Monthly Archives: January 2013

Human Rights, The Francis Report and beyond…… improving patient care

Whilst the release of the Francis Report has been eagerly awaited, let’s hope it makes a difference to patient care. Sadly many of the findings will probably not be new.

The Equalities and Human Rights Commission published a report in 2009 which highlighted many of the problems that persist currently in the sector. The Equality and Human Rights Commission conducted an inquiry to establish the extent to which human rights are embedded in service provision across England and Wales. 2,855 individuals provided evidence to the inquiry between April and December 2008. The aim of the inquiry was to identify barriers to the delivery of human rights and identify good practice to support the promotion of human rights.

The report from the Inquiry identified some of the everyday situations in which Human Rights were breached by public authorities

• Unexplained death in prisons, police stations and hospitals (Article 2)
Not being able to eat properly while in hospital or a care home (Articles 2 and 8)
• Provision of facilities or food which do not meet religious or cultural needs (Article 9)
• Abuse or neglect of older people, those who are learning disabled or other vulnerable people (Articles 2 and 3)
• Lack of respect for privacy on a hospital ward (Article 8)
• Unexplained death in prisons, police stations and hospitals (Article 2)

The report includes an interesting chapter on leadership (Chapter 5) which emphasised the need for cultural change, starting at the top with Government which then flows downward to those with leadership and management responibilities across the NHS. Does the Francis Report make a similar point?

If it does this will require a change in approach from leaders and managers across the sector, a change from a transactional style of leadership and management to one that is transformational. Transactional leadership is based on bureaucratic authority with an emphasis on task orientated goals. An organisation characterised by a transactional management structure leads to the development of a ‘defensive culture’ where members are expected to conform and follow rules without challenge.

However, transformational leadership is a process that motivates followers by appealing to higher ideals and moral values. Transformational leaders must be able to define and articulate a vision for their organisations, and the followers must accept the credibility of the leader. Organisations characterised by transformational leadership are more likely to have a ‘constructive culture’ where members experience constructive cultural norms, for example, organisations set challenging but realistic goals and manage in a participative manner where relationships are constructive and open so as to achieve agreed goals. This is not to suggest transactional leadership and management is not also required in some measure, however, the transactional approach seems to have carried greater emphasis across health and social care than the transformational, and this has been supported by managerial approaches incorporated from the business sector.

A human rights approach can provide a solid foundation for transformational leadership. Chapter 6 of the above mentioned report found where public sector providers embrace a human rights based approach they reported improved services along with better and more coherent delivery procedures and heightened staff morale. The Commission identified the positive effect a human rights based approach can have on patients following a change in culture within NHS trusts. Whether government accepts it or not The Human Rights Act does provide a common framework of values that can be useful for managing competing financial tensions and ethical obligations within the NHS.

Adherence to a culture of human rights has the ability to provide organisations with a clear framework on which to hang the transformation of health and social care provision. To achieve this those in leadership positions need to actively view their role as securing human rights for individuals because what is missing, perhaps, is a consciousness of the activities of large organisations as working toward promoting a basic human right for patients to be treated with dignity and respect by everyone employed in their organisation.

I read an interesting article in the Harvard Business Review which made a distinction between ‘leadership’ and ‘management’, suggesting large organisations are over managed and under-led. They may have a point.

‘Big Pharma’ and the future of the NHS

Government reform will mean multi-million pound opportunities for pharmaceutical companies in the provision of goods and services to the NHS in the UK.  As The Independent reported on the criminal wrong doing of drug companies and The Guardian  on GlaxoSmithKlines fine of $3 billion dollars, for admitting to bribing doctors to encourage the prescription of unsuitable antidepressants to children, and now reports that GSK  concealed data about the damaging side effects of the drug Avandia, I am wondering should we be worried about the increased influence and role of such companies in reforming the NHS?

A central tenet of the health care reforms is the introduction of ‘any qualified providers’, which within a few weeks will force PCTs to let private firms provide NHS services.  This means the Department of Health will take the most potentially lucrative, standardised, high volume and low risk treatments provided by the NHS and offer these up to private companies, the Americans charmingly refer to private providers who deliver such treatment as ‘focused factories’.  These healthcare companies will already have had some influence on deciding which treatment will be handed over to the private sector, for example companies like 2020Health  who have links to the two big pharmaceutical companies Pfizer (fined over 2 billion dollars since 2009 for criminal wrongdoing) and Lilly.   There is evidence to suggest pharmaceutical companies explicitly determine which health care problems are publicised and researched to maximise their profits.

