DR MAX PEMBERTON: Care and kindness beats ticking NHS boxes

The maternity scandal at Shrewsbury and Telford Hospital NHS Trust has become one of the worst in the history of the National Health Service. Over two decades, hundreds of babies have died or suffered brain damage, with nearly 1,500 cases investigated.

Grieving parents have now denounced the NHS regulator – the Care Quality Commission (CQC) – for not listening to them. He told parents he would not support an independent inquiry into the baby deaths just months before an inquest was ordered.

One mum said she had ‘absolutely no confidence’ in his ability to regulate and spot future scandals. I’m afraid I tend to agree.

Dr Max Pemberton says patient care and kindness must be a priority in the NHS and recognized by inspectors

A few years ago, the hospital where I worked was inspected by the CQC and I could see how the criteria used to evaluate a hospital are distorted and useless.

My hospital was by no means perfect, but the staff worked incredibly hard and were unwaveringly dedicated and passionate about their work. Everyone really cared about trying to get the best for their patients.

Prior to experiencing a visit to the CQC, I had assumed that patient care would be their primary concern. I’m stupid.

Prior to their visit, we were warned that rather than using actual clinical encounters to assess quality of care, they would instead focus on the weird and trivial things.

For example, inspectors can ask staff questions such as “Do you know the physical location of the infection control strategy folder?” »

It does not matter that they have undergone training and are fully aware of the infection control policy. They need to know where the folder is with the typed instructions. If they don’t, it’s a black mark.

During a meeting before the visit, someone realized that the carpet that was between two rooms was not the right type of carpet. Apparently it needed a special mat that doesn’t attract dust. It was regularly vacuumed by the cleaners and the rooms were rarely used, but apparently that didn’t matter.

Everyone ran like headless chickens frantically changing mats so as not to be noticed.

It is clear that the people who invented these ridiculous criteria have absolutely no awareness of what is really important for patients who are sick in a hospital.

If they did, they’d go see if the nurses brought you water when you were thirsty, or held your hand when you were scared, or if a doctor stayed up late to explain something to a worried relative – or any another myriad of things that actually relate to care and what affects people’s experience of the NHS.

As well as being an NHS doctor, I have also been a patient. I know what mattered to me when I felt bad and vulnerable.

A few years ago I swallowed an antibiotic that got stuck in my throat and burned a hole in my esophagus. At the hospital, I had to beg a phlebotomist to take my blood after she refused, saying she was on hiatus and I had been sent at the wrong time.

Dr Max Pemberton (pictured) says he won't forget the nurse who gently took his hand as he had a bezel shoved down his throat

Dr Max Pemberton (pictured) says he won’t forget the nurse who gently took his hand as he had a bezel shoved down his throat

She finally relented and, mockingly, vindictively stabbed me in the arm with her needle. And this was not an isolated incident.

A grumpy receptionist made me cry. A radiologist yanked me when I turned around to answer a question while having a chest X-ray. I was talked about like I wasn’t there and, even worse, people were discussing their vacations while performing intimate procedures.

If these things can happen to me – a doctor who knows his rights, what to expect and how to be assertive and complain – what does it have to be for others? Imagine you are elderly, confused, or have a learning disability. Or simply being scared and in pain and not being treated with kindness, courtesy and compassion.

Surely it’s important? Not at the CQC, this is not the case.

Conversely, there was a kind volunteer who found me lost and took me to the door of the doctor I needed to see. I don’t remember what the doctor said, but I will never forget the volunteer.

Nor will I forget the nurse who gently held my hand as I had a telescope shoved down my throat or the doorman who went the extra mile to find me a blanket when I was cold.

Small gestures that make the biggest difference.

These are things for which there are no checkboxes yet, but which, for the patient, are vital. Sick people want care and kindness, not regulation mats.

If we can’t inspect how patients are treated, what’s the point of inspecting?

Carrie is right, words CAN hurt you.

Carrie Hope Fletcher (pictured) plays the lead role in Andrew Lloyd Webber's Cinderella.  She spoke of being the subject of nasty remarks about her appearance

Carrie Hope Fletcher (pictured) plays the lead role in Andrew Lloyd Webber’s Cinderella. She spoke of being the subject of nasty remarks about her appearance

Carrie Hope Fletcher, who plays the lead in Andrew Lloyd Webber’s Cinderella, has opened up about how playing a character who was subjected to nasty remarks, particularly about her looks, undermined her confidence. Although directed at Cinders, not her, it shows the power of negative feedback and how we can’t help but absorb it to some extent.

I often talk to patients about being mindful of negative comments that are said without thinking. If we’re not careful, we internalize them and they become part of a story we tell ourselves. We start to believe the comments, even if they are true.

I remember a teacher saying I was bad at math. I think it comes from the fact that we did not learn the multiplication tables at school. She thought I was stupid and I started to believe her. I would freak out when faced with sums and make stupid mistakes – it became a self-fulfilling prophecy. It wasn’t until I did statistics in college and went to Harvard to study health economics that I realized I wasn’t bad at math at all.

It is often assumed that private schools give children the best start in life. But researchers at University College London found that public schools did not lead to worse mental health or lower levels of ‘satisfaction’ in adulthood. A private education may give children an unfair advantage in life, but they are not happier adults.

  • Covid restrictions have left a generation of babies and toddlers struggling to crawl and communicate, according to an Ofsted report last week. They encountered a host of difficulties, ranging from difficulty making friends and developmental delays to anxiety about strangers. It shows how social humans are. It is fundamental for normal development to be around people. Although I despair of these reports, the thing I cling to is that children’s brains continue to change rapidly. Although development may be delayed, it does not have to be permanent. Next year will be pivotal to avoid a generation deeply damaged by the Covid. Now more than ever, we need to help them catch up.

Dr. Max prescribes…

Podcast to improve mood

In this podcast, Ricky Gervais talks with his friend Sam Harris, neuroscientist and philosopher

In this podcast, Ricky Gervais talks with his friend Sam Harris, neuroscientist and philosopher

In this podcast, Ricky Gervais talks with his friend Sam Harris, neuroscientist and philosopher. It’s fun, but tackles complex questions such as why do we dream, why do we cry at stories, and why are we afraid of death? A wonderful introduction to the philosophy of mind.

About Antoine L. Cassell

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