Wednesday, July 17, 2013

North Cumbria and East Lancs among NHS trusts placed in Special Measures

North Cumbria University Hospitals NHS trust, which runs my local hospital in Whitehaven, WCH, and the North Cumberland Infirmary at Carlisle, was among eleven hospital trusts placed in "Special Measures" yesterday by the Secretary of State for health following a review of the fourteen trusts which appear to have the largest gap in the wrong direction between actual mortality rates and the "erxpected" number of deaths.

East Lancashire was another of the trusts affected.

This action has been taken because review panels found serious issues at all eleven trusts, mostly going back many years.

The fact that death rates at these trusts have been above those expected does not prove that poor care at the hospitals concerned caused these deaths, but it does indicate the strong possibility of a serious problem which needs urgent attention.

There are many excellent people in the NHS who work hard for the welfare of patients, including many at the trusts affected, and this is not a criticism of those people. But patients deserve to be treated by an NHS in which failure to provide the best patient care is unacceptable - and most doctors, nurses and support staff would want this too.

The former director of public health in Cumbria, Professor John Ashton - not a man who is terribly popular in West Cumbria because he always says exactly what he thinks even when it will upset people, but for precisely that reason his views are worth listening to - said on BBC Radio four yesterday that he had been trying to raise concerns about our local hospitals since the middle of the last decade and those concerns had not always been taken as seriously by NHS leadership as he thought they should have been.

He referred to the problem with too many NHS targets and the wrong approach to them as "hitting the targets and missing the point."

The investigation into the North Cumbria University Hospitals NHS Trust found:

* Evidence of poor maintenance in two operating theatres, which were closed immediately.

It also found:
  • Significant weaknesses in infection control and prevention practices
  • Inadequate staffing levels and over-reliance of locum cover
  • Shortfalls in learning from serious incidents
The investigation into East Lancashire Hospitals NHS Trust

* issues of poor governance, inadequate staffing levels and high mortality rates at weekends, including a high level of still born babies.

There were problems found in the following areas:
  • The complaints process was poor and lacking a compassionate approach
  • Quality processes were not cohesive
  • Managing high patient levels, particularly in A&E.

"Hit squads" will go into all eleven hospital trusts placed in special measures to provide assistance and make sure action plans are in place and implemented to address the issues found.

With regard to the NHS culture, while I think abandoning all targets would be throwing the baby out with the bathwater, it is becoming clearer and clearer that there is a need for fewer and broader-based targets which are patient and outcome focussed rather than process focussed

E.g. we need targets based on whether patients survive and get better rather than the technicalities of how they are treated - for example, targets based on how many cancer patients survive and how satisfied they are with their care rather than statistics on what appointments they have by some arbitrary deadline.

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