The Crisis in Accident and Emergency.

It's been quiet on this blog for a while - we've reached the stage where the crisis in the NHS has gone beyond problems that can be fixed - the lack of investment, cutbacks and failure to train enough staff has left sections of the service unable to cope with the basic needs of the population.

This Christmas we saw two elderly people die while left on trolleys in corridors because there weren't enough staff to admit them to a ward.

A unattended vulnerable patient died after taking his blood transfusion devise and stand into a toilet, fell over and strangled himself.

This BBC article publishes a leaked document which sets out the crisis in Accident and Emergency;


Leak shows full extent of NHS winter crisis
By Dr Faye Kirkland and Nick Triggle
BBC News
10th January 2017

Record numbers of patients are facing long waits in A&Es as documents leaked to the BBC show the full extent of the winter crisis in the NHS in England.

Nearly a quarter of patients waited longer than four hours in A&E last week, with just one hospital hitting its target.

And huge numbers also faced long waits for a bed when A&E staff admitted them into hospital as emergency cases.

There were more than 18,000 "trolley waits" of four hours or more last week.

That suggests about one in five patients admitted for further treatment endured one of these long waits on trolleys and in hospital corridors - twice the rate normally seen.

Some 485 of them were for more than 12 hours - treble the number seen during the whole of January last year.

The figures come from a document compiled by NHS Improvement, one of the regulators in England, and show that this winter is proving to be the most difficult for more than a decade.

Since the start of December, hospitals have seen only 82.3% of patients who attended A&E within the four-hour target.
That is the worst performance since the target was introduced in 2004.

Chris Hopson, of NHS Providers, which represents hospitals, said what was being seen was not "ordinary winter pressures".
"Trusts are really struggling," he added.

The leaked document also showed:

Performance started deteriorating markedly in the first week of the new year with 22% of patients waiting longer than four hours to be seen in A&E.

In one hospital - Weston Area - that reached 44%
 
Just one trust hit the target of seeing 95% of patients within four hours with only nine within 5% of hitting the mark
 
Dangerously high levels of bed occupancy were reported with 94.7% of beds full
 
- well above the "safe" threshold of 85%

It comes after the British Red Cross said over the weekend the NHS was facing a "humanitarian crisis" this winter.

Ministers have denied this is the case, with Health Secretary Jeremy Hunt saying on Monday the health service was coping well given the increasing demands.

But he did suggest the four-hour target may have to be relaxed - it has not been met since July 2015.

He said there were growing numbers of patients attending A&E units with minor conditions and suggested in order to "protect" the four-hour guarantee in the future it may need to be applied only to those with urgent needs.

Dr Kathy McLean, of NHS Improvement, said the data given to the BBC had yet to be verified and was meant for "internal" purposes so the true figure could be lower.

But she accepted that the NHS was facing "exceptionally high" levels of demand.

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Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithp-romisestokeep@gmail.com

The Tories NHS crisis.

This 'Guardian' article neatly sets out the crisis that has developed in the NHS over the last couple of years of Tory rule;


NHS 'in perpetual winter of Narnia' as waiting list reaches record 3.9m

Waiting time targets missed, bed blocking at record levels, and medical leaders say system is close to breaking down

 

Denis Campbell  Health policy editor

Thursday 8 September 2016

The Guardian

 

The NHS is missing so many of its key performance targets that it has entered “the perpetual winter of Narnia”, a medical leader has said, after figures revealed the highest ever number of patients on waiting lists.
Claire Marx, president of the Royal College of Surgeons, criticised the NHS’s failure to give patients planned care in hospital within the required 18 weeks, such as surgery for cataract removals, hernia repairs and hip and knee replacements.

The number of people in England who are awaiting such treatments has climbed to almost 3.9 million.

Demand for NHS care is dangerously high, says thinktank

Over three-month period to June nearly 6m people visited A&E, creating ‘huge strain’ on the health service, experts say

           

Hospitals are meant to treat 92% of patients on the “referral-to-treatment” (RTT) waiting list within 18 weeks, according to guarantees in the NHS constitution. However, they did so in just 91.3% of cases in July, NHS-wide performance data released on Thursday shows. It was the service’s worst RTT performance in more than five years.

Hospitals met the 92% target in nine categories of RTT patients, including those requiring treatment for eye problems (92.7%), cardiac care (92.7%) and gynaecological problems (92.3%). However, it missed the target in 10 other categories. It treated barely four of of five (81.7%) of all those awaiting neurosurgery within 18 weeks, 86.9% of those needing plastic surgery and 88.9% of trauma and orthopaedic patients.

“It feels as if the NHS has stepped through the wardrobe and into the perpetual winter of Narnia,” Marx said. “We cannot forget that behind these statistics are potentially very ill and anxious patients who are being made to wait far too long for treatment. This is the true impact of the serious financial pressure we’ve seen the NHS come under in recent months.”

The NHS also missed targets covering A&E, ambulance response times, diagnostic tests, two forms of cancer treatment and rapid first treatment for those experiencing psychosis for the first time.

Dr Mark Holland, president of the Society for Acute Medicine, said: “This data reflects a system which is close to breaking down.”

