Lives torn apart by failure to do the basics at 14 hospitals

The 35-year-old insurance worker had been diagnosed with a low-grade brain tumour in July 2010. But when he was admitted to the hospital’s A&E department in August the following year, after falling ill on a night out, staff failed to take the condition into account and treat him appropriately.

His was one of thousands of deaths that might have been avoided, were it not for basic failings in care at 14 hospital trusts.

The figures make grim reading, but on Tuesday Professor Sir Bruce Keogh, the medical director of the NHS, will concentrate not on the figures, but on the failure of the health service to solve the problems that they made clear.

His review of hospital performance was conducted on the instruction of the Prime Minister in the wake of the Stafford Hospital scandal, where as many as 1,200 patients died needlessly amid “appalling” conditions.

In February, on the day a public inquiry into Stafford exposed appalling failings, Sir Bruce was asked to review the quality of care and treatment at 14 NHS trusts that had higher than expected mortality rates in the past two years.

This week he will show how excess deaths at the hospitals, which serve 5.5  million people, go back far further than two years, and deep into Labour’s time in government.

His report, an overarching one on the state of the NHS as well as a detailed examination of each of the 14 trusts, will show that the rot could have been stopped long ago.

Evidence that there were far too many deaths at the hospitals was available when the extent of the scandal of North Stafford Hospitals was emerging in 2009.

However, the failures at Stafford were repeatedly dismissed as an isolated case. In March 2009 Gordon Brown, then prime minister, told MPs: “I am assured by the Healthcare Commission [the then regulator]... that there is no equivalent case in all the other NHS hospitals across the country.”

Sir Bruce’s report will be seen by critics as evidence this was wrong, and add the names of 14 trusts to Stafford’s as a roll of shame: Basildon and Thurrock; Colchester; Burton; Northern Lincolnshire and Goole; Sherwood Forest; George Eliot; Tameside; Dudley group; North Cumbria; Medway; United Lincolnshire; Blackpool; Buckinghamshire healthcare; and East Lancashire.

It will also raise profound questions about Labour’s handling of the NHS.

None of that will bring succour to Mr Day’s family. He had been in London with friends when he started vomiting and suffering head pains, and was taken by ambulance to Basildon hospital, where A&E staff failed to make regular observations of his condition. No neurological assessments were carried out and his airways were not checked, despite the hospital staff being told of the tumour by paramedics. When his tumour haemorrhaged, Mr Day went into cardiac arrest, suffering irreversible brain damage.

Caroline Beasley-Murray, the Essex coroner, said that if Mr Day had been examined sooner and neurological observations taken there was an opportunity to stall his cardiac arrest. Although she acknowledged that even with appropriate treatment, he may still have died, she said: “There were very serious failings in the care he received in the A&E department.”

Mr Day’s death followed a report by the Care Quality Commission the previous November which described bad hygiene, blood-spattered equipment and mould on the walls at Basildon A&E.

The trust was ordered to improve, but critics noted that the CQC disclosed failings at Basildon only after the trust’s high death rates were exposed by this newspaper. Until then, the health watchdog had said the trust was providing good care.

Andrew Lansley, then shadow health secretary, raised fears that Basildon was not an isolated case. “It is unacceptable that inspectors can score hospitals as 'good’ when many patients could tell them that the opposite is in fact true. A number of other hospitals also have high death rates, including Colchester, United Lincolnshire, Dudley and Tameside,” he said.

Each of those hospitals is among the 14 in Sir Bruce’s review, but when the issue was raised in the Commons in 2009, Andy Burnham, the then health secretary, suggested that figures on death rates could not be trusted and that the public should put its faith in the new health watchdog, which Labour had set up and which began work fully in April 2009.

“The authoritative voice on these matters is the CQC,” he told Parliament. “The report [on death rates which Mr Lansley raised] … analysed a more limited set of clinical and quality data than the CCQ. The CQC … takes a wider view.”

