Leaders: Urgent action needed on patient care

Few more damning reports have been compiled than that by Health Improvement Scotland on the state of affairs at Aberdeen Royal Infirmary. “Unprofessional conduct” by senior doctors, a “significantly dysfunctional” surgical unit, “little evidence of effective performance management”, and a “failure to follow up concerns raised” are among the phrases that leap out.

The HIS warns that the potential for patient care and safety to be further compromised is overwhelmingly evident. Picture: SWNS

“We are also extremely concerned”, it finds, “that large numbers of consultants had no job plans and there was minimal evidence that clinical governance structures were working effectively.” And it adds that patient care at Aberdeen Royal Infirmary faces a “serious impact” if problems are not “urgently addressed”.

For any public service institution these would be deeply concerning conclusions. That they have been written about the state of affairs within a hospital almost beggars belief.

The HIS review – one of three critical reports into healthcare in the North-east ­published yesterday – has made 13 recommendations for improvement for NHS Grampian. Without urgent action it warns that the potential for patient care and safety to be further compromised “is overwhelmingly evident”.

Some consultants “acted to undermine management and have exhibited poor behaviour” while management of older patient flow and capacity in Aberdeen Royal Infirmary and Woodend Hospital “is not fit for purpose and puts patient safety at risk”.

It is extraordinary that such failures of leadership were allowed to develop despite warnings from staff, even more extraordinary that the situation was allowed to get so bad before alarm bells rang in the corridors of power. Nursing staff had been raising serious concerns both locally and nationally about the situation at Aberdeen Royal Infirmary for quite some time.

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Particularly damning is the conclusion of RCN Scotland associate director Ellen Hudson – that the Scottish Government should have recognised the problems in NHS Grampian earlier and taken action. “The government knew NHS Grampian consistently missed targets on treatment-time guarantees, cancer waiting times and bed blocking. It also knew that Grampian had below-average hospital nursing staff to staffed beds compared to the Scottish average”.

Clearly Scotland’s newly appointed health minister Shona Robison now has to take immediate action to address the issues and ensure improvements are put in place. But no less urgent is the need for an effective governance and reporting system to ensure far greater accountability.

Poor governance and arrogant behaviour have been allowed to run out of control at Aberdeen Royal Infirmary. Rooting out this culture and knocking more windows into the opaque governance structures within the NHS may prove a daunting task for the health minister. But it is one that must now be undertaken with an unflinching rigour.

Putting its own house in order

From behind the counters at Royal Bank of Scotland come rumblings of discord. Staff have been incensed at an internal memo asking them to volunteer to help spruce up the branch premises and mend broken furniture.

“Making it Happen”, it seems, does not extend to Making It Good. Totting up customer balances is one thing, furniture repair quite another. “Totally stunned”, “farcical” and “embarrassing” were among the more printable responses to the internal memo.

It certainly wouldn’t be right for customers to be kept waiting while the Superglue dries on the manager’s wobbly chair. But are the RBS staff not being a touch precious?

The reality for thousands of the bank’s small business customers is one of untidy, grimy offices with wobbly desks, chairs that don’t match, and crumbling plasterwork on the walls. There’s no budget for maintenance and repairs, so typically, the mess accumulates until it becomes unbearable.

At this point everyone from the work experience person to the manager mucks in to clear up the mess, fix the furniture, mend the chairs, empty the bins, put up shelves and clear the floor of detritus. Much grumbling gives way to spruced-up surroundings and pride in a job well done.

Bank back offices really are no different. The furniture’s perfectly salvageable – more often at RBS much of it was pushed into the back room because the blue cushions didn’t quite match Fred Goodwin’s insistence on Pantone 281, the RBS corporate hue.

A burst of DIY and tidying up would be no bad thing – and a reminder of how most businesses get by today.

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