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VINE VOICEon 2 April 2011
Format: Paperback|Vine Customer Review of Free Product( What's this? )
Patient safety is the single most important aspect of health care, but one which can be left to play second base to the government targets and financial restrictions. This book catalogues some of the results of that climate in the last ten years, particularly, but not exclusively, the situations which were allowed to develop in Mid Staffordshire NHS Foundation Trust, Stoke Mandeville Hospital (part of the Buckinghamshire Healthcare NHS Trust), and Maidstone & Tunbridge Wells NHS Trust.

The chapters in the book fall into several broad sections:
* guidance issued in the last decade on good basic care,
* a catalogue of incidents, divided into toileting, cleanliness and managing infection, nutrition, pressure sores and falls
* key system issues, such as bed numbers, patient type, cosumerist approach, staffing levels, targets and bullying
* responses which have perpetuated neglect, such as misinformation, not speaking up, denial
* regulation of health services

The book shows that a culture of patient safety has being severely hampered by successive government polices and a lack of central government accountability. To really address the issue, there needs to be a whole society movement to insist on good quality care, and to challenge politicians when this is not happening. This is not to take accountability from individual providers and commissioners, which still must have systems in place to address failures in basic care, but recognises that as a whole, any organisation is only as good as it's leadership.

It's a harrowing, and shocking, read. These are incidents of serious neglect of the most basic levels of care. Which should not happen. In terms of the book, though, I did wish there was an indication of whether the particular situations identified had been addressed. Surely some of the wards highlighted had shown an improvement since the incidents highlighted? I do appreciate the need to highlight that neglect is continuing in private and public parts of our health service, but are some parts of the service tackling the issue, with lessons to share? Charles Vincent's Patient Safety would be a useful complement to this book, in also looking at some of the small ways patient safety can, and is, being addressed.

The book is a difficult and emotional read, but it is worth reading, particularly in a climate when health services are still being asked to do more for less. I'd highly recommend this as required reading for all those in the Dept of Health, and all those who work in the health care industry.
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VINE VOICEon 21 May 2011
Format: Paperback|Vine Customer Review of Free Product( What's this? )
It took me a while to get round to reading this book, because I was in the process of witnessing first hand some of the issues raised in it, with regard to the care of my late father-in-law at a tertiary University Hospital NHS Trust. As such, the subject matter was a bit too close to heart.

However, this is a worthwhile book to read, if only so that one can see that what was happening in the aforementioned hospital was not just in that one site, and that similar issues have arisen elsewhere. The worrying thing, which is the point made by the author, is that such lapses in care have been happening for years, and that in theory, steps have been taken to correct those lapses.

The book is very thorough, covering clear examples of acts of criminal negligence, including where manslaughter has been deemed to have occurred. It also points out instances where staff have tried to highlight the problems, but there has been a lack of action both from the hospital/care home in question, and equally worrying from the professional body for those individuals.

My question would be that, if these abuses, and let's be clear, they can't be called anything else, were happening several years ago, and in theory measures were put in place to prevent them happening, why are they still occurring in 2010 (the extent of the book) and as I have seen, in 2011. Thus, the author's point that neglect in the care of elderly patients is an institutional thing, rather than a one-off (or several-off) is quite clear. However, there does not appear to be any suggestion of how this can realistically be addressed, hence my not being sure where this book is going.

This is a good book, and an excellent summary of events that have occurred and measures that have been taken to date to solve the problems, but it is clear that those measures have not been enough. What happens next, would be my question.
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VINE VOICEon 13 April 2011
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This book should be compulsory reading for all politicians and NHS senior managers. It tells some terrible stories about the treatment of the eldery and sick in our hospitals. Much of this has been exposed in TV documentaries over recent years but the timeline of this book indicates that in many NHS trusts nothing has really changed. The evidence is bang up to date (autumn 2010) and includes analysis of what went wrong in the now infamous Staffordshire hospital that has become the subject of a public enquiry. It is not so much about poor clinical treatment but much more about neglect and indignity; the author uses the term "institutionalised" to indicate that there is a culture of neglect in the NHS, and while this might seem harsh to the many very caring NHS nursing staff in particular, there are too many examples apart from Staffordshire in this book to ignore. If you care about how your parents are treated or indeed how you might be treated in the future, then read this book and demand action to change things. It is little wonder that older people are choosing to commit suicide rather than face this sort of future, and I for one am a little sick of the pro-life do-gooders and palliative care specialists who seek to impose their own brand of morality on the rest of us, tell us what is best for us and that we can all die with dignity. My mother is in a care home with dementia and I am just relieved that as a family we are able to monitor her care - imagine what it might be like for elderly people who have nobody.
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VINE VOICEon 13 December 2012
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This is a shocking book which exposes some truly awful slippage in standards of care in the NHS. I think caution should be taken, though, as the cases chosen as illustrative are in essence just that - single cases - and so it's hard to see the bigger picture at points. That said, I come from a family of nurses and carers, and certainly some of the criticism here do ring true, particularly understaffing and bullying in the workplace, although they agreed that some of the cases presented here are truly the worst of the very worse, and are (fortunately) not completely indicative of everyday experiences.

