Thursday 16 October 2014

One in the eye from Musgrove hospital.


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)