Monday, March 09, 2009

Failings at NHS children's hospital put patients at risk, says watchdog

A leading children's hospital is to be censured by the NHS watchdog for endangering the safety of vulnerable young patients by offering them substandard care. The Healthcare Commission will issue a highly critical report on Birmingham Children's Hospital that will highlight numerous failings in both quality of care and management processes. The hospital announced yesterday that Paul O'Connor, the chief executive, had resigned with immediate effect.

The report will acknowledge that poorly trained staff, inadequate equipment and a lack of operating theatres led to some youngsters receiving poor care, including some whose health was put at risk. It will make a dozen recommendations for major improvements.

Gordon Brown and health secretary Alan Johnson asked the watchdog to investigate last November after the Observer published details of a secret internal NHS report. It revealed that about 20 senior doctors were deeply concerned that recurring problems at BCH were hampering the quality of treatment being offered to patients with life-threatening conditions involving their liver, kidney, heart or brain.

BCH chairman Joanna Davis yesterday confirmed that O'Connor "has tendered his resignation with immediate effect. He has not been removed from his position." She declined to comment on the watchdog's report, the result of a four-month "intervention" inquiry, until it is published. Whitehall sources say commission staff, led by its chief investigator Nigel Ellis, uncovered evidence that seemed to endorse many, but not all, the concerns aired by medical staff.

The report is also expected to confirm another key concern raised by doctors: that some patients unnecessarily underwent major surgery designed to diagnose or treat their conditions because BCH could not offer them interventional radiology, which is minimally invasive and seen as best practice in the NHS. This is despite doctors repeatedly recommending the hospital take action to address the issue.

One surgeon described the liver transplant service at BCH as so poorly run that it had become "a third-class service [that is] putting patients at risk". Another said parents were being told lies about the unnecessary procedures because they could not admit that BCH lacked the personnel and equipment to offer an alternative.


Bankrupt Australian public hospital partly closed down

Bed numbers have been slashed this week at Sydney's biggest hospital, in a round of ward closures aimed at reining in a $70 million blow-out in the region's health spending. Ten of 16 operating suites have been closed and elective surgery has been cancelled, with staff forced to take leave, sources said. Forty-three cardiology and heart surgery beds have shut since late last year, said medical and nursing staff, culminating last week in the closure without notice of the heart surgery ward - which staff found empty and locked when they arrived for work.

The unprecedented axing of about 70 beds comes after the Herald revealed in late January that Sydney West Area Health Service, which oversees Westmead, owed $26 million to creditors - more than any other region and almost a quarter of NSW Health's outstanding debt to suppliers at that time.

Neurosurgery and general surgery beds have also closed, said the sources, while casual nursing shifts have been curtailed across the entire hospital, as displaced permanent staff are redeployed into vacancies on the roster. The closures represent about 9 per cent of Westmead's total capacity, and are the biggest round of cuts at a single hospital to strike the beleaguered state health system. The chairman of the hospital's Medical Staff Council, Andrew Pesce, said the closures were by far the most severe the flagship teaching hospital had seen. "It's a quantum leap [compared with] the modest bed closures usually built around [public] holidays," Dr Pesce said.

Coming a month before Easter and without any promise that beds would reopen or surgery resume, the closures were the equivalent of an extra Christmas closedown, said Dr Pesce - referring to the practice of selectively suspending services during the holiday period to save money. "If things continue the way they are going, the morale of the place will become so low that doctors and nurses will start leaving," he said. Hospital managers were not solely to blame because NSW Health gave them "unrealistic budgets".

Public hospitals had traditionally been insulated from state spending cuts, Dr Pesce said, but NSW's wider financial crisis meant they were no longer receiving favourable treatment. Health accounts for about one-third of the state's spending, and had blown out by about $300 million at the time of November's mini-budget. Area health services were ordered to save $943 million over four years.

A spokesman for the Health Minister, John Della Bosca, declined to address the Herald's specific questions about closures, offering instead in a written statement: "There have been adjustments to bed platforms and relocations of some services within Westmead's overall funding base . Westmead has further capacity to improve bed utilisation and this is a priority for management attention in the relevant services as part of the operational strategy." He also did not answer a question about the number of patients whose elective operations were cancelled, instead insisting elective surgery was still available but saying the hospital was "under resource pressure and needs to ensure that its priorities are met but not exceeded and that all opportunities to ensure it operates efficiently are explored".

The president of the NSW branch of the Australian Medical Association, Brian Morton, said he understood patients would be moved to general wards under the care of "staff who don't have the same skills". Patients would be at risk if already overcrowded hospitals were further stressed. .. That's when mistakes happen."

The Opposition's health spokeswoman, Jillian Skinner, said the closures would endanger patients. "The evidence is quite clear that delayed treatment makes conditions worse and makes the hospital stay longer - and therefore more expensive."


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