Shock report finds patients died due to cuts at Stafford Hospital
Mar 18 2009 by Alison Dayani, Birmingham Post
Abysmal failings at “virtually every stage” of care for patients at Stafford Hospital were a direct result of managers making unrelenting cuts to achieve financial targets, a shock independent report has found.
Independent watchdog the Healthcare Commission has criticised Mid Staffordshire NHS Foundation Trust, which runs Stafford and Cannock Hospitals, for significant failings in leadership and management, plus “appalling” emergency care that played a part in higher than normal death rates.
Martin Yeates and Toni Brisby, chief executive and chairman at the time, both resigned two weeks ago ahead of the investigation that found at least 400 patients were estimated to have unnecessarily died at Stafford Hospital between 2005 and 2008.
The Stafford coroner refused to provide inspectors with information about inquests so that figure could be higher.
Investigators found receptionists even carried out initial checks on patients at Stafford A&E due to lack of nurses and doctors, heart monitors were turned off because nurses did not know how to use them and board meetings were held in secret.
A review found the Trust was short of 120 nurses along with consultants and doctors. But this emerged after waves of cost-cutting to save £10million in 2006/07 to end the year in the black – a Department of Health target – and further plans in 07/08 to make £8million savings over the next two years.
The report says Mr Yeates came on board as interim chief executive in August, 2005, saying radical moves were needed to get the Trust on track financially from a forecast £2million debt.
The number of nurses and healthcare assistants fell by 297 between 2005 and 2008 with only three matrons for the entire Trust and high sickness levels along with 100 fewer beds.
But Healthcare Commission inspectors more worryingly found that the board failed to reinvest in staff after finishing the year with a £1million surplus, as this cash had to be used to repay brokerage to the Primary Care Trust.
Trust chiefs were criticised for “misjudging” the financial imperatives. Inspectors also said many staff considered the priorities were finance and achieving foundation trust status, which it gained in February last year, over patient care.
Sir Ian Kennedy, Healthcare Commission chairman, said: “This is a story of appalling standards of care. There were inadequacies at almost every stage. There is no doubt patients will have suffered and some will have died as a result.”
The Commission launched its investigation in March, 2008, after the Trust deviated an unprecedented 11 times from expected death rates between July, 2007, and November, 2008. They were instantly contacted by 103 relatives and patients, of which 99 had encountered a bad experience.
Mortality rates were 127 in 2005/06, compared to 100 nationally, and jumped as high as 145 over the next two years.
> See the full report in pdf here
Other findings were:
* Main concerns were A&E, emergency assessment unit and wards 6, 7, 10, 11 and 12;
* Patients were moved to an unstaffed “dumping ground” of a clinical decision unit to “stop the clock” of the four-hour A&E waiting time target;
* The ratio of nurses to patients by the end of 2007 was about one to 15 patients, compared to the recommended one to six;
* Minutes of board meetings from April, 2005, to 2008, showed discussions were dominated by finance, targets and achieving foundation trust status;
* The majority of doctors the Healthcare Commission interviewed would not have been happy for a relative to be treated at the Trust;
* The most senior surgical doctor in the hospital after 9pm was often junior as too few consultants provided on-call cover;
* A number of patients died after developing deep vein thrombosis from clots, a major cause of death following surgery, but there were not suitable procedures to use anti-thrombotic drugs;
* There were too few beds for patients who had had a stroke and not all patients with heart attacks went to the acute coronary unit. The medical wards were seriously under-staffed;
* Assessing the priority for care of patients in A&E was routinely conducted by unqualified receptionists. A patient with an open fracture of the elbow waited for more than four hours covered in blood with no pain relief;
* On medical wards, nurses could not always identify when patients were deteriorating after an operation. Nurse shortages compromised care with call buttons going unanswered when patients were in pain or needed the toilet;
* Sometimes a patient’s operation might be cancelled four days in a row, and they would receive ‘nil by mouth’ for most of the day, four days running.
