In court with the Mid Staffordshire NHS Trust.

The Mid Staffordshire Hospital scandal continues; The health and safety executive are now prosecuting the Health Authority for some of the most blatantly negligent of the 600 odd deaths caused by poor staff and management at this nightmare group of hospitals.

Except it is being wound up and effectively a 'legal body' is being taken to court when it should have been the management and those directly responsible.

This would be just a farce except one of the deaths occurred last year - long after the scandal was exposed, the official report was published and  a 'new' trust created to take over.

You can read about Mid Staffs and The Francis Report on the archive pages of this Blog.

This is from The Daily Telegraph;

Sponsored

 

Mid Staffordshire NHS Foundation Trust charged over four deaths

The trust at the centre of the worst ever NHS scandal is facing criminal charges over the deaths of four patients

 

     

By Laura Donnelly, Health Editor

15 Oct 2015

The trust which ran Stafford Hospital is to face criminal charges related to the deaths of four patients - one as recent as last year.
 

The Health and Safety Executive (HSE) has brought charges against Mid Staffordshire NHS Foundation Trust over the deaths of four elderly patients between 2005 and May 2014.

Mid Staffordshire NHS Foundation Trust was at the centre of one of the biggest scandals to hit the health service over the deaths of hundreds of patients, amid appalling failings in care.

The HSE said the charges related to the deaths of Patrick Daly, aged 89, who died in May 2014, Edith Bourne, aged 83, who died in July 2013, Ivy Bunn, aged 90, who died in November 2008, and Lillian Tucker, aged 77 who died in October 2005.

Mrs Tucker died after a junior doctor gave her a penicillin-based drug despite being told she was allergic to the antibiotic, an inquest heard. She had suffered fall, which led to a small fracture while on a family holiday in the area.

His son later said he "would not touch the hospital with a barge pole" after detailing the family's repeated warnings about his mother's allergy.

The HSE said it had charged Mid Staffordshire NHS Foundation Trust following a "thorough and comprehensive investigation into the circumstances of four deaths of patients under its care".

The trust is due to appear before Stafford Magistrates on November 4. A new trust began to run the hospital last November.

Last week police and health officials said they are investigating claims of an NHS “cover-up” over the death of a three-year old boy, Jonnie Meek, at Stafford Hospital, last year.
 
The parents of Jonnie Meek, who died at Stafford hospital, say failings were covered up .

This probe will check claims that statements from health workers who witnessed his death were falsified.
It is very rare for the HSE to act in cases involving clinical failings, and the body has previously been criticised for its reluctance to prosecute.
 
The Mid Staffs inquiry accused the body of “looking for reasons for not taking action rather than starting from a consideration of what is in the public interest. “
 
“The more serious and widespread a failure is, the less likely it is that the HSE will decide to intervene, even where it is apparent that no other regulator is likely to do so,” Robert Francis, the chairman of the inquiry said.

Last year the same trust was fined £200,000 over the death of Gillian Astbury, 66, who died in 2007 because nurses at Stafford hospital failed to give her the routine insulin she required to stay alive.
Wayne Owen, HSE principal inspector in the West Midlands, said: "We have concluded our investigation into the death of four patients at Stafford Hospital and have decided there is sufficient evidence and it is in the public interest to bring criminal proceedings in this case."

The trust remains in place as a legal entity but no longer provides patient services.
University Hospitals of North Midlands NHS Trust took over the running of Stafford Hospital and Royal Stoke University Hospital.

The Mid Staffs special administrator Tim Rideout said the remaining "shell organisation" would oversee any "potential criminal liabilities".
He added: "I am committed to bringing matters to a conclusion as efficiently and effectively as possible in the best interests of the families concerned.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com

 

Safety staffing levels to be ignored.

NHS 'backtracking' on ward nurse numbers introduced after Mid Staffs

Critics fear safety will be sacrificed to cut costs after NHS bosses tell hospitals that 1:8 nurse-to-patient ratio is a guide, not a requirement

 

Denis Campbell

Health policy editor

Tuesday 13 October 2015 

 

  

The NHS has been accused of backtracking on improvements in patient safety made after the Mid Staffs scandal by reducing the number of nurses on wards because of its growing financial crisis.