The book manages to avoid being sensationalist or journalistic, as might be the danger with an exposé piece like this. It's quite a balanced, unhysterical treatment of the topic, which makes a refreshing contrast with some of the tabloid exposés. There are positive suggestions by the end of the book, too, rather than a simple, desperate debunking. As with education, the straight-jacketing of working practices particularly stands out as a central focus for improvement. And unlike some of the current polemic on health and education, the blame isn't being shifted onto the people at the bottom, amongst whom there are some very dedicated and praiseworthy vocational carers.

Definitely worth a read on the strength of the potential solutions it offers, contributing to a very topical and heated current debate.
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Format: Paperback|Vine Customer Review of Free Product( What's this? )
I was interested in this book partly because of the experience over a period of about ten years of watching how my parents were treated in several hospitals and my own experience as an inpatient. I was staggered by the enormous variation in the quality of care in these various hospitals. Mandelstam's description of what has gone on makes grim reading. He describes hospitals failing to deliver basic care - hydration, nutrition, hygiene, infection control, dignity of the patient, failing to prevent bed sores. It should be shocking but it didn't surprise me.

Mandelstam's thesis is that these are systemic problems emanating from the top rather than local failures. Up to a point that may be true, but he didn't wholly convince me. To blame all the failings on government does not square with variations in care between hospitals, including hospitals within the same trust, nor between different wards in the same hospital, or indeed different shifts on the same wards. As both a patient and a relative of patients I have witnessed variations that appear to be based on the attitude of staff. Sadly some of what I have seen has seriously diminished my faith in the nursing profession, notwithstanding that I have come across truly wonderful nurses too.

Undoubtedly some of the poor basic nursing practice reflects staff shortages and pressure on beds, and some will be attributable to lowered morale, but that cannot explain all the poor practice. He quotes nurses or former nurses being appalled by the 'care' provided by other nurses. Mandelstam accepts this: "Despite this bond between too few nurses and decent care, it is not just about numbers. Competence and attitude clearly matter." However, he tries to lay the blame for this at a higher level: "Furthermore, whilst there will always be some staff with the wrong attitude, they and others will be tacitly encouraged in the wrong way if they receive an unspoken message from senior management that basic care doesn't matter, and that other things count for more." Sorry - but in my view this lets errant staff off too easily. Staff know right from wrong - basic care & dignity are not the stuff of rocket science. You don't need to be a medical professional to know that people will die if they don't receive adequate food and drink. As professionals they need to stand up for what is right, blow the whistle where necessary. If they don't, they risk being held accountable for the care provided even if the real responsibility lies elsewhere.

The author quotes a relative of a patient at the Royal Liverpool University Hospital who said "...I do not believe that nurses today actually care about people, and I do not know why they take up the profession." My own experiences bear out that view. As an outsider, it strikes me that something is going wrong with the recruitment and training of nurses. Somehow in the effort to increase the standing of the profession something has been lost, but this isn't even touched on in the book.

Mandelstam recommends that the regulators and professional bodies develop more backbone and that staff too may have to become more assertive, if only to protect themselves. He rightly refers to the dreadful response of the Nursing and Midwifery Council in seeking to strike off a nurse who blew the whistle on appalling care - this was only revoked after a public outcry. He notes that very few have been struck off their professional registers. In relation to the regulators, there is a major flaw in the system in that much of the assessment is conducted by the trusts. No doubt this explains the huge disconnect between the star ratings of hospitals and the experience of patients - my mother was 'treated' in a filthy hospital in a three star trust.

Although Mandelstam blames the target culture and financial performance measures for the problems, criticising PCTs for being focussed on outcomes & throughputs, he concedes that targets were introduced in response to earlier failures. Vast amounts of money have been put into the health service in the last ten years, with good effect in some areas, but Mandelstam doesn't mention this or discuss the allocation of resources and how this affects front-line care - e.g. no examination of the increases in management staff compared to front-line staff over recent years. Nor is there any discussion about the effective use of public money - high rates of sickness absence, use of expensive agency nurses, ineffective purchasing, enormous fees paid to management consultants. This struck me as a serious omission, particularly in the context of care being compromised because of staff and bed shortages.