Such downright unethical practice is linked to profit.  Pharmaceutical companies appear driven by a different set of moral and ethical standards than most professionals working in the health service.  The government is effectively asking advice from the market on creating a market for its products, which may actually damage patients health.   It  would appear on both sides of the Atlantic government considers the big pharma companies  not only too big to fail in providing services, but too big to jail!

All I want is honesty and integrity, and some accountability, and not accountability in the form of a fine which is actually a pittance and will do nothing to change the business culture within these organisations.

Free iBook: #LongLostFamilies (ITV) and the search for my mother…..The Adoption Files

(A free ibook of the complete ‘adoption file’ story can be downloaded here)

Who Do You Think You Are? producers, Wall to Wall, began making a series reuniting long lost relatives in 2010 for ITV called ‘Long Lost Famlies’. At the end of the first series I completed an on-line application form for the second series, and to my amazement I was selected for the 2012 show! But I had to remember, I was told,  the purpose of the programme is to ‘entertain’ the nation, not re-unite me with my natural mother…

“The strongest principle of growth lies in human choices” (George Eliot)

Whilst not keen on conducting the search for my mother in front of millions of viewers I knew this could be my best opportunity yet of finding her. After the excitement of finding my sibling the trail had gone cold.   Over the last 3 years my partner and I have flown to New Zealand to meet cousins who might have more information, they didn’t! We travelled to my mothers last known address (from 1964) knocking on doors and accosting strangers in the street showing random people her photo asking if they recognised her. I sent swabs to America to establish my mtDNA, incase anyone else was on file as a relative.  The closest I got to my mother was confirming we both probably derived from a female who lived in South Asia 60,000 years ago! We spent hours in the British Library tracking down my grandfather in ‘Thackers’ directories, these list Europeans who lived in India up to the 1930’s, as well as searching for my mothers birth/death certificate, which we have never found, (we have a lot of death certificates of women with a similar name and of a similar age!).  Passenger lists have been searched to find out when my mother travelled to the UK from India, and of course we spent several thousands of hours on Ancestry websites, google, 192, People Finder etc, etc…….but we were no closer to finding her.

The 'certificate' confirming my origins....
The ‘certificate’ confirming my origins….

Initially a researcher from Wall to Wall made contact requesting a meeting between us, where she would gather information whilst filming me.  This would then be viewed by the production team and a decision would be made as to whether our story was ‘in’ or not.  One of the first questions I asked was how many applicants were there, 7000!

The initial interview was very tiring, and something of a marathon. All the questions obviously related to my adoption.  However, what took me by surprise was the focus on how I ‘felt’ about everything. For example I went to Somerset House to see my birth certificate for the first time in 1978, “how did it feel to see your birth name for the first time?”, ummm it was 34 years ago I’m not sure I can remember. “What did it feel like when you saw your adoption record for the first time?” Ummm, ditto, it was over 30 years ago! In the end I just had to describe how I thought I might have felt in hindsight. Not sure how accurate this was but, I was as honest as I could be.  It did bring into sharp relief how emotional this journey has been and gave me an indication of just how emotionally draining this process might be.  It was sobering to say the least.

On receiving the phone call confirming our story had been chosen I was absolutely elated.  One thing that stuck in my mind was the researchers warning “this is an entertainment show not a family reuniting service”.  This was said in a positive sense to remind me of what I was letting myself in for (we would only appear on TV if there was a ‘result’ i.e. we were reunited and my mother agreed to appearing or if she were dead and I agreed to appear).  The whole purpose of the programme is to entertain viewers.  We as a nation seem to love watching such programmes if the viewing figures are anything to go by.  But in reality it’s more than entertainment, a ‘soap’. It is actually about real peoples’ lives, people like my mother and I, whose secrets could be laid bare to the whole of Britain!

This can get lost when watching. From my limited experience I can tell you it is an extremely hard and emotionally draining experience, and that for many involved it is through desperation rather than a desire to be on TV (I begged the programme makers on my application to include us). There is a cost to all those involved.  Those at the heart of the ‘story’ have to re-live highly disturbing events, giving up your child for adoption must rank as one of the most difficult things you face in life.  The consequences of  revealing such events and reliving long buried feelings remain long after the production has ended.

