Not an unwritten underlying principle of healthcare, not even an assumption that the public can make when facing treatment in hospital. No, this is apparently a directive which it has been necessary for NICE (The National Institute for Health and Care Excellence) to issue in relation to the care of the elderly and the dying.
Since the Mid Staffs controversy, where substandard care of an appalling nature became common practice, the status of the NHS as a sacred cow, immune to challenge or criticism has wavered. Whereas it was political suicide to question the standard of care provided by “our wonderful doctors and nurses”, Mid Staffs has opened the door to a more robust approach to failings in health care, although perhaps not the full extent of openness and honesty necessary to bring about wholesale improvements in the system.
It is of course a truism that many doctors and nurses do provide a good standard of care and are dedicated to their profession. Patient care and patient safety are important to them. That should not disguise the fact that there are instances where standards have slipped, be that as a result of institutional or individual failings.
The latest NICE guidelines are specifically focussed on end of life care and the much maligned “ Liverpool Care Pathway”(LCP), phased out in 2014. Ironically, the LCP was intended to provide high quality dignified care to the dying. It dealt with the provision of medication, nutrition and fluids in the period leading up to death. Unfortunately, what had been a useful tool for guiding those involved in end of life care, evolved in to a “tick box, one fits all” exercise, where the needs of the individual patient were sublimated to unthinking adherence to the guidelines, sometimes with distressing results for patients and their families.
NICE has called for a stronger focus on individual plans for each patient, insisting that their wishes and those of their family must be central to the treatment plan. That NICE should find it necessary to add that “Patients must be treated with respect and compassion”, is somewhat worrying. Perhaps it needs to be said, perhaps the assumptions about the approach adopted by clinicians and medical staff to their patients needs to be openly challenged. Perhaps such a bold statement of the seemingly obvious is the first step to acknowledging failings and bringing about improvements in the health care system for all, not just those at the end of their days.
If you have experienced unsatisfactory medical treatment in hospital or elsewhere and are looking for answers contact Chris Thorne at firstname.lastname@example.org or telephone 0345 209 1461