In summary, the book is excellent at setting out what has happened but is less good in my view at analysing why it has happened and what can be done to improve things going forward. I felt that Mandelstam had his own agenda. He may well be right in his contentions but he didn't always convince me and I think he missed some issues.
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Format: Paperback|Vine Customer Review of Free Product( What's this? )
This is an incredibly brave book for one individual to write. It should be compulsory reading for all PCT's and anyone involved in running a hospital or even anyone on a board responsible for people's care and well-being within the NHS.

Michael tracks and carefully collates reams of damaging, fatal, unnecessary suffering for patients being 'treated' in NHS.

It doesn't make for easy reading. I had to force myself to finish the book if only to honor the poor people who had suffered at the hands of incompetent, rushed, uncaring staff/managers and clinicians.

It's not about spending, it's not about cut-backs, it's about what Michael calls a systemic blight....that affects the:

"people at their most vulnerable, when they are sick, confused, helpless and maybe dying".

He suggests sensible solutions, and strategies that would prevent people from having to lie in their own vomit, excrement, and urine....pushing buzzers that don't work, ignored, or not being helped to the loo... removing all trace of dignity.

My sincere wish is that 'the powers that be' read this.....my worry is they won't and will just carry on subjecting more patients to needless suffering.
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on 15 April 2012
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This book should be a must read for anyone working in the NHS for a number of reasons. It not only lists a litany of events that have been the low points for the NHS, but also reveals the perception that the public have ingrained in their collective memories.
Unfortunately, it becomes a one-sided portrayal of a series of lapses and errors and degradation and deterioration, without any real attempt to analyse the root causes or forward any real solutions. It fails to identify whether these omissions of care are a result of a significant policy decision or a cultural change as a results of decline in societal values. It left me feeling frustrated at times, as there is no real analytical conclusions or incisiveness, and at times feels like sensationalist journalism on a tirade. At times, I felt that any industry or service if put under the microscope could easily be ripped to shreds!
However, even with its anecdote heavy approach, it sums up the gradual decline that the NHS is living with a warning shot that is not acceptable and that the NHS has to hold to a higher standard. This should serve as a wake-up call for those of us in the NHS as we all shoulder an individual as well as a collective responsibility.
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VINE VOICEon 21 July 2011
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This book bizarrely arrived just before I went into hospital. My friend bought it in for me to read (and strategically leave on my bedside table!) it is a subject close to my heart and feel strongly that most of the issues in the health service (after funding) are things that cost no money, politeness, a feeling of being cared for, time for a moment of conversation, understandable explanations all of which begin to leave you still feeling slightly human. Some patients, particularly the elderly, are treated appallingly and this book sets out in no uncertain terms to openly and unapologeticly explore where things go wrong. Without wanting to frighten people, if you have someone in hospital, especially if they are vulnerable, read this book and keep your eyes open, you are their champion. This may sound somewhat negative on the people often seen as angels but the reality is very diffent and it is very healthy for books like this not to be afraid of upsetting people in order for improvements to be found. It is full of case study style incidents and there was not one I found hard to believe, just on my own experience. Read this, even if only to get the other sides point of view. There are some wonderful people in the NHS and I would expect they would sadly agree with this book and the fact they stand out from the crowd simply underlines the need for improvement.
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on 1 May 2011
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With the current controversy about reforming the way the NHS is organised, and how services are commissioned, it is all too easy to lose sight of the absolute bedrock on which patients' wellbeing depends - the care they receive day to day on the wards from nursing and medical staff. The book is an antedote to any tendency to complacency on that score.

The author in an article for 'The Guardian' maintains that bad practice 'is now a systemic blight, rather than local blemish'. He does not attribute this parlous state of affairs to staff who have 'discarded compassion and humanity', but points instead to inadequate staffing and too few beds - so that, as he puts it, 'exhaustion and demoralisation may be mistaken for indifference'.

His new book covers the vital basics of patient care - maintaining patients' dignity, helping them get to the toilet, keeping the environment clean and managing infection, & helping patients eat and drink.

Students of medicine and nursing, and those currently involved in the management and delivery of patient care in the NHS will find this book well worth reading. It is not an easy read - some of the case studies are very distressing - but the problems it sets out are too important to ignore.
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on 3 May 2011
Format: Paperback|Vine Customer Review of Free Product( What's this? )
I have recently left the NHS after 28 years service. This book, even with its slightly anecdotal heavy approach, sums up the degredation & gradual dissolution of a previously outstanding service.
Successive governments of either main party have only speeded up the demise of what was once the jewel in the British crown. My own decision to go to the private sector, prompted by utter frustration, with management too interested in fast turnarounds & no interest in the best practice care of patient & family.
I cannot recommend this book highly enough
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