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A good dose of fear will cure our hospitals
National Health Service hospitals have been a disaster not only waiting to happen, but actually happening, for many years. I have received hundreds of bitter readers’ letters in evidence. However, it is a rule of public life that something quite exceptionally dreadful has to occur before anything is done.
Everyone has known for years that serious hospital-acquired infections have been winning their germ wars against the feeble hygiene of many NHS hospitals and have been killing more and more patients. But little has been done about it apart from the usual witterings about wake-up calls.
Now something terrible has happened: 90 people, according to last week’s report by the Commission for Healthcare Audit and Inspection, have died, quite unnecessarily, in three filthy NHS hospitals in Kent, as a result of being infected by clostridium difficile (C diff). The infection may also have contributed to the deaths of a couple of hundred more. And this because of the toxic filth, appalling care and abysmal management in three hospitals in one of the richest countries in the world.
The stories of patients lying for hours in their own excrement, of filthy wards stinking of diarrhoea, of unwashed nurses and unwashed equipment, would shame a Third World country. But this was Maidstone and Tunbridge Wells! Now, you might think, something will be done.
wouldn’t count on it. The response of Alan Johnson, the health secretary, last week was to wash his hands – forgive the tasteless irony – of government responsibility. He put the blame exclusively on the NHS trust – largely for failing to follow government guidelines about hygiene and antibiotics. He emphatically denied what happened in Kent reflects what is occurring across the country.
I wonder what he really believes. He must know that his government has been running, and indeed intrusively micromanaging, the NHS for the past 10 years, precisely so as to change its culture, precisely so as to ensure “delivery” of a “world class” health service.
He must know that his government has almost overwhelmed the NHS with money, protocols, guidelines, employment procedures, information technology – much of it clearly disastrous and with perverse consequences. The whole point of this tyranny of inspection, infection control teams, recording, box-ticking and, above all, the imposition of targets, was to make things better in the health service.
How on earth, then, can a Labour minister insist that it’s absolutely wrong to suggest the Kent failings reflect what is happening across the entire NHS?
In saying so he is flatly contradicting the findings of last week’s damning Health Commission report. This states quite clearly that the Maidstone and Tunbridge Wells NHS Trust was obsessed with government waiting time targets and financial targets, to the neglect of infection control. The report also remarked on a number of similarities between this case and its investigation of a C diff outbreak at Stoke Mandeville – “it seems unlikely these similarities are coincidental”, it commented tersely.
Perhaps Johnson hasn’t read that bit. Whatever the case, he could not offer any suggestion that the government should and would change anything after this report. Nor did he speak of lessons learnt: I do believe this government is incapable of learning them.
What strikes me most of all in this horrible story of stupidity, laziness, filth, incompetence, deception and revolting personal habits is the loss of something that used to be widely felt in hospitals – fear. What’s needed is more fear, except among the patients, of course; it’s among them only that fear now prevails.
When I was once anxious about some work I was doing, my kind employer tried to console me by saying that fear of failure is an excellent thing; it is the essence of professionalism. I don’t think I would go so far as to call journalists professionals, but I agree with his point. Fear is a spur. The fear of doing badly drives people to do well. At least it used to.
In these three hospitals it seems some nurses and doctors were not afraid to skip washing their hands, not afraid to tell patients to relieve themselves in their beds, not afraid of prescribing antibiotics without proper care. Managers were not afraid to ignore or fib about infections, to overlook evidence and to pull the wool over the eyes of their nonexecutive board members. Nonexecutives were not fearful enough of such possibilities, nor anxious enough for their reputations, to seek them out. Even after this emerged, managers were not scared of giving the chief executive a glowing reference and a huge pay-off.
All these people ought to have been afraid. But they weren’t, because there are few unpleasant consequences these days of doing one’s job badly. Except in the commercial sector, criticising people’s efforts is frowned on and it’s extremely difficult to dismiss them; the fear of being sacked for incompetence is a thing of the long-distant past in the state sector.
I imagine that’s why nurses often look so slaggy, with untidy hair falling over their faces, wearing hospital clothes in the street. Women doctors’ hair is often just as unhygienic and unprofessional and consultants of both sexes are notoriously bad about washing their hands.
High standards, like hygiene, are a state of mind – a kind of anxious professional perfectionism which insists on doing things well, whether it’s sweeping a room, washing a commode or tying one’s hair back neatly. I know that nurses are often too busy to keep up standards, but I also know that all too often they don’t care about them anyway.
The culture of fear, in which matron would insist on spotless fingernails, perfectly made beds and every hair in place, disappeared long ago, along with a sense of authority and hierarchy in the wards. The same is true in schools and in public places and institutions generally.
The kind of fear that I mean goes with unpleasant things such as blame, guilt and even punishment. It can be repressive. I used to think it was a good thing that the cultural pendulum had swung against an excess of this kind of fear. But now I think it has swung too far. True professionalism and true accountability mean fear, as well as pride and pleasure in doing well.
