Agata Miśkowiec recounts her recent experience of hospital care, and what it can be like being a patient in an inadequate trust. She argues that the NHS needs to learn from experiences such as hers and take decisive action, including using the opportunity integrated care systems offer to tackle poor leadership and support improvement.
Last month I became one of the NHS’s harrowing hospital statistics – I waited for 12 hours at A&E for a diagnosis and 18 hours for potentially life-saving surgery.
I’m not alone. Data released by NHS England earlier this year showed that one in 10 people attending A&E in England face a wait of at least 12 hours.
But that was not the end. Due to complications (which might have been caused by a long waiting time – although I will never know for sure), I had to stay in hospital for longer than expected. Over that time, I saw the symptoms of a system at breaking point, fuelled by a stark lack of communication and unclear lines of accountability. How did it manifest itself?
Repeating my story, having to describe my symptoms on four separate occasions to clinicians.
Errors and miscommunications with the wrong diagnosis recorded in my notes, missed appointments due to departments not speaking to each other and wrong discharge aftercare advice given by consultants not familiar with my case.
Shortage of crucial skills and the drugs to treat me, with key clinical services having been outsourced and a lack of drug inventory, leaving nurses to hunt for my antibiotics in other wards every 12 hours.
In short, my ‘lived experience’ during my hospital stay, was of a system that left me feeling unsafe, despite the front-line staff best efforts to provide compassionate care. Not only did it result in poor outcomes, but also duplication of work and wasted resource – luxuries the NHS cannot afford.
Why am I sharing this personal story? Because what this experience gave me – on top of a few scars – was an opportunity to reflect on the NHS, as a collection of organisations and a system of care.
As a public sector consultant, I have worked both with hospitals that have been both failing and outstanding. The prevailing narrative is that the workforce crisis is the main problem for failures in the quality of care. Yes, undeniably there are chronic staff shortages, high levels of turnover and high agency rates. However, in my experience, often the real make-or-break issue in organisations that are struggling – one that is underpinning their staffing problems – is a lack of the right leadership.
This was the case at the hospital in question. I met caring and dedicated staff (in particular, both permanent and agency nurses and care assistants) who wished they could do more to help. Yet they were operating in a dysfunctional organisation and their hands were tied.
This wasn’t just my subjective observation. The recent Care Quality Commission (CQC) inspection reports from this hospital, undertaken after whistleblowers had raised leadership and safety concerns, make for uncomfortable reading. The CQC noted that the clinical outcome data for mortality at that hospital was twice the national average. It reported the staff felt undervalued, unsafe, and unsupported. A culture of bullying and harassment pressured them into making unsafe decisions. Staff perceived this was being driven from the top down, with poor behaviour role modelled at a senior leadership level. And this was just the latest in a history of poor inspection results.
I have two main takeaways from my recent experience.
Firstly, it confirmed that the quality of leadership is pivotal when it comes to the quality of care. As we all know, the NHS is under pressure like never before and every hospital has its fair share of challenges. But good leaders provide staff with the right tools, oversight and foster a supportive culture to keep patients safe, in spite of pressures that their organisations face. Poor leadership is failing both patients and front-line staff who are trying to do a good job in difficult circumstances.
My second and more important takeaway is that more has be done to support those organisations with culture and leadership issues – particularly where it has been a pattern over many years. It is not enough to point out a failure and hope the organisation will come to grips with its challenges. Luckily, there are multiple NHS organisations that are beacons of good leadership. The establishment of integrated care systems, and a less competitive healthcare landscape, creates the environment for peer-to-peer support for struggling trusts. This should be exploited to its full.
A time of crisis is a time for strong leadership and bold action. Where leadership is poor, it must be tackled decisively whilst supporting trusts to improve. While healthcare is delivered by inadequate providers, sadly there will continue to be stories like mine.
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