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23 hours ago
1
Re Rachel Clarke’s article on Labour’s plans to introduce hospital league tables (Wes Streeting, you must have a better plan for ailing hospitals than public humiliation, 13 November), I left the NHS during Labour’s introduction of the “value for money” policy in the health service pushed forward by Tony Blair. I worked in a very deprived area in London as a psychotherapist when Labour became besotted with performance targets. The test of how successful we were “to get people back to work”, which was given uppermost importance, was spread across several pages of tick boxes, which we were expected to fill out for every patient.
There was nothing on the so-called evaluation form about demographics of the patients, their socioeconomic and unemployment levels and degree of the trauma present in the population we were serving.
In my area there was chronic generational unemployment, teenage pregnancies, overcrowded housing and a large population of traumatised refugees. The basic level of needs was so great that sometimes my work was, by necessity, similar to social work. Some of my traumatised patients could barely talk, others lived a chaotic life and had a very deprived upbringing, both physically and emotionally.
Not surprisingly, we didn’t come on top of the league table. But did we do humane work, gain the trust of most of our patients, give them an experience of their stories being heard, offer them continuity and consistency, and help them over time? Yes, mostly we did, but none of that appeared on the tick-box form.
How could I rate the impact on my patients of continuity, compassion, kindness, consistency and being able to bear some of their horrific stories? I couldn’t, so, after 11 years in the NHS, I felt there was no comprehension of the valuable work that me and my colleagues were offering patients. I resigned.
Rachel’s article speaks to my experience and it is a warning to Wes Streeting that under his scheme NHS staff will feel even more demoralised and could leave their posts. Not because of lack of care but by being humiliated, devalued and their work becoming a mere competition with other colleagues. I still miss my NHS work.
Pury Sharifi
London
I agree with Rachel Clarke that league tables, AKA naming and shaming, is not the answer for the NHS. Labour was in power when the Mid Staffs scandal became public, and asked Robert Francis to write a report on how such shocking abuse could have come about. The Francis report was published in 2013. It identified, among other causes, the target culture, which Tony Blair inherited from the Tories and then employed to devastating effect.
Managerial fixation on targets for performance, it was reported, played a significant part in the creation of a bullying, top-down institutional culture that prioritised positive results, while those concerns felt at the grassroots level were ignored. As you reported in 2015, a series of NHS listening events following the Francis report found that the main concern of staff in all disciplines was fear: “fear of annihilation, loss of jobs, service and of humiliation and being named, shamed and blamed”.
What is the point of setting up these expensive inquiries, with their wise and well-considered conclusions, only to ignore them now that Labour is back in power?
Alison Vaspe
Andover, Hampshire
Looking at hospitals to see which are performing poorly and which are performing well is not in itself a bad idea. But rather than pointlessly punishing or rewarding – why not team them up collaboratively – the more successful sharing their secrets with the ones that are struggling?
Sue Stephenson
Barrow upon Humber, Lincolnshire
English (US) ·