The Independent reported last month that a lack of hospital doctors was ‘not to blame’ for greater hospital mortality at the weekend. Instead, Lintern (2021) wrote, new findings ‘point the finger … at the state of community services and weekend GP cover, which … could be behind the higher risk of death for patients admitted at the weekend’.
The cited study (Bion et al, 2021) investigated former health secretary Jeremy Hunt's claim that fewer consultants at weekends contributed to higher mortality. Hunt's campaign for a ‘24/7 NHS' provoked doctors' strikes in 2016. The data examined included patient emergency admissions from 115 acute trusts and 4000 case records. The authors found that consultants' weekend hours have increased and emergency care has improved, but that emergency patients admitted on weekends have more comorbidities and a greater need of palliative care than those admitted during the week. Post-discharge deaths have risen and GP referrals at weekends are one-third of those on weekdays. The study called for more research into GPs' role in the pathway from community to hospital.
Bion et al's (2021) view that illness ‘starts in the community’ is probably true, aside from hospital-acquired infections and iatrogenic complications. They also said that ‘more staff, more funding [and] more support services' are needed to improve both hospital and community care. Therefore, it is unhelpful for the Independent to present the study as reason to shift the blame from hospital doctors to community practitioners.
The blame culture is an acute problem and puts patients at risk. Patient Safety Learning (2020) highlighted that assigning blame ‘deters staff from speaking up, reduces the likelihood of incidents being reported and therefore makes it less likely that we learn and take action to prevent unsafe care.’ Blame also contributes to staff burnout and resignations. The Nursing and Midwifery Council's (2020) survey of nurses leaving the profession found that 18% had fled a toxic workplace, including blame cultures, bullying and unsupportive management. Staff, as well as patients, need better care.
Ominously, Bion et al's (2021) study reflects a pre-pandemic NHS. The Government's mishandling of the pandemic response, condemned as ‘social murder’ (Abbasi, 2021), has exacerbated morbidity and mortality. With community services overstretched and hospitals cancelling elective procedures to deal with COVID-19, undiagnosed and inadequately treated community illness can only be rising. According to the Lancet Rheumatology (2021), 10 million patients now await surgery in the UK. Many will become emergencies.
A report on the pandemic's impact on staff burnout (Health and Social Care Committee (HSCC), 2021) makes for dire reading. Understaffing is a significant factor. The Health Foundation estimates a shortfall of 108 000 full-time equivalent (FTE) nurses and 11 500 FTE GPs in England by 2028/29. Recruiting all of them might still be insufficient to cope with the added load of the pandemic and long COVID. The prime minister's pledge of 50 000 extra nurses is hollow, and the much trumpeted NHS People Plan is still unfit for purpose: the NHS Confederation told the HSCC that ‘too many investment decisions have been postponed’. At the time of writing, the Government's response to the HSCC report was overdue.
The blame culture is systemic in society, spread by the media and exploited by politicians trying to evade accountability. Health practitioners are not to blame for the consequences of chronic underinvestment in the NHS. Already overstretched, under-supported and too few at the start of the pandemic, nurses and their colleagues have shown extraordinary commitment in the most challenging circumstances. Only political will to invest seriously in NHS staff and services can help reverse a deterioration that many believe is designed for full privatisation (Pilger, 2019).