POLITICIANS should work to- gether to maintain the NHS, rather than "endlessly engaging in slanging matches", the Rt Revd James New- come, Bishop of Carlisle and the Church of England's lead bishop on health care, said this week.

He suggested that the Church should act as a "critical friend" of the NHS, "not as a critic standing over the NHS in judgement".

His comments followed a report that found 14 NHS Trusts to be "trapped in mediocrity". The report, the Keogh review, published on Tuesday, was commissioned by the Government in February, in re- sponse to the publication of the Francis report into the Mid Staffordshire NHS Foundation Trust, which uncovered "appalling" standards of care there.

Professor Sir Bruce Keogh, the NHS medical director, was asked to investigate Trusts that had persistently high mortality rates. His said he was confident that "mediocrity" in the 14 Trusts named could be "replaced by a sense of ambition".

The report found in the Trusts a "limited understanding" of the importance of listening to patients and staff; a lack of value of, and support for, front-line clinicians; and transparency used "for the purpose of accountability and blame, rather than support and improvement".

In several cases, action taken at once to protect patients had in- cluded the immediate closure of operating theatres, and changes to staffing levels. Shortage of nurses was a problem. At Burton Hospitals NHS Foundation Trust, staff were working for 12 days in a row without a break.

All but two Trusts had had "never events": serious, largely preventable, patient-safety incidents. There had been 12 such events in three years at United Lincolnshire Hospitals NHS Trust. 

None of the Trusts was given a clean bill of health, and the Health Secretary, Jeremy Hunt, announced on Tuesday that 11 had now been put in "special measures" for "fundamental breaches of care". They would be subjected to close monitoring, and each partnered with a high-performing NHS organisation.

The Health Secretary has been accused of seeking to gain political capital from the report. On Tuesday, Mr Hunt told the House of Commons: "The last government left the NHS with a system that covered up weak hospital leadership, and failed to prioritise compassionate care. The system's reputation mattered more than individual patients; targets mattered more than people." 

The Shadow Health Secretary, Andy Burnham, said that this "partisan statement" was "not worthy" of Sir Bruce's "excellent" report, which was "about the Right Hon. gentleman's Government, and failings that are happening now, on this Government's watch." The Government, he said, was conducting "cynical spin operations".

On Wednesday, Bishop Newcome said: "It's a great pity when health becomes over-politicised. Because, actually, what we are concerned about is individual people and their families; and I would have thought that everybody shared a concern for their well-being and welfare. The NHS is a great institution which we want to preserve and maintain at all costs, and we are just jolly fortunate to have it. It should be the one area where politicians should be able to work together for the well-being of the country, rather than endlessly engaging in slanging matches about who is to blame."

One of the 14 Trusts investigated by Sir Bruce, North Cumbria University Hospitals NHS Trust, is in the diocese of Carlisle. Bishop Newcome said that the diocese's invitation to all NHS staff to attend "stress relief days" at its retreat centre, Rydal Hall, had been "very successful". He could relate to Sir Bruce's observations about the difficulty of recruiting staff to geographically remote areas.

On Wednesday, the Revd David Flower, Principal Chaplain at Colchester Hospital University Foundation Trust, another hospital mentioned in the review, but one not placed in special measures, said that the review's diagnosis of a failure to listen to patients and staff was not "typical" of his Trust. "We are encouraged to be involved in active listening, with clergy chaplains and volunteer lay chaplains, with patients, staff, and relatives. We are also encouraged to be part of multi-disciplinary meetings, and part of ward teams. We are also encouraged to attend training meetings with other chaplains, and in personal reflection. We feel very supported by senior managers and the Trust Board. The chaplaincy team feels it is in a strong place to influence this organisation."

Leader comment

THE Government's decision to abolish the Liverpool Care Pathway (LCP) is wrong, the Church of England's lead bishop on health care said this week, writes Madeleine Davies.

The Bishop of Carlisle, the Rt Revd James Newcome, said on Wednesday: "It's rather like saying that, just because some people crash their cars, you should stop everybody driving cars."

The Government's announcement was made on Monday, after the publication of an independent review of LCP, the guidance that informs end-of-life care in the NHS.

The LCP has been described in the press as a "pathway to euthanasia"; and the review was commissioned in January in response to concerns about the LCP raised by patients, families, and clinicians ( News and Leader, 4 January). It was led by Baroness Neuberger, Senior Rabbi to the West London Synagogue, together with nine other panellists, including the Rt Revd Lord Harries of Pentregarth, a former Bishop of Oxford.

The group concluded that the LCP worked well when it was operated by "well trained, well resourced and sensitive clinical teams", but heard about repeated instances of patients on the LCP being treated with "less than the respect than they deserve". Reports of poor treatment at night and at weekends - "uncaring, rushed, and ignorant" - abounded. The LCP had been "used as an excuse for poor-quality care".

Of greatest concern was the apparently unnecessary withholding of water from the dying patient. One family was told that the only way to give a relative a drink was to soak a paper towel from the dispenser in the toilet and let her suck it.

Some families were handed a leaflet without any explanation. The panel reported the use of "brutal, callous language", and of several cases in which relatives were asked by passing staff, "Oh, is X still with us?" The panel concluded that the LCP "entirely reflects the ethical principles that should provide the basis of good-quality care in the last days and hours of a person's life". These principles had not always been reflected in practice, however.

Bishop Newcome said: "One needs to go back to why the Liverpool Care Pathway was introduced: to give people the chance to have as good and as peaceful a death as possible. [Previously] the care that was offered to dying people was very hit-and-miss.

"I think the two key issues are the training of staff and communication with relatives. . . It is because those two things have not always happened as well as they might have that sometimes people have complained about it. . . When people are properly trained, the general experience has been that patients are as comfortable as they can be, and mostly relatives have been very grateful for the care their relatives received."

He suggested that "if we don't have [the LCP] we will just have to invent something similar." He agreed with the panel that there was a need for a National Conversation about dying: "It is reckoned to be the great taboo of our age. From the Church's point of view, it is something we can talk about quite readily because of believing that death is not the end of everything. We need to talk about the whole process of dying, and what it means to die well."

The Government has accepted the panel's recommendation that "generic protocols" such as the LCP should be replaced by an end-of-life care plan for each patient, backed by condition-specific guidance.

By Wednesday, a petition to overturn the decision to abolish the LCP had attracted more than 26,000 signatures. Dr Richard Vautrey, deputy chair of the British Medical Association's General Practitioners Committee, told Pulse magazine: "This yet again seems to be policy driven by certain sections of the lay media rather than by any real clinical evidence."

Comment

Question of the Week: Should the Liverpool Care Pathway be phased out?