Demeaning the dead -- the NHS continues its downhill slide

By Melanie Phillips

People say that you can measure how civilised a country is by the way it treats its dead. Judging by that yardstick, it would seem that parts of Britain are not very civilised at all. At Queen's Park hospital in Blackburn, the bodies of patients who have died have been left on hospital wards overnight, apparently because a funding crisis has resulted in a shortage of night porters who are needed to move them to the mortuary.

The East Lancashire Trust in charge of the hospital - which subscribes to an NHS scheme entitled `pursuing perfection' -says that because it is under pressure to save 11.6 million pounds by next April, it can't afford to replace four night porters who are off sick or who have resigned. Since it takes two porters to move and lift a body, when staff are left alone overnight it is therefore impossible for them to move from the wards patients who have died. One porter at the hospital has claimed that last week, three bodies were left on the wards for more than eight hours.

This is sickening and revolting. Leaving the bodies of patients in their beds like this is utterly unacceptable. It shows a total lack of respect for the dead, and the likely distress caused to other patients needs no imagination. The NHS budget now runs to a massive annual total of more than 80 billion. Yet the service cannot even afford to treat a dead body with elementary respect. Yes, we all know that despite the astronomical sums being poured into the NHS it has nevertheless managed to get itself into a 500 million deficit and is in a permanent state of crisis as a result.

Yet there is still money to pay the salaries of the serried ranks of bureaucrats, who have helped reduce the NHS to its current parlous state of mismanagement. The East Lancashire Trust itself is currently advertising on its website for a Director of Strategy and Implementation at an annual salary of 95-100,000 pounds. This exalted figure will get the `chance to transform services and improve the patient experience.' It is also advertising for something called a Supply Chain Director, at a salary of 75,000 pounds, a post which is apparently essential to ensure `we obtain maximum value from our 500 milion-plus annual spend within Cumbria and Lancashire.' Is it really `improving the patient experience' or `obtaining maximum value' for patients to find they are sharing their ward with a corpse that has been left in the next bed for hours on end? Isn't there something dramatically wrong with the Trust's priorities here?

Our health service is spending ever increasing sums on cutting-edge medical technology. As a country we are moving into the brave new world of designer babies, face transplants and cloning. These advances are held to be evidence of the superiority and prowess of our civilisation. Yet we seem to be no longer capable of observing even the basic decencies of a civilised society. The way we treat the dead is of the greatest possible significance not just to the health service but to society at large. For if we do not show respect to the dead, we will not show it to the living.

The rituals around our treatment of dead people signify the respect we have for human life itself. That's why the desecration of graves or cemeteries is so shocking. That's why we close the eyes of the deceased, or cover their faces with a sheet; it's why we prepare them decently before we bury them. We treat a dead body with this kind of reverence because to do otherwise would be to show that we have no intrinsic respect for our common humanity and for what it actually means to be a human being. We reaffirm this common bond even towards the physical remains of a life that has departed, precisely to signal that to be human is to be more than a mere assembly of working parts and that we are not just a lump of flesh. If we don't do this, if we treat a dead body as if it were no more than an inanimate thing, we dehumanise not just the person who has died but ourselves and our fellow human beings too.

Yet that is just what was done at the Queen's Park hospital, where dead people were treated with no more thought than bags of refuse waiting to be collected. It is simply no excuse to say there wasn't enough money. It suggests rather a breakdown in some pretty basic codes of decency. It appears that this scandal only came to light when a porter who was unable to move a body from a ward because he was alone wrote an incident report to the management. But what about the other hospital staff who must have noticed that a dead patient had been left for hours on a ward? What about the nurses who were seeing to other patients on these wards? Why didn't they immediately do something about it? Didn't they care? Did they even notice?

Unfortunately, the financial black hole is by no means the worst thing that has happened to our health service. Far more serious and disturbing is the loss of something much more fundamental than money, even though it is more intangible. What has disappeared in distressingly large measure is the ethic of care, at the heart of which is recognition of the dignity of every human being and the intrinsic respect to which that gives rise.

