You will all have been surprised that I waited so long before
I Blogged about Sir Bruce Keogh’s (The NHS Medical Director) review of the 14
failing hospital trusts – it’s not like me. That’s because this needed some
thought.
The Keogh Review, came about because of the public anger at
the unneccesary deaths (600 to 1200) which occurred at Mid Staffordshire NHS
Foundation Trust and in particular at the failure of the management, doctors
and nurses to provide basic, compassionate care to the elderly, terminally ill
and sick patients who were unlucky enough to be treated at this group of
hospitals. I commented widely on the Francis report into this scandal in my
other (rather silly) Blog at the time of publication:
The exposure of Mid-Staffs came about through the Dr Foster
Unit based at Imperial College, London and headed by Professor Brian Jarman,
who had been analysing mortality rates. The unit collated and published
mortality figures for all hospitals so that they could be compared with what was
expected. If the rate was too high, it was a cause for concern. It’s still
controversial – you can ‘fix’ the figures by changing the way deaths are coded.
I wrote a lot about that too. Some hospitals feel they are unfairly hit for
serving high risk communities or undertaking more complex operations or
treating high risk individuals. There’s a lot to argue about.
All the same, the result was the identification of 14 Trusts
that gave cause for concern – too many deaths over a long period.
As a result, Keogh, his team and Pricewaterhouse went in,
consulted and then analysed whether there was a problem and, if so, how to deal
with it. The press seem to have looked only at his covering letter to
the Health Minister, which is by way of a summary. We need to look a bit
further.
My first point is that it’s a remarkably quick report – far
too quick to be final but that’s really commendable. The patients in those
areas have waited too long, things needed to change and quickly. I think that’s
starting to happen.
Secondly, the most remarkable thing is how useless the management
of the 14 Trusts are. They knew that they were going to be investigated, it
wasn’t a secret. Not least, Keogh had a travelling consultation process which
went to each trust area to talk to patients. That means they had plenty of
notice of an inspection.
So, take a look at this damning passage;
“3.2 Where
we took immediate action to protect patients
The most
important part of my remit was to take action to protect patients from harm
where we found instances of poor care or risky environments or practices. We
employed the ‘precautionary principle’ in undertaking this review. Where we
found areas of concern, we acted immediately (we didn’t wait for a disaster so
that we could be absolutely certain).
Actions
taken included: immediate closure of operating theatres; rapid improvements to
out of hours stroke services; instigating changes to staffing levels and
deployment; and dealing with backlogs of complaints from patients.”
1) The review had to shut operating theatres?
The only reason to do that would be that they were unhygienic
or there was equipment unsuitable for use.
Was no one checking? Managers, Surgeons, Nurses?
2) Out of hours stroke services.
This simply means that those hospitals were not treating
strokes out of hours because they didn’t have specialist staff available. If
your stroke was at the weekend you waited in a bed till Monday.
Nowadays everybody knows that if you don’t treat strokes
quickly, outcomes are worse, people are more disabled than they need to be and
are more at risk of dying. Minutes count. Sometimes just taking Aspirin in time
makes a difference.
3) Changes to staffing levels and deployment – not enough
nurses and doctors.
All of this would have been obvious to the lowliest member of
staff and to most members of the public – yet it took this review to sort it
out.
I was very critical back at Easter about the way Leeds
General Hospital’s Children’s Heart Unit was closed down. It happened the day
after the campaign to save it had won a High Court Judgement declaring that the
decision making process which led to proposals to shut it down had been flawed.
At the time I felt this was badly handled by Keogh – I thought it was highly
‘political’.
I now realise that he was in the midst of this whole process
of 14 hospital inspections and in some cases this was leading to emergency
actions. I can imagine that he was appalled by what was being discovered and
trying to do something quickly to sort it out. It’s in that context that
interested and biased parties were lobbying him about Leeds.
I still don’t think it was handled well but I now understand
the pressures that he was under at the time. His ‘mistake’ was one which was on
the right side, compared with those made in the past which avoided the
problems. He’s trying to make a new start.
It also isn’t right to look at this report without taking in
the other changes that have been happening recently: last week, England’s new
Chief Inspector of Hospitals, Professor Sir Mike Richards ordered
investigations into Barts Health Trust as well as Barking, Havering and
Redbridge; Croydon; and South London Healthcare, based on their appalling
record in ‘never events’, the errors that should never happen.
There is a clear change in direction at the Care Quality
Commission: how it does its job of inspecting trusts and care homes, although
changing that will take time. In particular, inspections need to be carried out
by people with some qualification and experience to do so.
I get the feeling that the clinicians have finally got the
message that something very wrong was going on and that they had better do
something to change it. I hope so, anyway.
Am I getting soft in my old age? Well, I am being won over, the
question is whether I’ve just been schmoozed by this report or whether it’s for
real. I’m going to be a bit more critical in the second part of this review.
Neil Harris
(a don’t stop till you drop production)
helpmesortoutthenhs.blogspot.com
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