Hospital rankings risk undermining NHS morale | Letters
In Rachel Clarke’s article on Labour’s plans to introduce hospital rankings (Wes Streeting, You need a better plan for ailing hospitals than public humiliation, November 13), I left the NHS during Labour’s introduction of the ‘value for money’ health care policies put forward by Tony Blair. I was working as a psychotherapist in a very deprived area of London when Labor fell in love with performance targets. The test of how successful we were ‘getting people back to work’, which was given the utmost importance, was spread over several pages with check boxes, which we were expected to complete for each patient.
There was nothing on the so-called evaluation form about the demographics of the patients, their socio-economic and unemployment levels, and the severity of trauma present in the population we were serving.
In my area there was chronic generational unemployment, teenage pregnancies, overcrowded housing and a large population of traumatized refugees. The level of basic needs was so great that my work was sometimes, necessarily, similar to social work. Some of my traumatized patients could barely speak, others lived chaotic lives and had a very deprived upbringing, both physically and emotionally.
It is therefore no surprise that we did not finish at the top of the rankings. But have we done a human job, earned the trust of most of our patients, given them the experience of having their stories heard, provided them with continuity and consistency, and helped them over time? Yes, most of the time we did that, but none of it showed up on the checkbox.
How can I assess the impact on my patients of continuity, compassion, kindness, consistency and being able to tolerate some of their horrific stories? I couldn’t do that, so after eleven years in the NHS I felt there was no understanding of the valuable work I and my colleagues provided to patients. I resigned.
Rachel’s article speaks to my experience and is a warning to Wes Streeting that under his plan NHS staff will feel even more demoralized and could leave their posts. Not because of a lack of care, but because they are humiliated and devalued and their work becomes a mere competition with other colleagues. I still miss my NHS work.
Pure Sharifi
London
I agree with Rachel Clarke that league tables, or naming and shaming, are not the answer for the NHS. Labor was in power when the Mid Staffs scandal became public, and asked Robert Francis to do so write a report about how such shocking abuse could have come about. The Francis Report was published in 2013. Among other things, it identified the target culture, which Tony Blair inherited from the Tories and then used to devastating effect.
Managers’ fixation on performance targets, it was reported, played a major role in creating a bullying, top-down institutional culture that prioritized positive outcomes while ignoring concerns felt at the grassroots level. As you reported in 2015, a series of NHS listening events following the Francis report found that the main concern of staff across all disciplines was fear: “fear of destruction, loss of jobs, servitude and of humiliation and to mention, to be ashamed and blamed.”
What is the point of setting up these expensive investigations, with their wise and well-considered conclusions, and then ignoring them now that Labor is back in power?
Alison Vaspe
Andover, Hampshire
Looking at hospitals to see which ones perform poorly and which ones perform well is not a bad idea in itself. But instead of pointlessly punishing or rewarding them – why not work them together – are the most successful people who share their secrets with those who are struggling?
Sue Stephenson
Barrow-on-Humber, Lincolnshire