Although, I can not fault Wall to Wall in the support mechanisms they have in place. They arrange for a psychological assessment and provide an ‘intermediarry’ to act a kind of go between should a family member be found. Mine proved very supportive, keeping in contact right from the beginning to check all was okay.

People have mixed feelings about these types of programmes, so do I.  Participation should not be taken lightly, the potential to make a life ‘worse’ is definitely ever-present, so realistic expectations and the support of loved ones is vital.

Several months after my last contact with the intermediary, and after several non-committal e-mails from the interviewer at Wall to Wall, I receive a phone call.

There is good news and bad……… to find out what happened next click here to download a free short ibook (you will need an iPad to read it. The free ibook contains all the ‘adoption file’ blogs along with some extra details and a few more photos. Previous blogs are here, here and here)

Sugar and spice and all things nasty…the true cost of an under regulated food industry

The Guardian reports tighter regulation is required to remove sugar from food

Regulating the food industry is about more than health, it is about the role an active state should play in society.

Lets not get distracted from the real issue at stake here, the accountability of the food industry.   Tackling the food industry is about changing a business culture from one of making a profit, at any price, to one of honesty and accountability.

The current discussion on the food industry must not be overshadowed by the healthy eating debate because there are much bigger issues at stake here, not least the accountability of the food industry and the role government should have, if any,  in regulating the food industry to protect the health of the nation.  By narrowing the focus on healthy eating we risk  reducing the debate to stigmatizing those who eat unhealthily, and focus too much on individual responsibility.  For once could  the debate also include corporate responsibility.  Whilst Politicians might make noises about giving the food industry a chance to respond I would rather see decisive action from government because I trust the food industry about as much as I trust the banking industry, which is zero percent.

Just look at the food labelling debacle, which has been dragging on for over two decades  The coalition government announced in October 2012 that a consistent system of food  labelling is set to be launched this year, however, it is not quite a done deal with food producers still holding back.   Cadbury, amongst others, have spurned the ‘traffic light’ system suggesting it focuses too much on the negative ingredients in their food. Really!

But it is not just about food labelling, more importantly it is also about the food production process. For example research suggests high salt intake is associated with significantly increased risk of stroke and cardiovascular disease, so to reduce risk just reduce salt in take, easy.  However, the same research also suggests high levels of salt intake is related to food production processes, rather than individuals adding salt to their diet, and the biggest barrier to reducing significant salt intake for individuals  is the historical reluctance of the food industry to reduce the levels of salt used in food production.

The seriousness of this issue must not get lost in tabloid headlines about ‘obese’ people.  Health campaigners suggest clearer food labelling could save lives, and have been campaigning for 20 years on this issue against a food industry which has  spent over 1 billion in Europe to resist the introduction of understandable food labelling.  Why would any one resist implementing something that could save lives?  Profit of course.  How could successive governments in the UK stand by and allow this to continue for so long?

Any talk of government taking an interventionist approach is met with cries of ‘nanny state’ from the Tory right who use this as a pejorative term to describe excessive state action.  Those who support free markets object to the use of state power in this way perceiving such an approach as restricting individual choice.  However, real choice can only be effective if we have all the relevant information to make those choices, this is where a consistent and understandable food labelling system would support real choice for consumers.

Governments role on this issue is ideological, whilst for some intervention from government represents the worst excesses of the ‘nanny state’, to others it represents an ‘active state’ coordinating an approach to promote public health for its citizens, rather than protecting big industry from taking responsibility for its actions.

Strategies that might be developed include easily understood food labelling, then the consumer can make an informed choice and if we choose to abandon food rich in fat and high in sugar producers can provide what we do want to eat. Even better remove excessive sugar and salt from food production, that would provide the greatest benefit to public health. We need intervention because we can not trust the food industry, the average consumer can not fight against such unethical practices on their own.

A rise in the cost of food is an interesting argument presented by the food industry as an argument against healthier food production. Presumably the real cost of poor quality food should include the cost to the NHS in diet related illness, but of course the food companies do not pay for this, this is displaced onto the individual consumer via the taxes we pay to fund our health care system (Do not even get me started on corporate tax evasion).

All most of us want is honesty and transparency, and maybe even an ethical approach in business where our health is put before profit, is that too much to ask?