NHS bosses have told hospitals they no longer have to ensure that one nurse is caring for no more than eight patients at a time, in order to help tackle a £2bn black hole that has left 80% of hospitals facing deficits of up to £100m each.
The letter states: “We would stress that a 1:8 ratio is a guide not a requirement. It should not be unthinkingly adhered to. Achieving the right number and balance of clinical and support staff to deliver quality care based on patient needs in an efficient way that makes the best possible use of available resources is the key issue for provider [hospital] boards.
 
 
The move, set out in a letter to all hospital chiefs, has sparked fears that patient safety will be sacrificed to help hospitals cut costs. It makes clear that financial considerations are deemed to be as important as the safety and quality of care patients receive when deciding how many nurses should be on duty.

Cash-strapped hospitals may be tempted to cut their nurse staffing levels as a result of the new advice, the Royal College of Nursing (RCN) warned. Staffing takes up 70% of the NHS’s budget and its bill for employing temporary staff to plug gaps in rotas, especially expensive agency nurses, has hit £3.3bn in the last two years.

The letter has been signed by NHS England, the Care Quality Commission, the National Institute for Health and Care Excellence (Nice), and the regulator NHS Improvement. It recommends that hospitals can ask health professionals, such as physiotherapists, to help look after patients, and use technology to monitor their condition, to reduce the need for nurses on duty.

It urges hospitals “to take a rounded view of staffing” that shows they are “making the best use of resources” as well as providing safe care. It lists a set of variables, including how ill patients are, and then adds: “In some cases these factors will mean a higher number of nurses per patient, and in other cases it will mean a lower number or different configuration of staff can be justified.”

It adds: “It is therefore important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff.”

NHS facing £2bn deficit and 'worst financial crisis in a generation'

Hospitals have overspent by nearly £1bn in three months due in part to soaring bill for agency and other temporary staff, according to regulators. 

           

The NHS is under heavy pressure from ministers to make £22bn of “efficiency savings" by 2020 to help plug the £30bn gap expected to have developed in its finances.
The new advice is a substantial downgrading of guidelines produced only last year by Nice, which insisted that no nurse should look after more than eight patients to ensure good, safe care. That ratio was widely hailed as a way of avoiding a repeat of the Mid Staffs scandal, in which a lack of nurses was found to be a key cause of the appalling care.

Howard Catton, the RCN’s head of policy, said: “There’s a risk that people in the NHS may interpret this letter as a green light to row back on safe staffing when the NHS’s finances are in the perilous state that they are.”

However, he added that other suggestions in the letter, such as allowing hospital managers to use their professional judgment about how many nurses were needed and not rigidly applying fixed ratios, were “common sense”.

Labour said the NHS circular showed that patient care could be put at risk as a result of the fast-ballooning deficit.
“The idea that hospitals can ignore safe-staffing guidance will alarm patients. Safe staffing levels are essential for patient safety and were a key recommendation of the Francis report,” said Heidi Alexander, the shadow health secretary.
“If ministers attempt to balance the books in the NHS by cutting staff and putting patients at risk, then Labour will oppose them all the way. It is yet further evidence that the financial crisis in the NHS is now a real threat to patient care.”

Analysis Is NHS being overcharged by agencies – or are staff shortages the real issue?

Health secretary Jeremy Hunt is bringing in curbs on the use of employment agencies in the health service, but is he missing the point?            

            

Ian Wilson, chair of the British Medical Association’s representative body, said: “Adequate staffing levels are vital to deliver safe, high-quality patient care. Flatline funding at a time of rising demand has left services and the frontline staff who deliver them under enormous pressure. The solution is not to stretch existing staff even further, but to ensure the NHS has the resources needed to deliver safe care.”

But hospital bosses welcomed the move away from the 1:8 ratio. “NHS England boss Simon Stevens deserves credit for persuading Jeremy Hunt to soften his previous hard line on safety at any cost. We need to be pragmatic in the face of spiralling deficits,” one told the Guardian .
“It will give more discretion to senior nursing colleagues, giving them a vote of confidence. A ‘one size fits all’ is not the solution to staffing levels; it is about empowering frontline leaders.”
Canadace Imison, director of healthcare systems at the Nuffield Trust thinktank, said: “This letter shows a welcome attempt by NHS regulators to deliver a consistent message about safe staffing levels. It also rightly recognises that the 1:8 nurse to patient ratio is a crude metric and not to be seen as a benchmark.”