Of course, there are many nurses, doctors and other NHS staff who provide magnificent and sensitive care, particularly where sick children, patients in intensive care or relatively young people suffering life-threatening diseases are concerned. But in too many areas, respect for human dignity has been cast aside. Take mixed-sex wards, for example, which, despite many government promises to phase them out, still exist. These wards cause untold distress to many patients, particularly to elderly people. And it is the elderly who have suffered most of all from this erosion of respect within our health service. In too many of our hospitals, the treatment of elderly patients is simply inhumane. They are neglected so that some who are too frail to feed themselves are left without food. Others have their lives ended altogether by the withdrawal of food and hydration on the grounds that their lives are no longer worth living.

A recent survey found that up to 5,000 frail and elderly patients die each year because they are not put in intensive care beds for monitoring after their operations, having been written off because they are old. Such contempt for old people surely has its roots in the widespread erosion of religious belief, which has resulted in a loss of respect for the innate value of human life. Instead, respect is now afforded in proportion to the presumed usefulness of that life. Dead people, of course, are no longer useful at all - so much so that in some quarters they are not even being regarded as people but as useless objects. The shocking revelations from Blackburn suggest that the NHS is suffering not merely from a financial crisis but a moral one, too - and one that reflects upon all of us.

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One of my readers who is a public-hospital medical specialist in the USA wrote to Melanie regarding the above article as follows:

"I was touched like never before by your column on Demeaning the Dead. It was like being at the dentist when he is drilling and he hits a nerve. In a small space, you put into words what is wrong with society. A while ago, some woman was rescuing dogs disposed of in a city dump in South Africa. They were left to die. At first I thought this was extreme on her part. But then my wife said something wise - she said that, in a society that treats animals this way, how do you think they treat people? Likewise, how they treat the dead DOES reflect on how they treat the living.

The motive here is NOT economic. Someone can ALWAYS be recruited in a hospital - supervising nurses, who would have to be coerced to get their hands dirty hauling a body to the morgue. Security personnel, phone operators, cafeteria workers, even doctors. There is ALWAYS SOMEBODY. Leaving a body in a room with a living patient is just a passive aggressive stab at "the system".

And it's not good economics to leave a dead person in a hospital bed. As busy as hospitals are, economic efficiency would be greater with live patients rather than dead patients occupying beds".






The downward spiral continues in Queensland public hospitals

A shortage of nursing staff has forced Queensland's largest public hospital to cut back elective surgery for the next three months. More cuts are likely to limit operations to fewer than 1800. A leaked memo from the hospital revealed that since March "there have been ongoing elective operating sessions cancelled due to insufficient nursing and anaesthetic technical staff to provide safe patient care". "In addition, demand for emergency surgery is exceeding the current emergency OR (operating room) capacity," the memo says.

In the past year, the staffing shortages and additional demand for emergency operations have meant patients have faced last-minute cancellation of elective surgery. Several people who contacted The Courier-Mail said they had operations cancelled after they had been prepared and wheeled into the operating theatre.

Queensland Health Central Area Health Service acting general manager Terry Mehan said planned cuts in elective surgery were more appropriate than making last-minute cancellations to elective surgery lists. Mr Mehan said the hospital usually conducted 30 to 32 elective surgery sessions each day and the new roster would reduce that to 24 or 26 sessions each day. "Emergency surgery is exactly that. It is surgery that cannot wait. And this new roster system developed by the clinicians at the coalface aims to ensure emergency cases will not have to wait," he said. "We believe this will be a great improvement on ad hoc last-minute elective surgery cancellations. Last-minute cancellations result in stress and inconvenience for patients." Mr Mehan said demand for elective and emergency surgery was increasing throughout the state. "And there is a shortage of nursing staff, particularly of nurses with operating theatre skills," he said.

Australian Medical Association Queensland president Zelle Hodge said last-minute cancellations of elective operations had been "going on for some time" at RBWH. Dr Hodge said the shortage of beds meant Queensland's public hospitals were operating at full capacity and had no room to move should there be a disaster or seasonal fluctuations. "Ideally hospitals should plan to run at 85 per cent capacity to deal with these fluctuations," Dr Hodge said. "But we know the RBWH is constantly running at about 130 per cent capacity. This means patients with serious cancers have to wait. They are being significantly disadvantaged in our public hospital system."

Opposition health spokesman Bruce Flegg said that previously a lack of doctors had been blamed for cancellations. "Now it is a lack of technical staff and nurses to open operating theatre," he said. "This is the same government which has recently spent millions of taxpayers' money on promoting how things have changed inside our public hospitals because of its successful recruitment programs for doctors and nurses."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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