THE TELEGRAPH by LAURA DONNELLY (GERMANY FORCES SICK ELDERLY TO EUROPEAN COUNTRIES, AWAY FROM FAMILY, BECAUSE “IT COSTS TOO MUCH TO CARE FOR THEM.” AND NOW THIS! JM)
Stafford Hospital: the scandal that shamed the NHS
Patients lying starving, soiled and in pain. Over-worked staff dogged by targets. Laura Donnelly tells how a culture of fear meant that ticking boxes trampled over the basic needs of the most vulnerable.
By the time Stafford hospital’s failings were exposed by regulators up to 1,200 patients had died needlessly Photo: PA
By Laura Donnelly, Health Correspondent
7:20AM GMT 06 Jan 2013
It was the scandal that shamed the NHS.
Hundreds of hospital patients died needlessly. In the wards, people lay starving, thirsty and in soiled bedclothes, buzzers droning hopelessly as their cries for help went ignored. Some received the wrong medication; some, none at all.
Over 139 days, the public inquiry into the Stafford hospital scandal has heard testimony from scores of witnesses about how an institution which was supposed to care for the most vulnerable instead became a place of danger.
Decisions about which patients to treat were left to receptionists, inexperienced junior doctors put in charge of critically-ill patients, and nurses switched off equipment because they did not know how to use it.
Desperate relatives told the inquiry, chaired by Robert Francis QC, how patients were left so dehydrated that some began drinking from flower vases.
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By the time the hospital’s failings were exposed by regulators, in 2009, up to 1,200 patients had died needlessly between 2005 and 2008.
It happened in simple terms because managers attempted to cut costs and meet Labour’s central targets, so they could achieve the coveted “foundation status” for Mid Staffordshire NHS trust – enforcing 160 job cuts as they tried to succeed.
Now a public inquiry, which opened more than two years ago, is attempting to address fundamental two questions. How was it that the regulatory and supervisory systems which should protect all patients failed so catastrophically – and what is to stop it happening again?
Mr Francis and his team have heard from 290 witnesses, and considered more than one million pages of evidence, in an inquiry which has so far cost almost £13 million. Repeatedly, the evidence has led to one question – whether a “culture of fear” means that the demands of the NHS hierarchy take precedence over the most basic needs of patients.
The inquiry heard that at Stafford, NHS targets ruled supreme.
Orders were cascaded down the management hierarchy, from the executive board, to the operational managers, to the senior nurses and matrons; nurses and doctors who failed to meet them were threatened with the sack.
It led to junior nurses and doctors abandoning seriously-ill patients to treat minor cases who were in danger of breaching the four-hour Accident & Emergency (A&E) waiting time limit.
For the same reason, patients were often moved out of casualty soaked in urine or covered in faeces, because the target – to admit or discharge patients within four hours – was under threat.
Meanwhile, nurses were instructed by senior nurse colleagues to falsify waiting times, and to claim that patients had been seen more quickly than they were.
During the hearings, one young nurse, Helene Donnelly, told how she tried to speak out but said: “I’d seen people die, needlessly I think in some cases, but certainly with a lack of dignity or respect, and that was so distressing to me … it wasn’t just once or twice that happened, it was relatively frequently.”
After she made a complaint, other staff threatened to physically harm her.
Despite an internal investigation into the concerns raised by Mrs Donnelly in 2007, no changes were made, she said, and she was left to work with the colleagues she had accused of malpractice. She left the following year, and took a job at another NHS hospital.
Dr Christopher Turner, a specialist registrar in Stafford A&E which is now a consultant, described a culture of bullying and harassment towards staff, especially nurses. He witnessed nurses leaving meetings in tears, after being told that their jobs were at risk if the four-hour target was breached.
Often, patients who were approaching the time limit were put in a clinical decision unit – a “dumping ground” where they received inadequate care, but which allowed nurses to claim that the target had been achieved. An emergency assessment unit was frequently misused for the same reason, becoming so chaotic that staff nicknamed it “Beirut”.
NHS managers staffed the hospital so thinly that there were never enough consultants to properly supervise junior doctors, who took much of their instructions from the senior nurses and matrons who enforced the targets.
At nights it was worse. After 9pm, the most senior surgeon left in charge was often a junior doctor, with little experience of emergency surgery.
Many of the nurses had never been shown how to use basic life-saving equipment, such as cardiac monitors, which identify whether a patient is deteriorating; some turned them off.
When patients arrived at A&E, there were not enough nurses to assess them. In fact, the task was left to receptionists, who took decisions based on a “gut instinct”.
Meanwhile, on the wards, patients – most of them elderly – were left in agony and screaming for pain relief, as their loved ones desperately begged for help.
The human toll was dreadful. In the course of 18 months, one family lost four members, including a newborn baby girl, after a catalogue of failings by the hospital.
Kelsey Lintern, 39, from Cannock, in Staffordshire, lost first her six-day-old daughter Nyah, then Laurie Gethin, her sister, 37; Tom Warriner, 48, her uncle; and finally Lillian Wood-Latta, 80, her grandmother.
