The Trust

The Trust. Channel 4, Wednesdays at 9 pm, 16 January to 14 February. Rating: ★★★★ This five part documentary observes the parallel lives of NHS staff and the people they care for during several weeks last year at Queen's Medical Centre, Nottingham. In the intensive care unit, on the admissions ward, in the children's unit, and at the end of life, complete strangers make the best relationships they can in difficult circumstances. People who investigate complaints about health services will probably find the third programme, “System Error” (30 January), like a moving-picture version of their jobs. It covers the way that Queen's responded to two serious matters: the death of Wayne Jowett, following intrathecal rather than intravenous administration of vincristine; and the recognition that Queen's had stored a large number of human organs and other tissue, after death. It tells the stories from both “sides” and illustrates things that people who deal with complaints know well. When something goes wrong, the odd misunderstanding, false assumption, bad timing, cross purpose of everyday life—which has little impact as a rule—is magnified a hundred times. And when something goes wrong almost everyone involved aches with anxiety and distress. More and more (although still not often enough), NHS staff try to deal with mistakes in an open and honest way. They realise that forming respectful relationships with patients and their relatives is important; but they can get it wrong. When the error that eventually led to Wayne Jowett's death was discovered, clinical staff and the trust's managers were keen to be as open as possible. But Mr and Mrs Jowett weren't interested in meetings and explanations at that time—they just wanted to help their son. However, when they needed information about what had been done at Queen's and elsewhere to prevent such a thing from happening again, there was silence. They felt that their son's death had been swept under the carpet by the coroner's verdict of accidental death, and that the trust and its staff had “moved on. ” Their hurt was palpable, as was their memory of members of the trust team congratulating each other at the close of the inquest. The trust's chief executive, on the other hand, protested that much had been done to change practice, as a direct result of the inquiry into Mr Jowett's death. It's a common problem. One of the reasons why people don't complain about health care (and the figures suggest that very few do) is that they think that nothing will change as a result. In fact, complaints and inquiries can and do lead to changes in people and systems—but not much gets said or reported about that. Something else that people rarely know much about is how NHS staff think and feel when something goes wrong. The sadness, anger, disbelief, and trepidation expressed by the ward manager involved in Wayne Jowett's care were quite typical. Ask most clinicians if there is a patient for whom they think they should have done better, or differently, and they will be able to recall several, in detail. They will also be able to say what they now do differently as a result. That goes for most managers, too. There are times, and the series illustrates several, when the lives of staff and public turn into parallel universes, and the inhabitants of each guess at the other's knowledge, motives, and desires. The programmes are at their most absorbing, and moving, as you watch relatives coming to grips, on their own, with a disagreement between consultants about prognosis; parents suddenly appreciating that surgical removal of a brain tumour is a life threatening procedure itself—when there was no reason to suppose they should have known that already; clinicians withholding information, or holding back from a discussion, that they believed would be unduly distressing—and being seen as, variously, self protecting, paternalistic, and having well intentioned regard for another person. These failures in human communication feature in many of the complaints investigated by the ombudsman's office. Often, they arise because NHS staff assume that patients and relatives understand much more about NHS life than is reasonable. When the NHS says “tissue” most of the world thinks “hankie,” not organs, blocks, and slides. Handling these situations well takes time that some NHS staff say that they do not have. It certainly takes skill, maturity, and courage. But poor handling has a high cost—in the pain and anxiety felt by all when something goes wrong, and in the time and money spent if complaints and litigation follow.