When I quoted Professor June Andrews, Scotland's internationally renowned dementia expert, warning recently that hospitals were not safe places, it was not a new theme.
In recent weeks The Herald has reported on statements from consultants at Aberdeen Royal Infirmary (ARI) that accident and emergency services were not safe, due to staff shortages. That hospital is now undergoing an independent review. We have covered NHS South Lanarkshire where concerns about several hospitals, particularly Monklands, have focused on safety and staffing.
There was a report by the Mental Welfare Commission about services to patients on continuing care dementia wards which were described as "depressingly Victorian". Issues identified included over medication and poor standards of care. The British Medical Association Scotland has described doctors working under extreme pressure, caused by high vacancy rates and staff shortages.
Are these individual stories, or the same one? Prof Andrews's point was just this: that the problems are endemic and the public should understand that they can stop hospitals being safe.
They also mean standards of care are not what people expect. Hospitals have "sometimes' events"; mistakes or things that go wrong which are avoidable, but that will sometimes happen. And then there are "never" events, which shouldn't ever occur. Having the wrong organ or limb being operated on, for instance.
But Prof Andrews says many "sometimes" events are ones patients and families would see as "never" events. Patients missing medication because a nurse has recorded it as taken when it hasn't been. Patients having to use a bedpan because no-one is free to take them to the toilet. Patients missing meals routinely.
She argues whistleblowing is of limited use. Apart from the professional and personal challenges, it still leads to a staff member, it tends to lead to a focus on a specific area, or to geographical location. But it is a mistake to see the alerts over conditions at ARI, or Monklands, or long-term care of dementia patients in isolation, she argues. What is needed is a bigger discussion involving the public over resources.
In response to Prof Andrews's comments, Professor Jason Leitch, clinical director of the Government's Quality Unit said he didn't think they reflected the reality of the NHS "where hard-working staff strive daily to deliver safe and effective care".
But the comments didn't question the efforts of staff. They questioned whether there were enough of them and whether safe and effective care was being compromised.
I do think there is a need for an overview, when senior voices in and outside the NHS are raising the same concerns repeatedly.
In NHS Lanarkshire, the review of high death rates commented: "A recurrent theme was that problems were regarded as insoluble and so sub-optimal, and variable care was tolerated."
That sounds very much like Prof Andrews's analysis. Is it a recurrent theme across the NHS in Scotland?
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