Sunday, 10 February 2013

Staffordshire NHS Foundation Trust.


Most of the UK media has reported on the Francis inquiry into significant failures in care at the Mid Staffordshire NHS Foundation Trust.
The report suggests a raft of radical changes to help improve patient safety. These include proposals to make serious but avoidable medical mistakes a criminal offence.
The Healthcare Commission (the hospital regulator at the time) first raised concerns about the trust in 2007, after determining it had unusually high death rates.
These concerns led to a series of reports, undertaken by different bodies, which all found widespread evidence of significant failures in care, including:
  • patients being left in soiled bedding
  • patients not given ready access to food and water
  • chronic staff shortages
  • failure in the leadership of the hospital
  • a culture in which staff members who had concerns about failures in care were discouraged from speaking out
This current inquiry was commissioned in 2010 to investigate wider issues that may have contributed towards these serious problems. The inquiry, carried out by the barrister Robert Francis QC, was asked to come up with recommendations which could help prevent similar failings from happening in the future.
The findings of the inquiry have now been published.


What is a public inquiry?

Public inquiries are wide-ranging investigations commanded by the government to look at very serious issues, particularly where there have been numerous deaths.

Due to their scale and level of detail, they are not often carried out. The most recent health-related public inquiry was the 2005 Shipman Inquiry into the case of Hyde GP Harold Shipman who was imprisoned for murdering 15 patients.

What were the main findings of the inquiry?

The findings of the inquiry can fairly be described as damning. It highlights what amounts to a ‘perfect storm’ of systematic failures of care at multiple levels, including:
  • a ‘Somebody Else's Problem’ attitude among hospital staff – perceived problems were too often assumed to be the responsibility of others
  • an institutional culture that cared more about the needs of the hospital staff than the patients
  • an unacceptable willingness to tolerate poor standards of patient care
  • a failure to accept and respond to legitimate complaints
  • a failure of different teams within the hospital, as well as in the wider community, to communicate and share their concerns
  • a failure of leadership – in particular, financial changes needed to achieve Foundation Trust status were seen, by the inquiry, to take precedence over patient care
Mr Francis concludes that, ‘The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms.’

What recommendations does the inquiry make?

The inquiry makes a total of 290 individual recommendations. These include:
  • causing harm or death to a patient due to avoidable failures in care should be a dealt with as a criminal offence (rather than a regulatory or civil matter)
  • NHS staff, including doctors and nurses, should have a legal ‘duty of candour’ – so they are obliged to be honest, open and truthful in all their dealings with patients and the public
  • a single regulator of both quality of care and financial matters should be created
  • non-disclosure agreements (‘gagging orders’) – where NHS staff agree not to discuss certain matters – should be banned
  • there should be a ‘fit and proper’ test for hospital directors, similar to those set for football club directors
  • a clear line of leadership needs to be established, so it is always clear who is ultimately ‘in charge’ when it comes to a particular patient
  • uniforms and titles of healthcare support workers should be clearly distinguished from those of registered nurses

What happens next?

The final report of the public inquiry has now been published, and the government has said it will respond to the recommendations of the inquiry in March 2013. Changes required by earlier reports into the failings at Mid Staffs are already underway.
The Prime Minister David Cameron has said that “quality of care” should be on a par with “quality of treatment”.
He said: “We have set this out explicitly in the Mandate to the NHS Commissioning Board, together with a new vision for compassionate nursing.
“We have introduced a tough new programme for tracking and eliminating falls, pressure sores and hospital infections.
“And we have demanded nursing rounds every hour, in every ward of every hospital.”
Edited by NHS Choices. Follow Behind the Headlines on twitter.

Links to the headlines

Stafford Hospital: Hiding mistakes 'should be criminal offence'. BBC News, February 6 2013
Mid Staffordshire NHS trust inquiry report published. The Guardian, February 6 2013
David Cameron apologises for Mid Staffs scandal after damning report. The Daily Telegraph, February 6 2013
Medical staff must face criminal charges for failures, says care scandal report. The Independent, February 6 2013

Further reading

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive summary (PDF, 839Kb). Published 
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Saturday, 9 February 2013

Stafford Hospital scandal: Jeremy Hunt calls for police inquiry


Stafford Hospital scandal: Jeremy Hunt calls for police inquiry

Jeremy HuntJeremy Hunt said the police and the General Medical Council should review the evidence

