What does that tell us?
Does it tell us that they now feel that the local hospital is safe? Does it tell us that they are willing to forget the "atrocities" attributed-rightly or wrongly- to that hospital over the past 7 years? Does it mean that they think that the hospital was wrongly blamed in the past and the sins were exaggerated to the point of unwarranted closure? Or does it merely tell us that a hospital closure is what it takes these days to get the local community to speak up for that hospital?
Sadly, that is human behaviour of the masses. We will always wonder why the Jews did not fight against the visible practices that none of them agreed with. We will always wonder when the perfect time is to use a nuclear device against aggression; when the hostiles are at Calais? or Midway across the channel? or at Dover? When is it really time for appropriate and timely aggression?
Before the internet and widespread television, people believed that Elvis was still alive somewhere. Maybe not in the building, but somewhere. The same would have been true for Michael Jackson as well if we did not have the media telling us the truth all the time that he was dead and wouldn't be coming back. So when do we stop believing what we hear or see in the media that we rely on so much to keep ourselves informed? Or more importantly, what makes us choose to believe or not to believe what we read in the news everyday? Is it dependent on whether I woke up feeling all rotten and angry at myself and the world, winching against the injustice that happens all around me everyday and sometimes involving me directly at my workplace? Or is it my personality that makes me question everything I hear and see, rather than believe it just because it sounds plausible?
Bias is inbuilt into humans which constantly suppresses the truth-seeking behaviour that swells up briefly within us when we are supplied information that makes more sense to believe than disbelieve. For example, if someone tells me that 100% of my patients gave me good feedback, I am unquestioningly happy. I had always suspected that anyway.
Tell me that 90% of my patients were happy with my care delivery, I am immediately suspicious whether the 10% included that woman who was a hypochondriac and the man who did not have the patience to wait another 10 minutes in clinic. Neither aspects are really feedback on my care, but merely reflection of their own personal traits, I argue.
Tell me that only 30% of my patients were happy with my care delivery and I am immediately skeptic of the whole process of the data collection. I am convinced there has been huge bias in patient selection. I am sure that huge throngs of my satisfied patients were never approached for authentic feedback.
Now if you tell me that while 90% of my patients were happy with my care, 100% were happy with the care provided by my colleague, I can assure you that is absolutely ridiculous. Now the reliability of the whole process is under question. Let us start with "how did my colleague manage to influence the patient selection"? "Who distributed the questionnaire?" "Were all my patients sick inpatients or demented and confused not to have provided accurate information on my excellent care?" "Did all my patients have prepaid envelopes?" "Were they all literate or was a sizeable proportion intellectually challenged with learning disabilities?" I have always suspected the last one and this survey statistic merely confirms that now!
The point is, if your hospital has good statistics on a particular mortality measurement- HSMR, RAMI or SHMI- you choose to believe the statistics that reflect that. There is no reason for a happy London hospital doctor to doubt that the morbid statistics of a desolate hospital in Inverness is untrue. On the other hand, if your own local hospital has a high position on the mortality rate league table, you suspect the veracity of the measurements. So did everyone living near Mid Staffs believe their hospital mortality was true? Probably, because the whole country could not be wrong and there was no data saying otherwise. Did it confirm everyone's suspicions at that time? Probably not. I am sure many were probably happy and grateful for the care that they had received there and kept wondering if they were the exception, the ones that got away without becoming a statistic at that building, where all things evil now lives and breathes like the politicians repeatedly remind us. Yet, where were they till now?
The sad truth is that many of us will only fight when our own existence or interests are threatened. Till that breaking point, it is someone else's problem. This happens at all levels of the NHS. Within hospitals or within CCG's the same behaviour will be demonstrable where we wonder why people do not engage with processes trying to improve care. Seemingly good people who have the potential to bring about change do not do the right thing or offer timely solutions but favour inaction and choose to watch from the stands at the unfolding action, as if waiting to see what comes out of it all, as if to see how bad things can get, as if to get personal satisfaction by letting fate prove the "I told you so" clause. I wouldn't go as far as maligning the natural behaviour of vultures and jackals here, but there are undeniable similarities that cannot be ignored. Some people may continue in optimistic expectations, constantly reassuring themselves that it is unlikely to get much worse on their patch, a behaviour not too dissimilar from many of our diabetic patients who sincerely believe that diabetic complications will be other patients' problems and never theirs. When an unexpected turn of events threatens their own existence or jobs or local healthcare sustainability in a mortal fashion, such people may rally to the battle, expressing the views they never expressed, trying to fight the fight they never fought when it could have made a difference.
So how can this be addressed. More Berwick reports? More generic training sessions? More mandatory training? More duty of candour clauses? More zero tolerance statements? Printing out Hippocrates Oaths on every remaining space on hospital ward walls? Appointing champions of frankness and truth? Empowering everything that moves to challenge everything that can be challenged? Even more Patient groups/ expert patient groups/LINK groups/ local health watches and hoping some one with a voice turns up for the meeting ? Throw more money to incentivise experienced clinicians to give their erudite opinion in a timely fashion ? Set up groups with fledglings fresh from medical school in the dire hope that some bright spark, however ill-informed, may bring new perspectives to turn things around magically? Give time out for more managers to set out on pilgrimages called "a piece of work" to seek out the hidden truth and answers that they believe exists somewhere out there along with the UFOs? Turn to the centres of apparent excellence -based on this month's statistics-and hope for solutions to be twittered back from greater-than-thou elsewhere? Put the people, who spout goodwill-talk every time they open their mouth, in leadership roles hoping that they can chat people into doing the right thing every time?
All that is necessary for the triumph of evil is that good men do nothing is what Edmund Burke said.
I say, all that is necessary for the closure of your local hospital is for you to believe everything and do nothing.
Blessed are the non-believers for they will continue to have a local hospital.