After the dreadful revelations from the Stafford report the NHS across the UK has woken up to the fact that some services are unsafe- a fact that many service users have been stating for years, whilst often being portrayed as trouble-makers. Everyone welcomes the rigorous enforcement of decent standards of care within our NHS. It seems the main indicator that inspectors are using to identify poor standards is Hospital death rates. This coupled with whispers of corporate manslaughter proceedings, has led to the recent emphasis in public statements from Health Boards that they will not run unsafe services. As a result, where there are problems delivering a service, the easiest management option is to discontinue that service. The Hospital with the lowest death rates is one with no patients.
The exclusive emphasis on the safety of patients actually receiving care may well have a deleterious effect on the accessibility of care, especially in Mid Wales. With the undeniable problems of resources (money and manpower) the centralisation of services provides senior managers with solutions-economies of scale, easier oversight etc. It is vital in this atmosphere to remind the Welsh Health Boards that they have a duty of care to all the residents of Wales, not just those currently receiving care. There is an equal duty to provide timely emergency care to residents of remote villages in Mid Wales as well as those in large conurbations. The piecemeal centralisation of services by various Welsh and English Health organisations cannot deliver this equity. Someone has to set out a strategic plan of where services need to be located to provide this equity across Wales, and then managers must find a way to make those services safe. At the moment the pressure is the other way round, services are being made safe by a “concentration” policy leading to problems of access.
I finish by reminding everyone how the corporate manslaughter offence is described, remembering that Health Boards have a duty of care to all residents, not just patients.
An organisation will be guilty of the new offence (corporate manslaughter) if all of the following apply:
The way in which its activities are managed or organised causes a person's death.
The person's death is the result of a gross breach of a relevant duty of care owed to that person.
The way in which senior management managed or organised the organisation's activities is a substantial element of the breach
Running unsafe services is a breach of the duty of care to patients, reorganising services so they are inaccessible to certain populations is equally a breach of the duty of care to those people.