Last month the watchdog’s “wider view” was exposed as a culture of cover-up, with allegations that senior figures were determined to suppress evidence of poor performance at hospitals. Accusations have been made that regulators acted as they did because they were bowing to government pressure.

Other warning signs were there if those overseeing hospitals had looked. When it came to paying out compensation, for example, Basildon and Thurrock University Hospitals was one of the worst.

Between 2009 and 2012 it spent £19 million on settlements, compared with the average of £3.2 million among English trusts. That was not the largest total for an individual hospital. East Lancashire Hospitals NHS Trust and Tameside Hospital, in Ashton-under-Lyne, each paid out £30 million.

Data collected for Sir Bruce’s review, and seen by The Sunday Telegraph, make disturbing reading. The investigation examined not just mortality rates but infection levels; the number of patients suffering from preventable and potentially fatal signs of neglect; and the numbers harmed by “never events” such as operations on the wrong part of the body, or surgical instruments left inside a patient.

At United Lincolnshire, there were 12 such events in three years, with seven at Basildon and Thurrock and five at Buckinghamshire.
 
It was at Grantham hospital, part of United Lincolnshire Trust, that Lorraine Brewin, 46, underwent a routine operation on varicose veins in January 2009. However, she suffered a dangerous build-up of blood in her leg and was transferred to another hospital. Delays and a lack of physiotherapy meant her lower left leg had to be amputated 12 months later. The trust apologised, said it had given its staff extra training to avoid a repeat and paid compensation. Another test was being failed: at North Cumbria University Hospitals Trust only 35 per cent of staff said last year that they would be happy for a relation or friend to be treated there, compared with a national average of 60 per cent.

Another key measure is the ratio of qualified nurses to patients measured in terms of “productive hours” spent on patients by a qualified registered nurse per month. At all but one of the trusts this fell short of the national average.     

At George Eliot Hospital NHS Trust last year only 15.5 hours were spent by each qualified nurse per month directly benefiting patients, compared with the average of 85.6 nationally. The picture at Tameside hospital, was little better, with just 17.4 hours, and 25.5 hours at the Dudley Group of Hospitals.

It was at Tameside in January 2009 that Brian Wade, 69, died in agony after lying on a ward for five days while his stomach condition went untreated. Killed by blood poisoning caused by colitis, a severe but treatable inflammation of the colon, his last words were begging his daughter to get help.

A month later, Liz Degnen’s mother Betty Dunn, 79, died after contracting the superbug Clostridium difficile at the hospital in February 2009. Describing visiting her mother the day after she was admitted, Mrs Degnen said: “She was slumped across the bed with blood seeping out of her arm. Her eyes were rolling around in the back of her head and she was squirming and trying to climb over the rails of her bed. That image is planted in my mind for ever.”

Later that year the CQC rated the hospital’s services as “good”, based on a system which allowed NHS trusts to rate themselves.

Then, in February last year, a 12-year-old disabled girl lay dead in a bed at Tameside without anyone noticing for so long that rigor mortis set in. Emma Stones, who suffered from cerebral palsy, was admitted with flu-like symptoms in February last year and died 16 hours later from blood poisoning.

John Pollard, the Manchester South coroner, said she might have survived with better care, adding: “The nursing and medical care of Emma fell below the standard that most people would consider satisfactory.”

A spokesman for Tameside said it had acknowledged failures in the case of Emma and Mrs Dunn and reached an out-of-court settlement of £40,000 with Mr Wade’s widow.

The chief executive, Christine Green, and her medical director, Tariq Mahmood resigned 11 days ago, after fresh disclosures that patients were having to wait up to four days to see a consultant, or were left in corridors for hours.

For thousands of families Sir Bruce’s review may provide some answers about what went wrong for their relations; for everyone else they must provide a way of rebuilding faith in the NHS. 

This article is courtesy of the Telegraph.