Staffordshire NHS scandal

The deaths of patients at Stafford Hospital should be investigated by the police, the Health Secretary has said.
In an interview with the Daily Telegraph, Jeremy Hunt said it was "absolutely outrageous" that nobody had been "brought to book".
Staffordshire Police said it was currently "studying the report's full contents."
It said it had previously investigated two cases at the hospital but found no evidence to bring prosecutions.
"This was a public inquiry that was designed to help us understand why the system didn't pick up what went wrong but I think it is absolutely disgraceful with all those things happening, whether it is doctors, nurses or managers, nobody has been held to account," Mr Hunt told the newspaper.
'Duty of care'
He said that it was not for politicians to decide whether people should be prosecuted but that evidence should be reviewed.
The findings of the public inquiry into failings at Stafford Hospital were published on Wednesday.
Helene DonnellyNurse Helene Donnelly left the hospital trust in 2008
The 12-month inquiry, which cost £13m, came after a higher-than-expected number of deaths at Stafford hospital between 2005 and 2008.
The report by Robert Francis QC strongly criticised hospital managers and the Department of Health.
Helene Donnelly worked as a staff nurse in the casualty department at Stafford Hospital and raised concerns about patient care about 100 times in six years.
She said there had been a culture of neglect at the hospital and that she was in favour of the evidence being looked at.
"As a nurse who went through it and saw some terrible things, I think there does need to be some accountability certainly with some of the nurses I spoke out against," she said.
Staffordshire Police said two cases of misdiagnosis had been formally investigated following patient deaths but no evidence was found to suggest the hospital had been negligent in its care.

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FEBRUARY 25TH, 2010

Why Burnham Didn’t Want An Inquiry

Guido understands that Andy Burnham is about to be in some deep trouble. Yesterday he said he“did not believe that a lengthy, adversarial inquiry would be in the best interests of health care in Staffordshire.” Today it has emerged that in 2007, as a Junior Health Minister, he signed offon one of four stages of the Mid-Stafford Hospital’s elevation to Labour’s coveted Foundation Trust status. This was despite four formal alerts about the hospital’s dangerous practises. The rest they say is history.
No wonder Dave was asking about this at PMQs yesterday. Guido just got off the phone with Julie Bailey of Cure the NHS, a local group campaigning for a full inquiry into the case, who said she had to go because “we’re just about to start filming” as Andrew Lansley was on the way.
After Burnham’s “tired and emotional” outburst at Lansley last week for the death tax posters, Guido senses he may be dodging Nokias by the end of the tea time news…
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Friday, 8 February 2013


Stafford Hospital: Does NHS boss have case to answer?

Sir David NicholsonSir David Nicholson has been chief executive of the NHS for the past six years

Staffordshire NHS scandal

For a man who is so renowned for keeping a tight control on the health service, the past few days have been undoubtedly uncomfortable for NHS chief executive Sir David Nicholson.
Campaigners have been calling for his resignation from his £270,000 post following the public inquiry into the failings at Stafford Hospital.
And on Thursday he found his picture splashed on the front pages of two national newspapers.
Both included critical articles about his role in the scandal.
But what is the evidence against Sir David?
Anybody in charge of an organisation that has just had its culture criticised in the way the public inquiry did with the NHS would find themselves being asked questions.
But what makes Sir David even more vulnerable is the fact he had contact with Stafford Hospital when he was a regional NHS boss - as has been documented in the the 1,700-page report.
In fact he was on the panel that appointed a new chief executive for the hospital in the second half of 2005. The panel chose Martin Yeates, the man who would subsequently order a deep round of cost-cutting at the trust that contributed to the "appalling" levels of care.
Sir David actually became interim chief executive of the health authority that oversaw Stafford Hospital in August 2005. At the time, a number of health authorities were being merged and Sir David had been leading a neighbouring once since 2003.
The inquiry report makes clear that even at this time it was apparent that the Mid-Staffordshire Trust, which ran the hospital, had problems with finances and management structures.
Plain Mr Nicholson, as he was then, met with Mr Yeates and the chairwoman of the trust, Toni Brisby, soon after he took charge, to discuss what was being done.
Documents from the time show he was concerned about the performance of the trust and wrote to the trust to say so.
A letter back to him from Ms Brisby convinced him that new leadership at the trust was engaged with tackling the problems. The inquiry questioned this, suggesting the letter could be interpreted as the trust being in denial.
Top job
But Mid-Staffordshire was soon someone else's problem, as Sir David left the West Midlands in June 2006 to take up the reins of the NHS in London.
Within months he was on the move again after being appointed to the top job, chief executive of the whole health service in England,
The next time Stafford Hospital loomed large on his horizon was in the summer of 2007.

