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  1. OBSERVATIONS Medicine and the Media Worst cases of patient care in the NHS http://www.bmj.com/c...3/nov23_1/d7592 BMJ 2011; 343 doi: 10.1136/bmj.d7592 (Published 23 November 2011) Cite this as: BMJ 2011;343:d7592 Margaret McCartney, general practitioner, Glasgow margaret@margaretmccartney.com The media made a lot of the recent Patients Association report of the worst cases reported to it but largely ignored the Commonwealth Fund’s report that found that the NHS provides excellent care, writes Margaret McCartney www.patients-association.com/Portals/0/Public/Files/Research%20Publications/We%27ve%20been%20listening,%20have%20you%20been%20learning.pdf). In particular it described patients “desperately thirsty” and a relative who had “to run out into the corridor screaming for help as her husband lay dying in his bed, because nobody answered the call buzzer.” The Patients Association has done it again. Its “damning report into poor care in England’s hospitals,” released on 9 November 2011, “contains some shocking accounts of care received by patients in hospitals across the country, focusing on four key fundamentals of care—communication, access to pain relief, assistance with toileting and help with eating and drinking” ( www.telegraph.co.uk/comment/telegraph-view/8879458/A-filthy-shame.html). Christine Odone wrote in a blog on the Telegraph’s website, “We’re talking neglect so horrific, that patients were left to lie in their own faeces, and to die of dehydration” (http://blogs.telegra...ightback-begins). ITN said that it was a “harrowing report,” describing patients “left ‘starving’ in hospital,” and recommended “tough action” (www.itn.co.uk/home/33084/Patients±left±starving±in±hospital). The Daily Mail reported, “Scandal of OAP [pensioner] treated like a ‘slab of meat’ exposed in damning report into NHS care” (www.dailymail.co.uk/health/article-2059211/NHS-care-Hospitals-treat-elderly-like-slabs-meat.html). The report consisted of 16 stories of patient care, mainly written by relatives. The press, somewhat predictably, ran with it. “A filthy shame,” said the Daily Telegraph. “Neglect: the inadequate care of the elderly has been known for many years yet the scandal continues” ( www.patients-association.com/Portals/0/Public/Files/Research%20Publications/Listen%20to%20patients,%20Speak%20up%20for%20change.pdf). The previous year, 16 cases were described in Patients not Numbers, People not Statistics (www.patients-association.com/Portals/0/Public/Files/Research%20Publications/Patients%20not%20numbers,%20people%20not%20statistics.pdf). The Patients Association has produced similar reports. In 2010 it wrote Listen to Patients, Speak up for Change, 17 accounts of NHS care ( The association selects the cases on the basis of the worst calls its helpline receives, making it difficult to judge care in hospitals fairly. At the back of the new report are responses from hospitals to the reports of poor care. Some hospitals accept the diagnosis of poor care. Others do not. For example, Patient B’s daughter said in her narrative, “I was contacted by a senior officer from Social Services and was told that a safeguarding alert had been requested against me by members of the ward staff.” The hospital responded: “All of the complaints made in this case were extensively investigated at the time. The findings were shared with the family at the time and we have always been prepared to meet with them should they wish.” Undoubtedly examples of poor care among staff exist in the NHS, but because of confidentiality the Patients Association’s report contains no detail from hospitals to clarify, explain, or indeed challenge the allegations made. Is this the best way to improve clinical care? Or do unintended harms result from this kind of report? 10.1377/hlthaff.2011.0923;BMJ 2011;343:d7237, doi:10.1136/bmj.d7237). It found that the United Kingdom produced the fewest errors and gaps in care and was least likely to skip care (adults going without care because of cost). Patients in the UK had the greatest ability to see a doctor or nurse the same or next day (first equal with Switzerland); had the least difficulty in getting out of hours care without having to go to an emergency department; and were most likely to have their prescriptions reviewed and discussed. UK patients were most likely to believe that staff encouraged them to ask questions and spent enough time with the patient; were just one point behind Switzerland in reporting a positive experience of shared decision making; and were best overall in being able to call to get advice or ask a question. This was a glowing report for the NHS, but it went almost entirely ignored by the UK press. On the same day the Commonwealth Fund, a US “private foundation working towards a high performance health system,” reported findings from its 2011 survey of patients with complex care needs in wealthy countries (Health Affairs doi: “The unbalanced nature of the coverage for that day was outrageous,” said Clare Gerada, chairwoman of the Royal College of General Practitioners. “I accept that we always have to improve patient care and that the Patients Association presented 16 cases of really bad care. This is about one in a million cases of patient care. “And yet the Commonwealth Fund’s report, which comes from an independent think tank, found yet again that the NHS outperformed all other industrial countries’ health indicators and that British general practice was the best. This was an embargoed, press released report, yet there was zero coverage [in the general press] with the exception of the Daily Telegraph.” She is concerned that such unbalanced reporting results in wider harms. “For those of us working in the NHS, and doing our best, we find this demoralising and humiliating. Week in, week out, an organisation or charity or company does an audit and concludes that GPs need more training or more funding is needed. Yet the NHS is not failing.” She is also mindful that this debate is taking place in the context of the passage of the health bill, currently being examined in the House of Lords. On the press’s coverage of doctors Dr Gerada says, “I talk about this as our weekly humiliation.” www.virgin.com/company/assura-medical). Richard Branson, who set up Virgin, is a vice president of the association. The reports the association have issued have not led it to report any improvements. Instead the reports may decrease morale, leading to the most caring healthcare professionals bailing out, and this remains a real potential harm. The Patients Association is funded by “corporate partners,” including the drug companies Abbot, AstraZeneca, and Pfizer. It is also sponsored by Virgin Healthcare, the majority shareholder in Assura Medical, which half owns 25 “GP provider companies” in England together with local general practitioners ( Notes Cite this as: BMJ 2011;343:d7592
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