Equality & Human Rights Commission, June 2011 accessed at
  3. Winterbourne View 'failed to protect people', BBC News, 18 July 2011 accessed at
  4. Changing attitudes, changing hearts – reflections on the Care Quality Commission report, CMF Blog 19 October 2011, accessed at
  5. Philippians 2:3-4
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