Friday, April 12, 2013

Balancing ‘good news’ with risk assessment-how the two discourses are managed

Neil Zammett writes
We all have a stake in Queen’s and we want it to succeed and provide good services but this has to be balanced by a realistic assessment of how the Trust is performing.
I have been very impressed by the Trust Chair’s, Sir Peter Dixon, statement in response to the Francis Enquiry which was published in their last Board papers.  I think it is exemplary and I would commend it as a model to those who read this Blog.  I have reproduced an extract from his paper below:
“In discussing the obstacles to the achievement of the sort of culture which puts patients at the centre and insists on nothing but the best, the report also outlines the sort of behaviours which prevent this happening:-
A lack of openness to criticism;
A lack of consideration for patients;
Looking inwards not outwards;
Misplaced assumptions about the judgments and actions of others;
An acceptance of poor standards;
A failure to put the patient first in everything that is done.
I endorse this totally”
Despite the protests and the Council motion the maternity ward at King George has now closed.  I was outside Beckets House before the NELC meeting with fellow campaigners just to show my personal commitment to local services and solidarity with the women of Redbridge whose views and opposition to the closure are recorded in the Opinion Leader report commissioned by Health4NEL.
I was stunned to read the story of the last baby born in the Recorder and the Guardian and along with a lot of other people astonished to find out that the parents had rushed there from Queen’s after being kept waiting in a corridor for 40 minutes.  So much so that I had to mail a member of the Council’s Health Scrutiny Unit to make sure that I had understood the sequence of events correctly. Apparently I had.
It now emerges that the story of the final birth at King George was originally intended to be a “warm” one promoting the service at Queen’s.  What the public do not know is that there were two BHRUT press releases relating to the birth of baby Dovydas. The first on the 19th, which is available on the Trust’s webpage, quotes a midwife making very positive comments about the new unit at Queen’s.
The second press release issued a day later on 20th, which does not appear on the Trust’s webpage states that Mr Donatas had to wait “a few minutes...” not the forty he claims but a new edition of BHRUT News which I received on 26th March appears to backtrack and admits that “... there will occasionally be bottlenecks in triage ...”
I am delighted that little Dovydas and his mother and father are all well but what is unclear to me is how these “bottlenecks” will impact on the service at Queen’s and if they will lead to additional risks for women.  My concern is that if it had not been for the publicity associated with this birth we would all have been totally unaware of the problems with triage that evening. 
Queen’s, along with other units in East London went through a supposedly rigorous quality assurance process before the decision to close the ward at King George was taken and yet this happens.  In my recent Blog “No room at the Inn” I observed:
“Women may have to travel further to have their babies and possibly change units at short notice because of daily spikes in demand. Under these conditions they will have no choice ...”
Mr Donatas agrees “If they hadn’t got space then, what’s going to happen now? Will they go to Whipps Cross or further away?”  We are very fortunate that he has such a clear view of the public interest.  Many of us would simply have been grateful that in the end all had gone well and not said anything.
Well one incident doesn’t make a trend and this was apparently a personal decision on the part of Mr Donatas and his partner.  I would certainly agree that Queen’s has more than enough capacity, triage apart, but there is a very tight situation across East London as a whole. What we need to see is how many women have to switch units at short notice because of capacity problems.
Unfortunately this is not the only example of ‘information management’ in this press release.  It also says that “There will be no redundancies in these plans which will strengthen staffing at Queen’s and in the community.”  This is not the full picture because Queen’s will be losing over 50 midwifery and three medical posts because of the cap placed on the number of deliveries.  The Trust intends to lose these through natural wastage but this represents a major reduction in the workforce.
Many will remember that only recently the Trust was recruiting in Italy and elsewhere in Europe to build up the numbers. The reduction therefore represents a significant waste of public money and effort on the Trust’s behalf, although I would say that this is not their fault but more something which can be laid at NHS London’s door.
What is clear to me is that two quite separate discourses are going on here.  The first is PR led and is about presenting the Trust in a very positive light with the objectives of promoting morale amongst staff and reassuring patients and the public.  It enters the public domain through press releases and tends to receive a high profile.
The second is evidence based and is aimed at making a balanced risk assessment of the Trust and its services and making planned interventions to reduce and manage this risk.  The risk management discourse enters the public domain through a different route, largely reports and board papers which are published by various bodies such as CQC and until now, NELC and NHS London. It often has a fairly low profile as a consequence.
Of course I can see the logic behind the PR led discourse and I would support its aims. Unfortunately, it is also obvious to me that if there is too big a “gap” between that and the risk management discourse there are going to be problems of credibility and perceptions of openness.
The crucial bed forecast for BHRUT has been withheld for nearly six months now, despite my asking for it at just about every meeting I go to, and more recently the extraordinary board minutes for February have disappeared from the website. They appear to have been replaced by finance and quality reports for month 9 (December).
I have seen a copy of the minutes for the extraordinary February meeting which was exclusively to discuss a response to the CQC before their deadline of 27th February when conditions would have been imposed.  While I can understand that there might be reasons for having a board meeting with the public excluded, I do not understand why there is no such statement to this effect on the website which would be the normal portal for public enquiries.
I hope Sir Peter Dixon reads this blog and more importantly does something about it.
NB  This blog was delayed because my daughter was admitted to hospital.  She’s fine now but I have been travelling to the Royal Free every day.