But it also leaves NHS trusts no wiser about whether they should under-staff or overspend in order to provide high-quality care, Imison added.

                                ----------//----------

This article in today's 'Guardian' is very worrying; we spent two years analysing the appalling mistreatment of patients at Mid Staffordshire Hospitals and the long awaited official report made clear (among many other recommendations) that a minimum of one nurse to 8 patients was an absolute requirement.

This was endorsed by N.I.C.E. and the other regulatory bodies.

Now that money is short?

Forget it.

All the studies show that patient safety and outcomes are worse when there are too few nurses to patients. We came to this conclusion years after other advanced countries.

For some reason, we have historically trained too few nurses and doctors and there is always a shortage.

Secondly, there is a historic reluctance to accept that too few staff is dangerous.

Neil Harris
(a don't stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Contact me: neilwithpromisestokeep@gmail.com 
 

News update.

Here’s a news roundup;

Stafford General Hospital

This was the main hospital in a trust which saw a great many unnecessary deaths (600 to 1200).

No Doctor’s were disciplined and only a handful of nurses – no managers at all.

The trust went bankrupt and went into administration under the control of a liquidater. There have been a lot of protests – patients and staff were due to be punished twice over – first the abuse and deaths and then the loss of the hospital.

Maturnity is saved although Paediatrics will be lost. People power (25000 on a march) had an effect. The hospital survives and will be given University Hospital status. In a way it’s a happy ending although the local MP is rightly saying the struggle isn’t over yet.

 

Meanwhile;

Colchester General Hospital…

….had a climate of bullying which meant that staff were forced into forging cancer statistics to make it look as though targets were being met when they weren’t.

Today, ‘By mutual consent’, the Chief executive has resigned. Police are investigating.

What payoff was given to ease the pain?

Neil Harris

(a don’t stop till you drop production)

Home; helpmesortoutthenhs.blogspot.com

First response to the health Minister's response.

The Government’s responses to the Francis report are now out; I’ve only scanned the headlines so far because it’s a mass of documents and a lot of data to download. I’ll do a proper analysis in a couple of days.

So far pressure is being put on the Royal College of Nursing to split its union function away from its regulatory one – which I have called for a long time. No mention of doing the same for the BMA – it’s just as important that Doctors are both regulated and represented properly and one organisation can’t both punish and protect at the same time.

Every patient will have a named nurse – which sounds fine as it makes one person responsible. However there are three shifts a day, sickness and holidays as well as courses to attend etc. it means if the named nurse isn’t there nothing will happen. Better to have a named Doctor to supervise overall treatment and be responsible but of course that is never going to happen.

The problem is that patients often rarely see a nurse – most work is done by unqualified care assistants. There should be a regulatory body for them with the ability to ‘strike off’ a care assistant. That’s not happening.

The new criminal offence I dealt with a few days ago if you scroll back – a pointless gimmick.

The ‘duty of candour’, will require that patients or families are told when there has been a medical error – at the moment they get hushed up. It’s alright as far as it goes but doesn’t go far enough.

It may be that I just reviewed the report without meaning to, hopefully there is some more in it besides.

I think my fear is that the Health Secretary, who still practises on a part time basis, is still too concerned about the sensitivities of the health professionals.

Neil Harris

(a don’t stop till you drop production)

Janice Harry gets away with it.

There you are, you are a nurse and you rise to become Director of Nursing and Quality Assurance, then you get made Director of Clinical Standards as well as becoming Chief Nurse and Infection Prevention and Control Director.

These aren’t everyday nothing jobs: in a hospital they matter. They are well rewarded with a salary and benefits that matches the responsibility.

In fact the nurse was Janice Harry and she did those jobs for Mid-Staffordshire NHS Foundation Trust and its predecessor between 1998 and 2006. She was a bully to her fellow staff and presided over a culture of neglect and cruelty towards her patients.

This week she was convicted by the Nursing and Midwifery Council of misconduct – she failed to ensure there were enough staff on wards, put patients lives at risk, failed to ensure patients were fed or given water.

People died – between 600 and 1200 of them according to statistical analysis and government reports and while she was not responsible for all of those deaths, she was certainly responsible for a number of them.

The penalty? - ‘A caution’ for five years.

That means she can continue to practice as a nurse, be an NHS manager or do similar work in the private sector or care industry.

It is unbelievable that she will enjoy comparable earnings, have a big fat NHS pension and be able to go on as if she had done nothing wrong.

My heart goes out to the bereaved relatives and Janice Harry’s unfortunate work colleagues as once again someone like her walks away unpunished.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Another guilty verdict from Mid Staffordshire Hospital Trust.

This is another case from Mid Staffordshire Hospital, taken from The Independent newspaper today based on a Press Asssociation report.

At least this is a ‘manager’ in the firing line – but no sentence yet.

Also where were the Doctors when this was happening?

 

 

Stafford Hospital former chief nurse Janice Harry found guilty of misconduct

 

Ella Pickover  

Wednesday 06 November 2013

 A former chief nurse at scandal-hit Stafford Hospital has been found guilty of misconduct.

Janice Harry's fitness to practise is "currently impaired", a Nursing and Midwifery Council (NMC) panel ruled.

 

Yesterday the disciplinary panel concluded that Mrs Harry had exposed patients to danger during her time at the hospital.

 

By not ensuring that there were adequate nursing staff on a number of wards, Mrs Harry put patients at risk, the panel ruled.

 

Between 1998 and 2006, Mrs Harry failed to ensure there were adequate numbers of nurses working in the accident and emergency department, the emergency admission unit (EAU) and another ward, they said.

 

Mrs Harry was criticised for not ensuring that her colleagues provided patient dignity and privacy in the EAU between 2004 and 2006.

 

The nurse also failed to ensure there was appropriate food and drink in the unit, the panel concluded.

 

She will also be reprimanded for using inappropriate language towards a colleague after telling her that she was a "waste of space".

 

Mrs Harry was employed by Mid Staffordshire NHS Foundation Trust and its predecessor Mid Staffordshire General Hospitals NHS Trust from 1998 to 2006. From 1998, she was director of nursing and quality assurance at Stafford Hospital and in 2002 was appointed director of clinical standards and chief nurse as well as director of infection prevention and control.

 

The panel will now decide what sanctions to impose on the nurse.

 

Stafford Hospital was at the centre of a major public inquiry after it was found that poor care could have led to the deaths of hundreds of patients as a result of maltreatment and neglect.

 

The inquiry highlighted the "appalling and unnecessary suffering of hundreds of people" at the trust and investigations into the scandal revealed that many patients were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.

I don't think we should quickly forget Janice Harry’s contribution to human well being.

Neil Harris

(a don’t stop till you drop production)

Time for a big fight.

The article below came from ‘The Independent’ today although the medical Director of NHS London has been very busy briefing the press today and appeared just now (1900hrs) on Channel Four News.

For good measure, my inability to sleep wasn’t helped by listening to BBC News 24 last week where Sir David Nicholson appeared on ‘HardTalk’, a half hour interview. There, he was reading from the same page, only arguing for nationwide hospital closures.

As a result I’ve put a couple of old articles up on ‘Pages’ on the right hand side of this Blog – setting out the arguments as to why shutting A and E’s is a death sentence for many.

Nicholson should have long gone by now but he has stayed on. It’s to push this argument – he’s touting for a seat in the house of lords and some nice part-time QUANGO jobs after he’s gone.

During his ‘HardTalk’ interview he had no answer as to why 2000 of his NHS managers earn more than the Prime Minister or why he will not accept responsibility for the scandal at Mid-Staffs NHS Trust which was part of his responsibility.

What he said was the NHS must consult with the public and yet not be constrained by elections. What he meant by that is that the NHS should be free of any democratic control which will be replaced by sham consultation exercises which all health service campaigners are very familiar with.

Kashmira Gander  

 Sunday 13 October 2013

 The medical director of the NHS for the capital has warned that services are at “breaking point” and that patients are unsafe.

 

 

Dr Andy Mitchell has said that London’s health system is “unsustainable” the day before NHS England will publish a report stating that it can no longer afford to staff all of its hospitals at safe levels.

In an interview with The Sunday Times, Dr Mitchell stated that the public must face up to the reality that hospitals are overstretched and that patients receive an inadequate service.

“They don’t understand how watered down these services are. What we cannot do is carry on with the idea that all hospitals provide a whole range of services. That is completely unsustainable and would become, frankly, unsafe, and is becoming unsafe in many areas.

“The public isn’t really sufficiently aware, that many places don’t meet acceptable standards of care. The expectation is that, as they walk into hospital, they get high-quality service, and in fact, they don’t in many places,” he said.

He admitted he felt anxious about revealing the system’s safety issues because of his “responsibility to change it and improve it” but stated that his team “are trying to patch up all the time.”

 

However, a report by NHS England says the health service cannot afford to staff all its hospitals at safe levels, especially at weekends.

A combination of zero financial growth forecast for the NHS and increasing demands from an ageing and growing population means the public needs to accept that hospitals must be shut or downgraded to medical centres, according to the document.

Current problems in London are seen as a symptom for problems that will blight the country as a whole, with health chiefs forecasting that half the capital's causality departments will have to shut to make the service sustainable. Sir David Nicholson, the outgoing chief executive of NHS England, has warned of a massive funding gap if NHS services are run in the same way as they are now, with the report revealing that maintaining hospitals at their current standard would lead to a £4 billion shortfall over the next seven years in London, a gap that will be part of a £30 billion funding gap by 2020 across the country.

The number of hospitals offering emergency surgery and treating patients who have suddenly become seriously ill must also be reduced. Meanwhile paediatric and maternity departments need to be cut and centralised, making it easier to staff institutions at safe levels. The remainder will become urgent care centres run by GPs to deal with minor injuries and out –of-hours calls.

Shadow Health Secretary Andy Burnham said: “The severity of this funding crisis is entirely of David Cameron’s making. People pleaded with him to stop the reorganisation so the NHS could focus on the financial challenge. He refused to listen and threw the entire system into chaos. The result has been three lost years in the NHS and billions wasted on back-office restructuring.”

We’ve got a very big fight on our hands.

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

Mid Staffordshire Hospital updated again.

I keep hoping it will be the last time I Blog about Mid Stafford Hospital trust but it just keeps getting worse.
Recently, one nurse was struck off and another had a limited suspension. One of those two continues to be a manager at that trust - I'm still waiting for the decision as to whether she is a fit person to still be working there.

This weekend, the real victims of all this, the patients, were marching in their thousands. They want to keep Stafford Hospital open, with its Accident and Emergency and Maternity unit and why not?

Haven't they earnt the right to have a good, functioning local hospital to put right all the wrongs that have been done to them?

The only response from the NHS has been to merge this failed trust out of existence and to pay for it all? Shut down Stafford hospital.

meanwhile the managers went on to better things - big payouts or promotions.

What about the lead Clinicians?

 BBC News - 23 September 2013
No action over Stafford Hospital doctorsBy Nick Triggle

Health correspondent, BBC News


Four senior doctors who worked at Stafford Hospital at the height of the neglect
and abuse scandal will not face disciplinary action.
Dr John Gibson, Dr Valerie Suarez, Dr David Durrans and Dr Dermot Mulherin, who
all held senior management positions, were investigated by the General Medical
Council.
But the regulator has now said it is dropping the cases.
Legal advice found there was "no realistic prospect" of success.
The decision comes after widespread criticism when the public inquiry was
published in February that those responsible for the scandal have not been held
to account.
At the time, Prime Minister David Cameron said the likes of the GMC and the
Nursing and Midwifery Council had "some difficult questions to answer".
Since then three nurses have been struck off the register - with one
disciplinary hearing ongoing.
The GMC has given warnings and advice to other doctors who worked at Stafford
Hospital.
But as yet no-one has been struck off for their role in providing medical care -
one doctor has been erased from the register for fraud.
'Systematic management problems'

GMC chief executive Niall Dickson said: "Following the extensive investigations
we have undertaken there is not the evidence to establish either misconduct or
impairment against any of the doctors."
The GMC got legal advice from Tom Kark QC, who worked on the public inquiry,
after taking statements from 26 witnesses.
Mr Kark advised the GMC that while there was evidence that would have
demonstrated there were systematic management problems at the trust - none of it
could be attributed to any individual doctor.
However, Mr Dickson said he was in talks with the Department of Health to relax
the regulatory framework under which the regulator operates.
At the moment, the GMC has to not only prove that a doctor's performance fell
below what was expected, but that they also provide an ongoing risk to patients.
The GMC believes the system would be improved if cases were only judged on what
the individual has done.
"We are not a doctors club. We are not here to protect doctors," Mr Dickson
added.
But Katherine Murphy, of the Patients Association, said while it would be unfair
to comment on the four individuals, serious questions needed to be asked about
the regulatory process.
"The general delay in holding individuals to account for failings at Stafford is
outrageous.
"Years on, and after huge numbers of avoidable deaths, we have still only just
scratched the surface of holding the nurses, clinicians and managers to account
for the failings that occurred."

Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com

More Mid Staffordshire Hospital fallout.

This report from the BBC News website brings to an end one of the more shocking incidents from the scandal at Mid Staffordshire Hospital.

I would have used a report from The Nursing Times, usually very reliable but not today. Their report wasn’t helpful and a comment made by a reader (a nurse?) afterwards sought to belittle the episode.

For the record neglect is generally very difficult to prove. This pair were guilty of a number of different acts of cruelty – the failure to test or provide insulin just being the easiest to prove;

Nurse struck off for Stafford Hospital deathGillian Astbury Gillian Astbury died at Stafford Hospital in April 2007

A nurse has been struck off after failing to identify a patient who died at Stafford Hospital was diabetic.

Gillian Astbury, 66, died at the hospital in April 2007 after not receiving insulin.

In July, a Nursing and Midwifery Council panel found former Stafford nurses Jeannette Coulson and Ann King guilty of misconduct.

King has been struck off by the panel, while Coulson was given a caution for a period of three years.

During the earlier hearing, King was also found to have lied about having changing patients' dressings and giving them medication, while Coulson admitted swearing at staff.

The panel heard the pair had failed to carry out blood-sugar level tests on Ms Astbury.

She was admitted to Stafford Hospital a week after suffering a stroke on 1 April 2007.

She did not receive insulin for 48 hours, and was discovered collapsed in a bed at 22:30 on 10 April.

 

In a statement, Ms Astbury's daughter Kate Beeson said: "While we are happy that the conclusion of the NMC hearing draws a line under the case, whatever the ruling, nothing can bring my mother back, and nothing can truly reflect the severity of the nurses' negligence.

 

"We have been fighting for justice for several, very tiring years. Since her tragic death, I have been unable to put my mother to rest.

 

"Today's judgment, and all of the effort that has gone into getting to this stage, will be completely in vain if others in a similar position do not step out and make their voices heard.

 

"It is important that those responsible are brought to account and people need to speak up in order to make that happen."

 

In a statement, the Mid Staffordshire NHS Foundation Trust said its thoughts were with Ms Astbury's family and apologised for the "appalling care" she received.

 

It added that both nurses had since left the trust.

The trust is itself facing a prosecution over Ms Astbury's death, brought by the Health and Safety Executive, under the health and safety at work act.

What was important was the creation of a ‘culture’ where this behaviour became acceptable, just as bullying becomes ‘acceptable’ and was probably also present.

Neil Harris

(a don’t stop till you drop production)

Home:helpmesortoutthenhs.blogspot.com

Don't call the midwife.

 

 

When I criticised the Chief Executive of the Trust which is taking over the Mid-Staffordshire NHS trust and closing down maternity at Stafford Hospital, I called him sexist for suggesting that mum’s could have their children at home.

This article in today’s ‘Observer’ explains why – there just aren’t the midwives to do it;

 

“The NHS's chronic shortage of midwives will last into the mid-2020s, despite ministerial pledges to improve maternity care amid a continuing baby boom, according to new figures.

 

The calculations, by the Royal College of Midwives (RCM), suggest that the gap between the number of midwives the NHS in England needs and the number it now has will not be closed until 2026. The shortage is certain to force maternity units to close suddenly and lead to some mothers receiving inadequate care before, during or after giving birth.

 

Belinda Phipps, chief executive of the parenting charity the National Childbirth Trust, said women giving birth between now and 2026 would be let down as a result of the shortfall. "It's extremely frustrating to think that we'll have to wait 13 years before mothers are getting the level of support they need. Childbirth is so important that they shouldn't have to wait that long. A whole generation of mothers and babies will not get the support they need."

 

She criticised ministers for not taking maternity care more seriously. "Given the government's understanding of the importance of the first 1,000 days of parenthood, which starts at conception, it's disgraceful that they aren't acting more quickly to ensure that women get proper support in those first 1,000 days from midwives. The rhetoric is there about that period, but it looks like they're not backing it up with action," Phipps added.

 

The Care Quality Commission (CQC), the NHS care regulator, last year warned that one in seven of the 141 hospital trusts in England that provide maternity services did not have enough midwives. Maternity care was "emerging as a problem area for a number of NHS trusts, due to midwife numbers not increasing in line with demand and an increase in complex births, owing to risk factors such as maternal age, weight and co-morbidity", it said.

 

The acute shortage is leading to the temporary closure of both some hospital maternity units, forcing mothers-to-be to go elsewhere when they are already in labour, and some midwife-led birth centres. The Trowbridge Birth Centre in Wiltshire shut on 15 July for 12 weeks until 29 September because of staffing problems there and at maternity units nearby. Women now have to travel 13 miles to Chippenham's birth centre.

 

Trowbridge's midwives are now working both there and in the Princess Anne wing of Bath's Royal United hospital to help fill gaps in the rotas. Earlier this year the CQC voiced concern that the Princess Anne wing had "not enough qualified, skilled and experienced staff to safely meet people's needs at all times". Great Western NHS Foundation Trust, which runs all those units, is recruiting more midwives to tackle the problems.

 

The projections are uncomfortable for David Cameron who, before the 2010 general election, voiced concern about staffing problems in NHS maternity units and pledged to recruit 3,000 more midwives. However, official NHS figures showed that the number of qualified midwives in the NHS in England had only increased from 20,132 in May 2010 to 21,410 in April this year – a rise of just 1,278 in three years under the coalition.

 

Cathy Warwick, the RCM's chief executive, welcomed the increase in midwives but said the NHS is still 4,501 below complement, based on the ideal ratio of one midwife for every 28 births in a year – a figure the Department of Health accepts. While there are likely to be 697,893 births in England this year, there are 21,356 full-time equivalent midwives, which means each one handles 32.2 births. It needs those other 4,501 midwives to guarantee both safety and quality of care, Warwick added.

 

The RCM's projections show that, if the rising birthrate seen between 2010 and 2012 continues at the same rate, and the number of midwives in the NHS keeps growing at the rate seen recently, the shortage of midwives will fall from 4,501 to 2,276 in 2020, then 811 in 2024, before finally disappearing in 2026, although the ratio of 28:1 will be achieved slightly earlier, in 2024, the analysis shows.

 

The Department of Health says it has taken action to ensure 5,000 midwives are being trained. But the RCM says numbers in post are not rising accordingly because hospital trusts are not hiring as many as are needed. In April, deputy prime minister Nick Clegg, confronted by a student midwife on his radio phone-in, denied that ministers were "deceiving" voters by emphasising the 5,000 training places, but admitted that some trusts were too cash-strapped to boost their midwife numbers.

 

Labour claimed the RCM's figures showed the prime minister had broken his "cynical" pre-election pledge and that mothers were being failed. "On David Cameron's watch we're seeing maternity units downgraded or facing closure as hospitals struggle with NHS budget cuts. The lack of midwives has left some units with no alternative but to temporarily shut their doors," said Diane Abbott, shadow health minister.

 

"New mums are being badly let down. David Cameron needs to get an urgent grip on the staffing shortages across the NHS. One in 10 hospitals is understaffed as almost 5,000 nursing jobs have been lost since the election. The time for excuses is over. Patients cannot afford for the government to ignore expert warnings," Abbott added.”

Neil Harris

(a don’t stop till you drop production)

Home: helpmesortoutthenhs.blogspot.com

The facts about the Liverpool Care Pathway.

In my last Blog entry I got angry about the Liverpool Care pathway and just ranted on about it. That’s the way I go on in my more silly Blog;

helpmesortoutstpeters.blogspot.com

This subject was perhaps too close to home, so I’ve calmed down now and put together some real life facts which I’ve taken from a ‘Daily Telegraph’ article by John Bingham, 31/10/12 based on sending out Freedom of Information requests to Trusts.

Then I took a look at a more recent story by way of illustrating what can go wrong down on the ward.