Bed blocking has reached record levels. In July a total of 184,188 bed days were lost to delayed discharges – when patients are fit to leave but social care support is not in place – up sharply from 147,376 in the same month last year, and the highest number since records began in August 2010.

At midnight on the last Thursday in July, 6,364 patients who were fit to leave were still in their beds, up from the previous record of 6,105 patients the month before.

“For every 100 people who come to A&E, around 30 are admitted and, of these, 20 come under acute medicine. That number is increasing and our front-of-house workforce is depleted”, Holland said.

“However, performance is most significantly hampered due to our inability to discharge people at the backdoor of our hospitals. Failure to get people home is, in my view, a national emergency.”

Medical leaders want ministers to urgently pledge more money for the NHS to tackle its growing problems.

 

 

Marx said: “The forthcoming autumn statement offers an opportunity for the government to provide more money for the NHS and social care, and to agree to a cross-party commission to review how we can make the NHS sustainable for the long-term. Without a serious look at what the NHS needs in funding, we will remain in a state of constant winter.”

NHS England said that despite missing so many targets, its performance was still very good by international standards.
“As the NHS responds to ever increasing care needs, hospitals are continuing to look after more than nine out of 10 A&E patients within four hours, and more than nine in 10 patients are waiting less than 18 weeks for their routine operations,” said Matthew Swindells, its national director of operations and information.

“While this is probably the best performance of any western nation, these figures underline the pressures facing the NHS, and the obvious risks to patient care posed by weeks of further drawn-out industrial action. 

Neil Harris
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How privatisation costs us money.

Here's how saving money by using the private sector ended up costing the NHS nearly £9 million pounds;

University Hospitals NHS Foundation Trust

Millions of pounds of taxpayers' money was wasted on an NHS outsourcing contract, investigators have found.
Under the £726m deal, UnitingCare was meant to provide care for older and mentally ill people in Cambridgeshire.
But the consortium claimed the contract was not financially viable and pulled out of the deal in December.
A joint statement from the two organisations in the consortium said the National Audit Office's (NAO) findings provided "clarity".
Cambridgeshire and Peterborough Clinical Commissioning Group had been been in charge of care for older and mentally ill people but put these services out to contract because it was trying to save money.

The UnitingCare Partnership's business case estimated net savings of £178m to the local health economy by 2020.

'Astonishing array of errors'

But the NAO's investigation into the contract - which ended just eight months after it started - has criticised the planning and the lack of data setting out the true cost of the service.
The report found the consortium had not taken account of VAT costs and underestimated both the changeover and running costs of delivering the service in drawing up its bid for the contract.

The report also found negotiations between the CCG and the UnitingCare were continuing when the contract started.
As a result, one month into the contract UnitingCare asked for £34m in extra funding which triggered fresh negotiations.

The report said: "The wasted cost to the NHS of the contract set-up and bidder costs was £8.9m."
Amyas Morse, head of the National Audit Office, said: "This contract was innovative and ambitious but ultimately an unsuccessful venture, which failed for financial reasons which could, and should, have been foreseen.

"Limited oversight and a lack of commercial expertise led to problems that quickly became insurmountable."

Meg Hillier, chairman of the Public Accounts Committee, said the report "details an astonishing array of errors" in implementing service changes.

"Despite drafting in specialist expertise from the private sector and the NHS, the assumptions underlying the contract's cost structure were not tested.

"Instead, the contract - which was not remotely ready - was rushed through without due regard for protecting taxpayers' money."

A joint statement from the two organisations behind Uniting Care, the Cambridgeshire and Peterborough NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, said: "We believe that the report is balanced and provides clarity on the reasons why the contract ended."

The CCG is yet to comment.

That came from a BBC news article.

Neil Harris
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Home: helpmesortoutthenhs.blogspot.com
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The '111' emergency service fails again.

For the last few years I've highlighted the catastrophe of the closure of the highly effective 'NHS Direct' phone line created by the 2002 Labour government.

The Conservative Liberal alliance closed it down and replaced it with the 111 service which is staffed by people who have no medical qualification.

There have been many examples of failure to spot serious conditions - this is just the latest. This inquest report makes it clear once again that 111 needs Nurses and Doctors available for patients; 


William Mead's 'fate was sealed' after NHS 111 call handlers failed to identify his deadly illness, says mother

The report called into question the NHS non-emergency helpline’s ability to identify deadly illnesses
Kate Ng  
The Independent

The mother of a one-year-old baby who died of sepsis said his "fate was sealed" after NHS 111 call handlers failed to identify his deadly illness. Melissa Mead, mother of William Mead, told BBC Radio 4: “When I dialled 111… we were told William’s condition was non-urgent and didn’t require any emergency treatment, and that we would get a call-back within six hours.

“But when the doctor called back after three hours, I think William’s fate was sealed. He died within 12 hours of that phone call. We found him just after 8 in the morning… he had been passed away for a little while [already].”

Her interview follows an NHS England report into William’s death in 2014, which found there were 16 missed chances to save his life.
The report, seen by the Daily Mail and the BBC, said he might still be alive today if NHS 111 call handlers had realised he was in a life-threatening situation.

