On 3 June the Northern Ireland Human Rights Commission (NIHRC) announced its intention to carry out a Human Rights Inquiry into Emergency Health Care in Northern Ireland. It has every right to do so, but I consider the NIHRC’s intention, ill judged and ill timed. It has the potential to significantly damage and further undermine Health and Social Care in Northern Ireland. Who is best served by this approach? Is it the public in Northern Ireland already deeply concerned about health care,? Staff trying to do a job under pressures most of us don’t understand – or is it the Commission itself?
What ,I wonder, will this investigation do other than put a human rights veneer over already known failings in our A&Es. It will investigate, advise and make recommendations but I know of no previous inquiries by NIHRC which gave the statutory body or system under investigation a clean bill of health. Human Rights lawyers will be rubbing their hands and our lazy media will jump at another easy headline.
Why also does the NIHRC believe it is equipped to carry out such a review? It plainly isn’t. For example on the Commission’s website people have been asked to provide views on their A&E experience in 18 hospitals. We don’t have 18 A&E hospitals. Many of those listed are community hospitals which provide no A&E services and treat only minor injuries. Others listed lost their A&E services years ago. This is basic stuff.
Given many of the incidents already reported around A&Es, it is obvious from the terms of reference of the inquiry and the questionnaire that supports the evidence gathering that the final report will find that Emergency Care in NI falls short of human rights standards. We need to reflect carefully on the implications of such a result for our healthcare system and those who use it and work in it.
This inquiry had been reported as ‘the first time such an inquiry has ever been held’ and has been commissioned following a very limited scoping study by NIHRC in March 2014. The Commission needs to explain why they are leading this charge.
It is significant how the much reported horrors in the failures in the standards and dignity of care in relation to the Mid-Staffordshire NHS Foundation Trust were investigated. Of the rigorous inquiries which followed none were carried out by the Equality and Human Rights Commission in GB.
There are reasons for that. Applying a human rights focus to aspects of a hospital healthcare system is a blunt instrument. The Equality and Human Rights Commission have followed events relating to Mid Staff, understanding that change takes time and in a healthcare system as complex as the NHS, the benefit of having the space to effect change matters more than investigations. That is not an abdication of responsibility, but does show a maturity around the problems the NHS face.
I believe that our health and social care system (not just the narrow focus on A&Es) requires a rigorous and independent review, commissioned at Ministerial level and similar in approach to those carried out by Robert Francis QC in connection with Mid-Staffs. Nothing less will do. In that way we can take a reasoned and above all transparent whole systems view of what is good about our system of care and where significant improvement are required.
We also need a new regulation and inspection regime for our health and social care trusts.
Francis’s wide ranging and forensic examinations probed not just the standards of care, but also why the significant failures in care went on for so long under the view of statutory and regulatory bodies which could have stepped in earlier.
It is this latter area which has caused such heart searching in NHS England and established an entirely new regulatory inspection system which puts dignity and the views patients and carers at the heart of those inspections. Their views carry an equal if not greater weight with clinical professionals when advising on changes to care.
There is now a regulatory system which is supportive of organisations who need to improve. It is changing the way services are being designed and delivered and putting dignity back at the heart of care in NHS England. It is a long road but hospital trusts are being given the space and support to effect this change.
Here is a process that is working. We should be follow their lead.
(David Finegan supported the regulatory review process in NHS England following the Francis Report 2013. His views are entirely his own and should not be attributed by association to any other organisation or individual).
1 Comment
As someone who was a consultant in Emergency Medicine in the RVH (and Clinical Director for Emergency services in Belfast) until I retired in 2008, I can only agree with all that you say.
The big thing is that this review (carried out by the wrong body) will assume that the problem is in Emergency Departments but this is incorrect. The main problem relates to the inadequate provision of beds in UK hospitals. We have the second lowest bed numbers per unit of population in Europe. If patients needing admission could leave the ED within a reasonable time after the decision to admit (say an hour), the problems of over-crowding would disappear, except for times when there is an unusual strain on resources – a flu epidemic, for example.
What happens now is that patients who need admission lie on trolleys for a long time (as we know) until a bed becomes available – sometimes days. It is not uncommon to have forty patients waiting for admission. Given that there are only about thirty patient spaces in the RVH ED (one of the biggest here), the maths is easy. Not only is it almost impossible to nurse and observe these waiting patients but it makes it extremely hard to see the new patients arriving at the department, so everything gets totally clogged up and patients suffer – as do the staff. It is little wonder there is a lot of difficulty in attracting doctors to work in the specialty now.