Tuesday, March 24, 2009

NHS hospital scandal: missed warnings

The shocking extent of the failures at an NHS hospital where hundreds of patients died unnecessarily can be disclosed today. Senior managers at Stafford Hospital were told repeatedly that the standard of care they were delivering was not good enough but each time the warnings were ignored. The disclosures follow the publication last week of a damning report by the NHS regulator, the Healthcare Commission, that found that hundreds of patients died at the hospital because of the "appalling" treatment they received.

Today, The Sunday Telegraph can disclose that executives at Stafford Hospital were warned as early as 2002 by the commission's predecessor that it had problems with the standard of its emergency care services and that it was not adequately staffed. However, they failed to act on the warnings. In 2006, a former government adviser warned the hospital about the standards of hygiene in A&E. Again, the warning was ignored. It was only when alerts were issued over the high mortality rate at the hospital that alarm bells rang.

At that stage an investigation by the Healthcare Commission began, resulting in the publication of last week's report and the suspension on full pay of Mid Staffordshire NHS Foundation Trust's chief executive, Martin Yeates, and the resignation of its chairman, Toni Brisby.

The Sunday Telegraph launches a campaign today for a series of measures to ensure that the crisis in Staffordshire is never repeated in the NHS. The Heal Our Hospitals campaign demands the establishment of an independent inquiry into the regulation and supervision of NHS hospitals. This has been endorsed by the Patients Association and the Cure the NHS campaign group, which worked to expose the crisis at Stafford Hospital. The two groups today launch a petition demanding an inquiry.

Richard Branson, the vice-president of the Patients Association, said: "The most important thing is that patients are happy and safe. I've signed the petition because I think patients need to have confidence that they will be. Inquiries are not about laying blame, they are about finding answers to important questions." This newspaper is also calling for:

* A review of hospital targets to ensure that they work to improve quality of care.

* Nurses to focus on patient care - not form-filling - as their central duty.

* Routine publication of comprehensive death rates for hospitals.

* Patients to be given a stronger voice in the running of hospitals.

* Assurance that senior hospital staff will not be rewarded for failure.

In an interview with The Sunday Telegraph yesterday, the chairman of the Healthcare Commission condemned the board at Mid Staffordshire NHS Foundation Trust and bosses at the strategic health authority for failing to act. Sir Ian Kennedy said it was clear that serious problems at the hospital were evident as far back as 2002, yet no action was taken by managers. Sir Ian said board members and managers who had not already left should "examine their consciences". "Anybody who had any responsibility for leadership and management must ask how they allowed this place to get into the state where patients were dying," he said.

Terry Deighton, an expert in risk assessment who carried out the inspection of A&E in February 2006 that led to another warning for Stafford Hospital, described the conditions as "absolutely disgusting". He found blood encrusted on seats, puddles of urine on the lavatory floors and doctors and nurses washing their hands in sinks encrusted with grime. Mr Deighton's report said standards of cleanliness risked placing patients in danger of infection but Mr Yeates insisted that Stafford Hospital was "very clean" and refused to meet Mr Deighton for over a year.

The commission has also criticised standards of care at Birmingham Children's Hospital NHS Foundation Trust (BCH) after it struggled to meet rising demands.

The commission is also investigating allegations that West London Mental Health Trust did not do enough to prevent patients harming themselves and other people.

The disclosures have led to concern about standards of care in the NHS and calls for a change in the target-driven culture that many emergency care specialists believe is distorting clinical priorities within A&E departments.

The Sunday Telegraph's campaign has received the backing of health experts and practitioners. Claire Rayner, the president of the Patients Association, said: "The target culture has led to a dreadful waste of professional time and extra layers of management." John Heyworth, the president of the College of Emergency Medicine, said: "The lack of doctors and nurses identified in Stafford is a dramatic example of what can happen when the focus on care in departments is lifted." Dr Peter Carter, the chief executive of the Royal College of Nursing, said: "Many of the catastrophic failings identified at the Mid Staffordshire trust could have been avoided if there were simply enough nurses to care for patients."

The Conservatives will set out their own plan to put patient safety first this week. It includes giving patients power to hold failing hospitals to account, an end to the target culture and tougher inspections to root out failure. Andrew Lansley, the shadow health secretary, said: "I welcome The Sunday Telegraph's campaign. We need to make sure that patients are listened to and give responsibility to doctors and nurses."

A survey for Channel 4's Dispatches programme to be broadcast tomorrow indicates that many nurses believe that the lives of patients were being placed in danger by a lack of training, staff shortages and long hours. It also indicates that more than a third (37 per cent) think that patient care in the NHS has become worse in the past five years. Mr Yeates refused to comment but his replacement, Eric Morton, said: "Care standards fell below those that our patients had a right to expect of their hospital and we regret this. We would like to offer our very sincere apology. "We would like to reassure the local community that our focus is, and will remain, on providing high-quality, efficient and safe health care for the people of Staffordshire. "We have put in place effective governance structures to address the key issues."

The Department of Health responded to the launch of The Sunday Telegraph campaign by insisting that the problems in Mid Staffordshire were down to "a complete failure of management" at a local level, which had been revealed through a "meticulous" inquiry by the Healthcare Commission.

A spokesman said the system of regulation and management would be reviewed; trusts were expected to monitor mortality rates, and there was no secrecy over the figures; and the system of targets set minimum standards which patients would expect.


Just move on: What boss of careless NHS hospital told boy's parents after missing fatal injury

The boss of Stafford Hospital, where appalling treatment may have killed hundreds of patients, sent a `callous and arrogant' letter to the grieving family of one victim. Chief executive Martin Yeates told the parents of 20-year-old John Moore-Robinson it was time to `move on'.