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What has been found to be wrong here cannot be cured by finding scapegoats”
Robert FrancisInquiry chairman
It had been put forward for foundation trust (FT) status - elite status that gives hospitals freedom from government control.
A Department of Health committee recommended the trust was in a fit state to be put forward for FT status.
Without any objections forthcoming, it was left to Andy Burnham, then a junior health minister, to sign off the relevant paper work and pass the application off to Monitor, the body that makes the final decision on FT status.
The following summer Sir David again found himself discussing Mid-Staffordshire in a meeting with the Healthcare Commission, the NHS regulator, which had just started an investigation into the trust following concerns about high death rates.
He is reported to have told officials from the regulator to beware of the Cure the NHS campaign, the group set up by local patients upset about the care provided by Stafford Hospital, suggesting they were "simply lobbying" as opposed to representing widespread concern among patients using the hospital.
Sir David denied using the phrase, leaving the inquiry to conclude that it was not possible to determine exactly what was said after all this time.
But the inquiry report did warn that care needed to be taken in these sort of situations to "avoid the impression that the Department of Health was seeking to influence an independent regulator".
'Cultural leader'
By March 2009 the Healthcare Commission published its findings on Mid-Staffordshire. They were devastating, lifting the lid for the first time on what had been happening.
A year later an independent inquiry was adding more harrowing detail to the picture. According to those who were close to him at the time, both reports are said to have shaken and upset Sir David.
The public inquiry also raised questions about the power the Department of Health wielded over the health service.
Of course, this will be influenced by ministers as well as senior officials such as Sir David.
The inquiry report described the department as a "cultural leader" but said the evidence did not suggest it was an organisation that bullied.
Instead, it concluded that "well-intentioned decisions and directives... have either been interpreted further down the hierarchy as bullying, or resulted in them being applied locally in an oppressive manner".
None of this was enough to convince inquiry chairman Robert Francis QC that Sir David - or anyone else for that matter - should go.
Mr Francis stressed in his statement to the media immediately after publication of the report that the blame game should be avoided, saying: "What has been found to be wrong here cannot be cured by finding scapegoats."
But this is not enough for Julie Bailey, the woman who set up Cure the NHS after losing her mother at Stafford Hospital.
She is adamant Sir David, who has apologised for what happened, should lose his job.
Ministers though are sticking by him.
As well as being chief executive of the NHS, he is also the head of the new NHS Commissioning Board, which will take charge of the health service from April.
As one government adviser put it: "Even if there was an appetite to get rid of him we couldn't afford to. We have a major restructuring on our hands and growing financial problems.
"He is the man who has a grip on the system. Without him we would be in real trouble."
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Horsemeat tests ordered on beef products


Horsemeat tests ordered on beef products
Catherine Brow
Food retailers have been told to carry out tests on all processed beef products after some Findus lasagnes were found to contain 100% horsemeat.
The Food Standards Agency (FSA), which ordered the UK tests, said it was "highly likely" criminal activity was to blame for the contamination.
It said there was no evidence of a health risk, but its chief executive said it was an "appalling situation".
Findus has apologised to customers and withdrawn the meals from sale.
Findus is the latest company to be caught up in the controversy surrounding contamination of meat products, which has affected companies in the UK, Irish Republic, Poland and France.
Findus's affected products were made by a third-party French supplier, which had alerted the company to concerns that the beef lasagne product did not "conform to specification".

“Start Quote

We will take whatever action we consider necessary if we discover evidence of criminality or negligence”
Owen PatersonEnvironment Secretary
'Criminal trade'
Catherine Brown, the FSA's chief executive, told the BBC: "I have to say that that the two cases of gross contamination that we see here indicates that it is highly likely there has been criminal and fraudulent activity involved.
"We are demanding that food businesses conduct authenticity tests on all beef products, such as beef burgers, meatballs and lasagne, and provide the results to the FSA. The tests will be for the presence of significant levels of horsemeat."
The agency has asked for test results by next Friday.
It has also ordered Findus to test the contaminated lasagne for the veterinary drug phenylbutazone, or "bute".
"Animals treated with phenylbutazone are not allowed to enter the food chain as [the drug] may pose a risk to human health," it said.
Findus had withdrawn its beef lasagne in 320g, 360g and 500g sizes as a precaution on Monday.
The FSA said Findus had tested 18 of its beef lasagne products and found 11 meals containing between 60% and 100% horsemeat.
It advised people who had bought any Findus beef lasagne products not to eat them and to return them to the shop from which they were purchased.
Environment Secretary Owen Paterson said the findings were "completely unacceptable" and the presence of unauthorised ingredients "cannot be tolerated".
Mr Paterson said the government was working closely with businesses to "root out any illegal activity" and enforce regulations.
TescoSupermarket chains Tesco and Aldi have also withdrawn some beef products
"Consumers can be confident that we will take whatever action we consider necessary if we discover evidence of criminality or negligence," he said.
Shadow environment secretary Mary Creagh said the latest revelations raised questions about the extent of the scandal.
"This is no longer just a food safety issue but possibly a criminal trade," she said.
Findus confirmed the product was manufactured by a third-party supplier and said all its other products had been tested and were not affected.
Supplier concerns
The company said: "We understand this is a very sensitive subject for consumers and we would like to reassure you we have reacted immediately. We do not believe this to be a food safety issue.
"We are confident that we have fully resolved this supply chain issue. We would like to take this opportunity to apologise to our customers for any inconvenience caused."
Earlier this week, French food supplier Comigel had alerted Findus and Aldi and advised them to withdraw Findus Beef Lasagne and Aldi's Today's Special Frozen Beef Lasagne and Today's Special Frozen Spaghetti Bolognese.
Tesco also decided to withdraw Everyday Value Spaghetti Bolognese.
The Tesco product was produced at the same Comigel site but there was no evidence of contamination, the supermarket said.
The wider food contamination controversy arose in mid-January when Irish food inspectors announced they had found horsemeat in some burgers stocked by a number of UK supermarket chains, including Tesco, Iceland and Lidl.
Asda has withdrawn products supplied by Newry-based Freeza Meats, which was storing meat found to contain a high proportion of horse DNA. Two samples were found to contain 80% horsemeat.
The horsemeat controversy has hit the Irish meat-processing industry, with a number of suppliers on both sides of the border affected.

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