Britain's National Health Service was a pioneer in public health care for the world, but it now faces disturbing charges that standards of care have sunk so low that thirsty and untended patients at one hospital were reduced to drinking water from flower vases.
The charges came in a 1,700-page report released Wednesday that described horrific conditions at a hospital in Stafford, England, where, it said, as many as 1,200 people died unnecessarily between 2005 and 2009. Patients were often left unfed, unwashed and lying in beds soiled with excrement, the report concluded. One woman wasn't told for six hours that her mother had died. When she came to collect her mother's belongings, staff handed her a bag at the reception desk.
The report marked the culmination of a two-year public inquiry led by lawyer Robert Francis into patient care at the hospital. But the conclusions went far beyond Stafford. Mr. Francis said the NHS – along with nurses, unions, surgeons, bureaucrats and hospital administrators – failed patients on every level. His report cited cover-ups, falsified records and a culture that rarely questioned what was going on and almost always looked the other way when problems surfaced. Above all, Mr. Francis said, the NHS was driven by financial targets, not patient care.
"This is a story of appalling and unnecessary suffering of hundreds of people," he said after releasing the report. "They were failed by a system which ignored the warning signs and put corporate self-interests and cost control ahead of patients and their safety."
The report provides sober reading for any country with a public health-care system, including Canada, because it touches on issues common to most. Mr. Francis found that many of the problems at Stafford came about because of staff shortages, budget cuts, crowded waiting rooms and a disregard for elderly patients in particular. A nurse testified about falsifying records for wait times so the hospital would meet its targets. And a surgeon became so unstable in the operating room that other staff refused to work with him.
The report's recommendations include more focus on the elderly in medical training and the creation of a new type of nurse to be called a "registered older person's nurse."
"The time has gone when the care of the elderly can be comfortably regarded as a backwater of medicine; it is an area which requires a status in accordance with its proper social importance," the report said.
Mr. Francis also called for more transparency at the NHS, which he said ignored repeated warnings about problems at Stafford for years. He noted that the inquiry only came about after a local woman, Julie Bailey, began raising concerns and formed a group called Cure the NHS. Ms. Bailey's 86-year-old mother was admitted to Stafford in 2007 because of a hernia, and her care was so bad that Ms. Bailey virtually moved in to look after her. Her mother died a few weeks later after being dropped on the floor by a staff member.
"We've lost hundreds of people, and people knew that these failings were going on for so long," Ms. Bailey said in an interview Wednesday. "While we were outside with banners asking for the deaths to stop, these people knew what was going on but instead tried to cover it up and wrote to the local newspapers saying what a good hospital it was."
While she welcomed many of Mr. Francis's conclusions, Ms. Bailey said she believes senior managers should be fired – including NHS chief executive Sir David Nicholson, who once ran the health region that included Stafford. Mr. Francis declined to single out managers, saying that replacing bosses wouldn't solve the problems because they are so widespread.
Sir David has apologized on behalf of the NHS and promised to reform the organization, which has roughly 1.7 million employees and an annual budget of almost $200-billion. The NHS has "let people down in the most devastating way," he told a health-care conference last week, before the public release of the Francis report. "As a human being, and as chief executive of the NHS, I want to apologize to the people, their families and carers for the truly dreadful experiences that they had to go through."
Prime Minister David Cameron offered an apology as well in the House of Commons on Wednesday and said the government will review and act on the recommendations. He also announced the creation of a Chief Inspector of Hospitals.
He told Parliament that while he admires the NHS and that the institution "says a huge amount about our country and who we are," the events at Strafford were "dreadful." He added: "On behalf of our government and indeed our country, I'm truly sorry."
Some of what the inquiry heard about Stafford Hospital:
From the daughter-in-law of a 96-year-old patient: "We got there about 10 o'clock and I could not believe my eyes. The door was wide open. There were people walking past. Mum was in bed with the cot sides up and she hadn't got a stitch of clothing on. I mean, she would have been horrified. She was completely naked and if I said covered in faeces, she was. It was everywhere. It was in her hair, her eyes, her nails, her hands …"
From the husband of a patient: [S]he had been showing symptoms of diarrhea for two or three days … [S]he was not tested for C. difficile until the morning of the 10th … I discovered a faecal smear sample for analysis left on her bed table in amongst her drinking cups."
From a nurse: "The culture in the department gradually declined to the point where all of the staff were scared of the [senior nurses] and afraid to speak out against the poor standard of care the patients were receiving in case they incurred the wrath of the Sisters. Nurses were expected to break the rules as a matter of course in order to meet target, a prime example of this being the maximum four-hour wait time target for patients in [emergency]. Rather than 'breach' the target, the length of waiting time would regularly be falsified on notes and computer records."
From a senior staff member: "The situation in theatre appears to be fraught and the Panel learned of serious problems. It would appear that [the surgeon concerned] finds it difficult to work under stress, when the atmosphere becomes very tense. A number of theatre staff will not work with [the surgeon]. The [review] Panel understand that there have been a number of complaints made against [the surgeon] and at least three of these were allegations of assault, which the [hospital] has investigated and dealt with accordingly … when [the surgeon] is not in a stressful situation [he] is very charming and courteous when talking to patients … [The surgeon] has no idea as to why there are these perceived problems."
Total public expenditure on health per capita (purchasing power parity) in U.S. dollars, 2010: