LAST month the Healthcare Commission (HCC) published a report following an investigation into Mid-Staffordshire NHS Foundation Trust.
It found that the care of emergency patients was ‘appalling’.
There was an excess of deaths over that expected, of between 400 and 1200 patients, between 2005 and 2008.
The trust achieved Foundation Trust (FT) status on February 1st 2008.
The HCC inspection was carried out between March and October 2008.
The Hospital Standardised Mortality Rate (HSMR), as recorded by Dr Foster, the organisation which is the UK’s leading provider of comparative information on health and social care, was raised at 127 (instead of 100) in 2005-06.
Although this was discussed at a private hospital board meeting in April 2007, no action was taken.
The West Midlands Strategic Health Authority (SHA), responsible for ‘performance managing’ the trust, arranged an enquiry, which found nothing wrong.
The HSMR stayed between 127 and 145, between 2005 and 2008, for adults over 18 years.
When questioned by the HCC, the hospital Trust Board attributed the excess deaths to problems with data recording.
However, a very vocal local ‘Cure the NHS’ campaign group of patients and relatives sent in hundreds of complaints and picketed the local MP’s office.
This resulted in the HCC carrying out a full-scale investigation.
Standards of care
The HCC found that the care of emergency patients was ‘appalling’ from the moment they arrived at the Accident & Emergency (A&E) Department, all along the pathway to in-patient care and treatment.
It said: ‘The care and assessment of patients fell well below acceptable standards.’
Some of the deficiencies are listed below.
In A&E, patients were triaged by non-qualified receptionists and then waited out of sight.
Patients were ‘dumped’ in a ‘clinical decisions unit’ to ‘stop the clock’, so that the four-hour target would not be breached.
One of these areas had no staff and so the patients were not monitored.
The A&E had insufficient consultant cover. Junior doctors were often left on their own.
There were not enough nurses in the hospital to care properly for emergency patients; 120 more were needed, 17 for A&E, 30 for surgical services and 77 for the medical wards.
Even after the investigation in November 2008, there was still a net shortfall of 40 nurses.
Emergency patients were often admitted to an Emergency Assessment Unit (EAU) without proper assessment and without appropriate specialist care.
This unit also did not have enough trained nurses.
Some nurses could not carry out observations like pulse, blood pressure, temperatures and monitor fluid balance, so that deteriorations in patients’ conditions were not detected.
Some could not use intravenous fluid pumps or connect heart monitors.
On the wards, the standard of nursing care was poor, with patients left in soiled beds, or waiting for food or medication. Bed sores were rife.
There was no experienced surgeon in the hospital at night.
Trauma patients, for example, patients with fractured neck of femur, frequently waited several days before getting their operation, sometimes suffering from lack of food and medication.
There were too few operating theatre sessions at weekends.
Patients developed unacceptable rates of post-operative complications, such as deep vein thrombosis.
There was no specialist trauma team.
There were shortcomings with resuscitation.
There was an absence of essential equipment on wards and in A&E, such as defibrillators, portable suction and breathing apparatus, where the patient was non ventilated.
There were too few specialist beds for patients who had strokes, or heart attacks.
The cause – FT status and financial cuts
The report was clear on how this state of affairs had developed.
It stated: ‘The year 2006-07 was a challenging one for the NHS, as Trusts were required to achieve financial stability.
That year the Trust set itself a challenging agenda to meet national targets for cost improvement, stabilise its finances and become an NHS Foundation Trust.
‘The Trust set itself a target of saving £10m, including a planned surplus of £1m. This equated to 8% of turnover.
‘To achieve this 150 posts were lost.’ (emphasis added AA)
It said: ‘The combination of the reorganisation of wards, the reduction of beds (more than 100 fewer beds between 2005 and 2008, 18% of the total) and the loss of staff meant that the care of patients was further compromised.’
And: ‘The evidence suggests that the top priority for the Trust was the achievement of Foundation Trust status.
‘The failure of the Trust to resolve the problems in A&E and to invest in staff is not consistent with the Trust doing its reasonable best to provide a safe and effective service for patients.’ (Report Summary, p9)
It added: ‘In the Trust’s drive to become a Foundation Trust, it appears to have lost sight of its real priorities.
‘The Trust was galvanised into radical action by the imperative to save money and did not properly consider the effect of reductions of staff on the quality of care.
‘It took a decision to significantly reduce staff without adequately assessing the consequences.
‘Its strategic focus was on the financial and business matters at a time when the quality of care of its patients admitted as emergencies was well below acceptable standards.’ (Main Report, p11)
Conclusion
It is clear that the loss of life at Stafford hospital was due to the Trust Board cutting 150 staff to save £10m, in order to comply with instructions from the Department of Health (DH) and become a Foundation Trust.
The board was ruthless in this aim, but then it had to be as it was appointed to follow central government directives. The Chief Executive (CE) and Chairman have resigned.
This saga is being repeated all over England as all acute Trusts have been instructed by the DH to become FTs by December 2008.
The HCC, before it was closed down last month, pointed out that there are another 10 trusts in England with extra high standardised mortality rates.
All hospitals trying to achieve FT status are in the same situation and patient care is suffering.
FTs have to run as a business and make a surplus. The same imperatives that forced these trusts to dangerously cut their nursing and medical staffing remain.
FTs have to compete for patients with private providers and other FTs.
They are threatened with reduced tariffs if they do not fulfil certain quality criteria under the ‘Darzi Next Stage Review’.
In addition, the government has stated that funding for the NHS will drastically reduce because of the economic crisis.
The government itself recognises that the task it imposes on hospitals is impossible and is pushing through the Health Bill which legislates for the closure of units on the grounds of financial, or clinical, ‘unsustainability’.
These units can be closed down, or taken over by the private sector, within 120 days.
The HCC itself has been wound up. In is its place is the Care Quality Commission (CQC), whose new CE, Cynthia Bowers, is the very person who was the CE of the West Midland SHA, which was responsible for performance management in Staffordshire.
The responsibility for the excess deaths at Stafford, and all the other Staffords which have not come to light, rests with this government.
It has directed the large increase in NHS spending it has made since 2000 to privatisation restructuring – PFIs, ISTCs (Independent Sector Treatment Centre), management bureaucracy and market ‘reforms’.
The only way out of this devastation is to replace the Brown government with a workers’ government, committed to socialist measures, including undoing the privatisation reforms, dismantling the huge management bureaucracy and restoring funding to frontline NHS care.