“According to responses from a sample of 72 trusts, at least £12.4 million has been paid out in the past two to three years to trusts which hit targets associated with use of the care pathway. But the full figure could be more than £20 million.

Under a system known as “Commissioning for Quality and Innovation” (CQUIN), local NHS commissioners pay trusts for meeting targets to “reward excellence” in care.

These can range from simply recruiting a set number of people to classes to help them stop smoking to providing specialist end-of-life services on wards - such as LCP.

As the goals are set locally, they vary from area to area but in some cases trusts are given specific targets to ensure that a set number of people who die in their hospital are on the LCP.”

 

This is a breakdown;

“Overall 61 of those which responded said that they used the pathway, translating to 85 per cent of the total.

Of those, 62 per cent disclosed that they had either received, or expect to receive, cash rewards for meeting targets associated with the implementation of the pathway. The remainder said they had adopted the LCP without receiving any payments.”

These are some specific figures which vary because these are local incentives;

“Central Manchester University Hospitals - which received £81,000 in 2010 for meeting targets relating to the LCP - said the proportion of patients whose deaths were expected and had been placed on the pathway more than doubled to 87.7 per cent in the past year.

In Berkshire the Heatherwood and Wexham Park Hospitals Trust received more than £1 million over two years for meeting its LCP goals. Its targets included carrying out an audit of the number of deaths of patients on the LCP as well as having a “meaningful conversation” with the patient themselves but did not set a specific goal for the number of deaths.

Bradford teaching Hospitals, which qualified for CQUIN payments of more than £490,000 in the last two years, has seen the number of patients dying on the pathway more than double to 51 per cent over the last three years.

In Birmingham the Heart of England NHS Foundation Trust disclosed that 38 per cent of patient deaths occurred on the LCP in 2010 and 27 per cent in 2011. It received a CQUIN payment of £603,886 in the financial year 2010-11 alone.

 

This is why it’s a problem;

“A handful of trusts openly spoke of either hitting or missing targets connected to the LCP in their responses.

And this is the only proper response;

Dr Gillian Craig, a consultant geriatrician who was among the first doctors to raise the concerns over the possible flaws of the LCP, described the use of the incentives as “absolutely shocking”.

“I think there should be questions in Parliament as to who instigated this policy and I think the cash payments should be stopped forthwith,” she said. “You can’t pay people to use a certain protocol that everybody knows to be lethal.”

This is what the government said about it at the time;

 “We are clear the Liverpool Care Pathway can only work if each patient is fully consulted, where this is feasible, and their family involved in all aspects of decision-making. Staff must properly communicate with the patient and their family - any failure to do so is unacceptable.”

Now, a year later, the governments review has indicated the LCP should be scrapped. 

 

So I thought I would give you an example of the reality, down on the wards. These are extracts from a recent hearing of the misconduct and competence panel of the Nursing and Midwifery Council, dealing with Janice Harry who worked as director of nursing, and later as clinical director and chief nurse for Mid-Staffordshire NHS Foundation Trust.

The case hasn’t yet been decided, as far as I’m aware, so I will only quote what she said in evidence rather than the other serious allegations that have been made (but not yet considered) against her.

This is what she had to say about allegations that she went from ward to ward to find out who was near to death;

“When asked by the panel if she had inquired about the availability of a bed by asking "whether anyone was going to go to heaven", Mrs Harry replied: “I am not sure if those were the words I used but it was a question that was asked.”….. "It does seem to be hard, but if we knew there was someone within a period of time known to be dying ... at the end of the day the care people would receive would be as it should be, but we needed to know if there was the capacity or space of a bed."

This Chief Nurse faces allegations of bullying and rudeness from colleagues and from the nurses under her charge as well as other allegations. This is what she had to say;

Mrs Harry admitted she had been abrupt in some dealings with staff, but added that she had been given coaching to help her improve her manner. "Sometimes I can be very straightforward. Sometimes it can be read as aggressive – but it is not intentional," she said. "I can understand why some people may see it that way."

 

So now we have financial inducements from the NHS to put people on the Liverpool Care Pathway, a Chief Nurse storming from ward to ward to find out ‘Whose going to heaven?”

Now, I wonder how the LVP consultations with patients and relatives were conducted at that hospital Trust?

 

Neil Harris

(a don’t stop till you drop production)

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