The Sunday Times | Sunday, October 14, 2007 | Comments (0)
Fear of giving offence is killing our culture
‘So, Minette Marrin – all cultures are equal, yes or no?” This was the challenge put to me live and rather scarily by a BBC World Service presenter a few years ago. She was chairing a debate about multiculturalism in front of a large audience of people who were mostly black or brown. Judging from her manner and from the previous panellists’ remarks, her question was one of those that expect the answer yes, at least from a civilised person.
“No,” I said firmly, but nervously, since I don’t like inviting contempt and anger any more than anyone else. Those were the days when the multicultural orthodoxy prevailed and when it was genuinely hard to point out that cultures that treat women as irresponsible inferiors, that hang young gay men, mutilate criminals and silence debate are not equal to ours. They are inferior and it is not self-evidently racist to say so.
For at least 20 years there was a debilitating fog of moral relativism in the air, a miasma of guilty self-loathing, to the point when some natives persuaded themselves that although all other cultures were equal, ours alone was less equal than others, or might at least be offensive, and should be suppressed. Even the phrase “host culture” was considered unacceptable.
We have moved on since then, supposedly, and surprisingly suddenly. Many prominent multiculturalists, including the Commission for Racial Equality itself, have recently performed swift U-turns and the bien-pensant orthodoxy now is that multiculturalism has been a divisive failure. Integration is the new big thing.
The host culture is no longer to be demonised, but to be accepted and respected. Even manipulative politicians, such as Gordon Brown, now realise that saying so will do them no harm these days. It might seem, superficially, that the Victoria Climbié report and the massacre of 7/7 in London, among other shocks, have brought us back at last to our cultural senses and our cultural self-respect.
Not entirely so, unfortunately. There are still signs that many people are in the grip of the old orthodoxy; its hold on public institutions and the public mind seems to be remarkably persistent. A week ago The Sunday Times reported that some Muslim workers in Sainsbury’s are refusing to check out purchases of alcohol on the debatable ground that it’s against their religion. Whenever the sinful stuff is presented by a customer at the till, the Muslim expects an infidel colleague to hurry over and sully his or her hands with the transaction instead.
This is preposterous and a depressing sign of the times. But the painful truth is it would be just as preposterous to blame the Sainsbury’s Muslims. For years now ethnic minorities have been encouraged to insist on their cultural differences and on their human right to have these differences respected and actively promoted. It is hardly surprising that they have responded by doing so. It is those who have encouraged them who are to blame.
The point about this story is not the absurd demand, but that Sainsbury’s gave into it, quite unnecessarily, of its own free will. It wasn’t even being pressed to do so by any prominent Muslim figures. Ghayasuddin Siddiqui, leader of the Muslim Parliament, said last week: “This is some kind of overenthusiasm. One expects professional behaviour from people working in a professional capacity and this shows a lack of maturity. The fault lies with the employee who is exploiting and misusing their goodwill.”
Surely the fault lies with Sainsbury’s, for cultural funk. And it lies with all those others who out of some strange abandonment of common sense – such as the government’s laissez-faire guidelines on wearing Muslim veils in schools last week – bottle out.
Think of the headmistress in Yorkshire who removed stories about pigs, including the Three Little Pigs, from her school in case they might offend her tiny Muslim pupils. Think of the councils that have banned Christmas, or hot cross buns, or the council worker who banned a flyer about a Christmas service from a council notice board but held a party to celebrate Eid.
I remember being shown round a good care home for young people dying of a terrible degenerative disease. Unable to move, talk, see, hear, taste or eat, they had to be spoon-fed pureed food and the staff told me proudly that they made a point of respecting cultural and ethnic differences. In practice this meant that one person (the only person who was not 100% British) had a great deal of meat in her puree (unlike the others) because she was a Turkish Cypriot, from a meat-eating culture.
I could only assume these care workers were the victims of extensive brain washing. Theirs was the behaviour of underconfident and undereducated people who have been ceaselessly bullied by ideologues.
This example is trivial, but there are countless well documented cases that are not trivial, because cumulatively they constantly wear away at our customs and our identity – we being the host culture. In many cases Muslims (or Jews or Hindus – or Cypriots no doubt) who are asked to comment say publicly that it was all quite unnecessary. They would not have been offended at all and nobody had bothered to ask them. People in the grip of this daft racial correctness take it upon themselves, or make others feel obliged to go far further than good manners or common sense or the law would take them.
In the case of European Union regulations this is known as gold plating and the British bureaucrat is notorious for it. Some – perhaps a lot – of the European red tape and rules that we love to hate may not be European at all but British, added on to satisfy the strange moral imperatives of interfering apparatchiks. Ethnic gold plating is even more mysterious; it comes from a decadent loss of belief in ourselves, in our own culture and in its superiority – warts and all – to others that may threaten it.
No well mannered person wants to go about pronouncing that western civilisation, particularly the British variety, is better than others. But sometimes it is necessary to risk giving offence, to defend what matters. It may not cause offence; it might even command respect.
The Sunday Times | Sunday, October 07, 2007 | Comments (7)