Nyah had to be delivered in January 2007 by Mrs Lintern’s mother, Shirley, because a midwife was not attending – after another had tried to give Mrs Lintern a painkiller to which her notes said she was allergic, a potentially fatal error.
Nyah was born not breathing, she was resuscitated, and discharged after two days, despite the family’s fears she was still seriously ill. Four days later, she died, with a post-mortem disclosing four holes in her heart. Mrs Lintern said it might not have been possible to save her child, but that the hospital should at least have realised there was a problem.
Three months later Mrs Gethin died of lung, bone and lymph cancer, at the age of 37. It had taken 18 months to be diagnosed, despite clear symptoms, and only been detected when she was scanned at another hospital.
In January 2008, Mr Warriner, died after his intestine was accidentally pierced in an operation for bowel cancer. Then Mrs Wood-Latta, 80, died hungry and dehydrated after suffering a stroke. The family said hospital staff failed to give her enough fluids.
All around the wards there were lapses. Patients were left without medication, food and drink, and left on commodes. Basic hygiene was neglected: a woman was left unwashed for the last four weeks of her life.
Relatives tried to keep their loved ones clean, scrubbing down beds and furniture and even bringing in clean linen. One consultant described how amid the chaos, it seemed at though nurses became “immune to the sound of pain”.
For those whose relatives were deprived of care and even food and drink it was difficult to understand why there were so few nurses to tend to patients.
They could little imagine that in August 2005 in the hospital trust’s executive offices, a board led by Martin Yeates had decided to embark on cost-cutting plans as it attempted to secure “foundation trust” status.
Foundation hospitals were a flagship policy for Labour, supposedly the best in the country, and given many freedoms from Whitehall, including over executive pay, and holding board meetings in secret.
The trust needed to convince Monitor, the regulators, that it could meet key targets, particularly the four-hour wait, on a lower budget.
The NHS trust was desperately short-staffed, with 100 vacancies for nurses alone, but from 2005 onwards it embarked on widespread job cuts. Between 2006 and 2008 160 nurses left the trust either through retirement or redundancy; £1.3 million was spent on redundancy payments.
The board’s obsession about the project left executives blind to the impact cuts would have on patients.
Wards became more reliant on unqualified and untrained healthcare assistants, employed at much lower cost than nurses. On one floor of the hospital, the staff shortages became so extreme that two nurses were left to care for 40 patients.
In September 2007, Bella Bailey, 86, was admitted. Her daughter Julie became so horrified by the care her mother received, and the screams of agony from those left untended around her, that she and her family took turns every night by her mother’s bed. Complaints fell on deaf ears. A letter to Mr Yeates was not answered.
Her mother died after eight weeks of suffering, Miss Bailey began campaigning to ensure no other family went through such torment.
After she wrote to a local newspaper to describe the family’s experience, and to ask others to speak out, she was inundated with letters, and calls.
What nobody knew was that in April 2007 statistics had shown that death rates at the hospital were dramatically higher than elsewhere in the country.
West Midlands strategic health authority, which had responsibility for supervising the hospital, commissioned which took more than a year to decide – wrongly – that the flaws lay with the data not the care being given by the hospital trust.
As a result no action was taken to examine the actual quality of care at the hospital. In July 2008, a month after the report on the figures was produced, the authority’s chief executive, Cynthia Bower, was promoted to run the Care Quality Commission (CQC), which would be given oversight of all health and social care in England and Wales.
By now, the trust’s bid for foundation trust status had been approved in June 2007 by Andy Burnham, then a junior health minister.
Amid the celebrations when the status was granted the following February, the trust’s chief executive Mr Yeates told local papers the hospital had made “the premier league” while all staff were given £25 Marks & Spencer voucher.
The authorisation was made by one regulator – Monitor, which is responsible for foundation trusts – without being told that another regulator, the Healthcare Commission, later replaced by the CQC, was poised to announce a full-scale investigation of the trust, because of its concerns. Within weeks of the celebrations, the year-long probe was under way.
It was another year, before, in March 2009, the scandal was finally exposed. By now, Mr Yeates, the chief executive of the trust, and Toni Brisby, its chairman, had already quietly stepped down.
The investigation into Stafford found that failings were such that between 2005 and 2008, there were between 400 and 1,200 “excess deaths” – in other words, up to 1,200 more people died than would have been expected at a hospital with a similar catchment area. In the regulator’s last act, Sir Ian Kennedy, the chairman of the Healthcare Commission, described the findings as “appalling” – the worst that the regulator had ever uncovered.
Gordon Brown, then prime minister, said that what went on was “inexcusable” and a plethora of reviews and inquiries were announced – but crucially, not a public inquiry to establish how the systems supposed to supervise hospitals – the health authorities, and a labyrinthine regulatory system – failed so catastrophically.
In opposition, the Conservatives called for such an inquiry, which was also demanded by patients’ group Cure the NHS and by a campaign led by this newspaper.
On 9 June 2010, just a month after the Coalition was formed, Andrew Lansley, then health secretary, announced that a public inquiry would go ahead, and now its findings are about to be sent to Jeremy Hunt, his successor.
For those who died or suffered its findings are too late; for the millions who depend on the NHS they will be absolutely crucial.
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