Mr Moore- Robinson died because doctors at the hospital failed to discover he had ruptured his spleen in a cycling accident. They sent him home with painkillers - and he bled to death. A year later, an inquest told the hospital to improve its standard of care. But it was another nine months before Mr Yeates wrote to the family. He told them: `I hope that the way the matters have been resolved speedily will go some way to help and your family feel that it's time to put the matter behind you and move on. `Please accept my apologies and regret for the death of your son.'

Mr Yeates is suspended on full pay - 15,000 pounds a month - after a damning report from the Healthcare Commission found that his NHS Trust board prioritised Government targets over basic patient care. An inquiry has been launched into his role in the scandal. Last night, Frank and Janet Robinson, both 57, branded his words ` despicable' and `insulting'. Mr Robinson said: `It makes my blood boil to think that Martin Yeates has got away with it and he's living it up it on full pay. `We can't possibly start to move on when we know that John lost his life needlessly. We've lost our boy and he thinks he can make everything OK with a letter. 'The arrogance of it is despicable. The letter is an insult. I don't for one minute think that he's truly sorry. `He was in charge of the hospital and he's at least partly responsible.'

Mr Moore-Robinson, a telecommunications worker, was thrown over the handlebars of his mountain bike on a day trip to Cannock Chase, Staffordshire, with friends in April 2006. He was taken to Stafford Hospital A&E department where an X-ray revealed broken ribs. He was vomiting and in agony but doctors prescribed pain medication and discharged him, his family said.

Friends drove him back to his home in Coalville, Leicestershire, but within hours his family called 999 because he was still in severe pain. He died minutes before paramedics arrived. His father said last night: `It's every parent's worst nightmare to lose their child but when somebody's incompetence is to blame it becomes worse. `John's treatment was shambolic and I am demanding that senior management be brought to account for the shocking waste of life.' Mr and Mrs Moore-Robinson plan to join other grieving families in suing the Mid-Staffordshire NHS Trust.

Health Commission investigators uncovered a shocking series of failings between 2005 and 2008, including staff shortages and unqualified receptionists carrying out initial checks on A&E patients. More than 100 people told them that patients were ignored as they called for help on filthy wards covered in blood and excrement. Staff showed a general lack of compassion, dignity and respect, the commission's report said. As many as 1,200 patients may have died as a result of the appalling treatment they received.


U.S. health care overhaul may cost about $1.5 trillion

Your lungs may work just fine, but the estimated price for universal health care could take your breath away. Health policy experts say guaranteeing coverage for all Americans may cost about $1.5 trillion over the next decade. That would be more than double the $634 billion 'down payment' President Barack Obama set aside for health reform in his budget. About 48 million people are uninsured, and the problem is only expected to get worse because the cost of coverage keeps rising.

Still, administration officials have pointedly avoided providing a ballpark estimate for Obama's fix, saying it depends on details to be worked out with Congress. "It's impossible to put a price tag on the plan before even the basics have been finalized," said White House spokesman Reid Cherlin. "Here's what we do know: The reserve fund in the president's budget is fully paid for and provides a substantial down payment on the cost of the reforming our health care system."

The potential for runaway costs is raising concerns among Republicans and some Democrats as Congress prepares to draft next year's budget. The U.S. spends $2.4 trillion a year on health care, more than any other advanced country. And some experts estimate that a third or more of that goes for tests and procedures, rather than prevention and treatment. "We shouldn't just be throwing more money on top of the present system, because the present system is so wasteful," said Sen. Judd Gregg of New Hampshire, the ranking Republican on the Budget Committee.

The health care plan Obama offered as a candidate would have cost nearly $1.2 trillion over ten years, according to a detailed estimate last fall by the Lewin Group, a leading consulting and policy analysis firm. The campaign plan would not have covered all the uninsured, as most Democrats in Congress want to do. But it is a starting point for lawmakers.

John Sheils, a senior vice president of the Lewin Group, said about $1.5 trillion to $1.7 trillion would be a credible estimate for a plan that commits the nation to covering all its citizens. That would amount to around 4 percent of projected health care costs over the next 10 years, he added. The cost of covering the uninsured is "a difficult hurdle to get over," Sheils said in an interview. "I don't know where the rest of the money is going to come from," he added.

Some of the leading advocates of coverage for all use cost estimates around $1.5 trillion. "Honestly ... we can't do it for the $634 billion the president put in the reserve fund," John Rother, public policy director for AARP, told an insurance industry meeting in Washington last week. "In all likelihood, it will be over $1 trillion," he added, citing his own estimate of $1.5 trillion.

Economist Len Nichols, who heads the health policy project at the New America Foundation, said guaranteed coverage will cost $125 billion to $150 billion a year when fully phased in.

White House budget director Peter Orszag told the House Budget Committee earlier this month that the president's $634 billion fund is "likely to be the majority of the cost." Roughly half of the money would come from spending cuts, and the other half from tax increases. But whether the $634 billion represents 50 percent, 60 percent or 70 percent of the cost "will depend on the details of whatever is finally done ... as we move through the legislative process," Orszag added.

The overall cost matters because the expansion of health coverage is meant to be a permanent reform. That means future generations will have to bear the cost. "We are dealing with huge numbers," said David Walker, a former U.S. comptroller general and now head of the Peter G. Peterson Foundation, a group that promotes fiscal responsibility. "We need to have a much better sense of what we are talking about doing, and whether or not it's affordable and sustainable over time."


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