Is there more patient abuse in the NHS today than there was, say, thirty years ago, or are we just better at exposing it? Dr No does not know for certain. He chose a thirty year comparator because it was about that time ago that he was a medical student, and then a junior doctor, and so frequently exposed to different wards and hospitals. His recollections from that time are more of starched white sheets, and of course the starched but very beguiling nurses who smoothed them out, than of beds doubling up as commodes. He does recall once seeing a cockroach on the polished wooden floor of a ward, but it was a one-off sighting of a very lonely cockroach. Today, it seems, the cockroaches have grown in both size and number, many now standing on two legs as they mishandle and maltreat the patients on their ward. Has it come to pass that the once occasional failing has now become normal practice?
Searching in the BMJ, on the grounds that its news coverage would pick up on reports of patient abuse, Dr No found surprisingly little. Top of the hit list was a 1905 report on abuse, not of, but by patients, of the out-patient (then acting much as A&E does now) department – nothing new under the sun there, then. The second hit was a 2003 report not of doctors abusing patients, but patients abusing doctors. Thus far, the trend seemed to be more of the boot being on the other side’s foot. Third up, however, was a report, from November 2000, of an NHS Trust that had ‘condoned abuse of elderly patients’. The boot was back on the medical foot.
But the next seven hits all came from the late 1800s – that’s right, 1800s, all over a century ago – and again were about patients abusing the system. Overall, reports on patient as victims of abuse were rare. One from 1990 covered abuse by carers, but outside hospital, and so not in or by the NHS. A 2005 report, ‘Blind eye to complaints allowed psychiatrists to abuse patients’, did cover the Haslam and Kerr scandal, but, generally speaking, on the basis of contemporary BMJ reports, there wasn’t a lot of it about. What was about, rather strikingly, was a lot of still familiar themes. Page 883 from a 1894 issue of the Journal takes in: (in)competent GPs, medical fees, the threat posed by madwives, and the hazards of artificial feeding on the [incapacitous] insane, all topics very much alive today.
Be that as it may, if there was patient abuse going on, the BMJ clearly wasn’t, at least via its search facility, saying much about it. So Dr No widened his search, to scandals and other sources. To cut a long story short – Dr No wont trouble you with the details – he did find this 2002 BMJ paper, which reports that the number of NHS scandal inquiries has risen sharply in recent decades, from one in the 1960s, to two in the 1970s, five in the 1980s, and over fifty between 1990 to 2001. At least one other significant inquiry, covering seven hospitals, but not included in the 2002 paper, was published in 1968, while a BMJ editorial from 1999 alluded to several others.
So, by the barometer of pressure of significant inquiries, we certainly have seen an exponential increase in patient abuse by NHS staff. But we still don’t know whether that increase reflects an true increase in underlying abuse, or is instead an apparent increase caused by a greater will to expose and investigate abuse, which has itself remained at relatively constant underlying levels.
That said, Dr No does suspect, based entirely on his own direct personal experience, and notwithstanding the loose nature of his present proxy-dependant research, that the rise in inquiries does reflect at least in significant part a true rise in underlying levels of patient abuse in the NHS. He also notes that this rise appears to have risen most sharply over the last two decades, following the introduction in the mid to late 1980s of general management and market forces to the NHS. Could it be that managers, now playing their market and management games in the once consensual NHS, have wrought the most dreadful changes on what was once, bar occasional failings, generally a decent service? If there is even a grain of truth to that chilling proposition, then it is management blowback on a monumental scale.