This exclusive report from The Guardian does a valuable
service – it’s the secret NHS report into the scandal at Musgrove Hospital
where the NHS contracted out Cataract operations to a profit making private
company which then subcontracted out as much of the contract as possible.
The operations were going wrong at an alarming rate,
eventually (far too late) the contract was suspended and then cancelled.
There is no conclusion about what went wrong, so I’ll tell
you; too many operations carried out too quickly with too few staff who were
inadequately trained.
Who foots the bill? The NHS – who do they sue out of the four
companies?
Who takes the profit?
Leaked report into cataract surgery revealed
Complications at Musgrove Park hospital in Taunton were ten
times the number that might have been expected.
Steven Morris
The Guardian, Thursday
16 October 2014
Musgrove
Park Hospital in Taunton, Somerset outsourced eye surgery to a private company.
NHS
patients who suffered complications during eye surgery outsourced to a private
company felt the procedures were rushed and complained they endured pain during
the operations and were shouted at by medical staff, a confidential report
obtained by the Guardian has revealed.
The report,
which health bosses are refusing to publish, says that the private company
agreed to perform 20 cataract operations on patients a day, at least six more
than the hospital’s own surgeons would usually undertake.
In
addition, the report suggests that the combination of staff, equipment and facilities
had not been tried before. It says that training was still going on when the
first patients arrived at the mobile operating theatre at Musgrove Park hospital
in Somerset. Concerns are also raised that the operations were not halted as
quickly as they could have been when it became clear that patients were
suffering complications. Rather than stopping procedures and finding out what
had gone wrong, they pressed on.
By the time
the operations at the Taunton hospital were stopped, 62 patients had undergone
surgery. Of them, only 25 had a “normal recovery”.
The report
says the complications reported were ten times the number that might have been
expected.
Among the
complications were burns caused by the machine used to break up cataract and
loss of iris pigment. Some were left with microscopic metallic fragments in the
eye, others had to have further surgery because cataract fragments were left in
their eyes.
The report,
marked “strictly confidential: not to be disclosed to any other party”, also
gives a rare insight into how contracts between NHS hospitals and private
operators work. Musgrove Park drew up a contract with the global health giant
Vanguard Healthcare Solutions. It in turn sub-contracted the provision of surgeons
and equipment to another private company, which in turn sub-contracted the
provision of some equipment to a third company.
It raises
worrying questions about how a private healthcare company and an NHS trust work
together. The decision not to publish the report seems to fly in the face of
the government’s commitment to openness about mistakes following the Mid Staffs
hospital scandal Musgrove claimed it wanted to publish the report but was advised
not to do so for fear that it would be defamatory and open the hospital up to
legal action.
Mike Rigby,
an independent Somerset county councillor, who has been trying get answers
about what went wrong since the problems happened in May, said many unanswered
questions remained. He said: “I have long been concerned that this sort of
problem could occur following the fracturing of comprehensive patient care
caused by the government’s reorganisation of the NHS and the huge involvement
of private health firms that it invited.”
Rigby said
the report did not get to the “root of the problem”, adding: “Many questions
are left unanswered.”
The report
says that in spring 2014 Taunton and Somerset NHS Foundation Trust needed a
“decisive” solution to a backlog of cataract cases to meet government waiting
list rules.
The trust
drew up a contract with Vanguard to treat 400 patients during May 2014. The
final contract was agreed on 1 May and operations began next day.
Operations
were carried out on 2, 3 and 4 May.
But on 6
and 7 May, according to the report, concerns were raised by Musgrove consultants
regarding three patients who had attended the eye casualty department with
problems following surgery at the Vanguard facility.
No issues
or concerns had been raised by Vanguard. Following discussions between
the trust
and the private companies involved, it was decided that products – drugs and
chemicals – used during the operations rather than surgical problems were
likely to be the problem. It was decided to change the products and carry on
with surgery as planned on 9 May.
Concerns
were still being expressed by hospital staff but operations began again at
9.48am on 9 May. By 11am it was clear that other patients were reporting complications
and operations were stopped. The contract was suspended and cancelled on 12
May.
The report
found that the two surgeons had “significant relevant experience” and both were
working in NHS consultant posts. But the combination of staff, equipment and
facilities had not been brought together before.
Investigators
looked at whether poor surgical technique was to blame. But the report says
this “cannot be the whole explanation” or such problems would have been picked
up by the surgeons’ own hospitals or while working in private practice.
Patients were affected following operations by both surgeons.
But the
report says the “pressure of operating on 20 patients each day may have contributed
to the possible deterioration of surgical quality and reduction in patient
experience.”
it says
some patients reported the procedure felt “rushed”. Several reported experiencing
pain during the procedure and being “shouted at” for moving.
The report
concludes that “no single cause was identified....the trust has not been able
to identify any clear cause that explains all the complications.”
It says:
“From the first session on the first day of operating, the number of cases was
fixed at 20 per day. “This did not allow for significant on-site training
time....Patients were arriving at the Vanguard facility while training was
going on, creating pressure to start the lists promptly and shorten training.”
The report
said that “in retrospect” the products identified as the possible reason for
complications were unlikely to have been the cause for complications.
It suggests
that “clearer escalation processes” could have led to an earlier decision to
halt operations.
The report
says that by the time it was written, of the 37 patients who did not have a
“normal recovery”, 32 had now been discharged and five were still receiving
follow-up treatment.
In a
statement released before the report was obtained, Musgrove said: “We have now
concluded a thorough investigation. The purpose of this was to try and establish
what happened to cause the complications that the patients operated on in the
Vanguard mobile theatre experienced, and how we could learn from these events
to minimise the risk of recurrence in the future.
“As with
similar ophthalmic incident clusters there is no clear single cause for the
range of problems our patients appear to have experienced.
Instead we
have identified a number of factors which may have led to the unusually high
level of complications seen. The detail of the investigation has been shared
with patients.”
Ian
Gillespie, Vanguard’s chief executive, said: “Our focus remains first and foremost
on the patients and their care, and I’d like to personally convey my sympathy
for any patients who have experienced discomfort or distress.
“This was a
collaborative contract, and we have been working closely with the trust
throughout this investigation. The investigation does not identify any one cause,
but instead points to a number of different factors which may have led to the
complications experienced by patients. No issues have been identified with the
Vanguard mobile theatre facility itself; however, there are clearly lessons to
be learned by all parties. We are working with the trust to ensure that measures
are put in place to prevent this happening again.”
As usual, when private companies take over NHS work they take
the profits but the NHS is accountable for the mistakes and it’s us who pick up
the bill.
Neil Harris
(a don’t stop till you drop production)
Contact me: neilwithpromisestokeep@gmail.com