The NHS 111 non-emergency helpline’s ability to identify deadly illnesses in children and babies has been called into question.
NHS 111 call handlers are not medically trained. The report suggested that if a doctor had taken the call instead of 111 staff, they would have most likely recognised the need for "urgent medical attention".

The report detailed the opportunities missed to save William’s life.

Out of 16 missed chances, the five main windows were:
 
William’s GP had not recorded all the relevant information in his notes
 
The severity of William’s symptoms had not been recognised
 
Inadequate advice was given to William’s parents about what to do if his condition worsened
 
The out-of-hours GP service had no access to the baby’s primary care records

 
The pathway tool used by NHS 111 call handlers was not sensitive enough to pick up “red-flag” warnings of sepsis

It also included failure by GPs, who saw William six times in the months prior to his death, to spot pneumonia which could have prevented his circumstances.

The report said: “Had any of these different courses of action been taken, William could probably have survived.”

Recommendations made by the report included training call advisors to spot when there is a need to probe further into the condition of the patient, and when to escalate cases.

It also called for better recognition of the signs and symptoms of septicaemia by GPs.

The report is the result of a year-long campaign by William’s parents, Paul and Melissa, to find out what really happened to cause their son’s death.

Director of nursing with NHS England in the south west, Lindsey Scott, told the BBC: “One of the significant learning points for us is how difficult it is for both professionals and parents to diagnose septicaemia.

“Everyone involved in this report is determined to make sure lessons are learned from William’s death, so other families don’t have to do through the same trauma.

“None of this detracts from our profound regret at the loss of William. For that loss, on behalf of all NHS organisations involved, I would like to apologise publicly to Mr and Mrs Mead,” she told BBC.

Neil Harris
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Latest figures for NHS payrises.

This Daily Telegraph article has researched the current state of pay rises for NHS Chief Executives against a background of staff pay rises limited to 1% and a forthcoming dispute with junior doctors;

Daily Telegraph

By Laura Donnelly, Health Editor

02 Jan 2016

       

NHS hospital chief executives have been handed pay rises of up to £35,000, with the highest annual earnings reaching a record £340,000, a Daily Telegraph investigation has found.

Despite government pledges that the most senior NHS managers would have their pay frozen, 40 per cent of trusts increased executives’ wages by at least £5,000 during 2014-15.

Some managers’ earnings rose by almost a quarter, the findings from more than 200 NHS trust boards show. Patients’ groups accused the NHS of “scandalous excesses” at a time when the health service is facing the greatest financial crisis in its history.

The head of the Royal College of Nursing said it was “immensely demoralising” to find that some executives had been awarded rises larger than a full year’s salary for the average nurse.
The highest individual increase of £35,000 went to Sir Andrew Morris, at Frimley Health NHS Foundation Trust in Surrey, taking his earnings to £215,000. The 19 per cent rise followed a takeover of another nearby NHS trust. The finance director, Martin Sykes, also received a 19 per cent, or £25,000, increase in his earnings taking them to £155,000. Nicola Ranger, the director of nursing, enjoyed a 23 per cent boost, taking her earnings to £135,000.
Simon Barber, chief executive of 5 Boroughs Partnership trust in the North West, was paid £200,000 during 2014-15 – a rise of £25,000 thanks to a pay bonus. David Sloman, chief executive of the Royal Free London Foundation Trust received a £20,000 rise, taking his earnings to £240,000. And Lewisham and Greenwich trust in south-east London awarded £20,000 pay rises to its chief executive, Tim Higgingson, whose salary rose to £195,000, and to its director of nursing, Claire Champion, boosting her earnings to £150,000.

In total, 40 per cent of boards made at least one pay rise of between £5,000 and £15,000.

At least 10 senior managers received rises of at least £20,000, according to the analysis by the Telegraph.
 
Because trust boards do not publish precise pay figures, the lowest point of published ranges was used for all calculations, leaving a £5,000 margin.

The highest overall package went to Dr Tracey Batten, the chief executive of Imperial College Healthcare, who was paid £290,000 plus a £50,000 relocation payment to move from Australia.
 
Several of those with the highest earnings left the NHS in recent months. The second highest earner overall was Peter Morris, the chief executive of Barts Health trust, on £275,000 until he resigned in February amid a growing financial crisis. The trust is now facing a deficit of £135 million, the largest any trust has ever had.
 
Another of the highest earners, Dr Keith McNichol, who came from Australia to run Addenbrooke’s Hospital, resigned in September — just before a damning inspection report saw the trust plunged into special measures. A salary of at least £260,000 made him the fourth best paid chief executive.
 
Tim Smart, who earned £255,000 a year as chief executive of Kings College Hospital Foundation Trust, announced his retirement in April, just after an inspection which later saw the trust rated as “requiring improvement”.

Katherine Murphy, the chief executive of the Patients Association, said she was concerned that the NHS had developed a culture of “rewards for failure” with many of the highest salaries paid to chief executives who had left as serious problems emerged.
In March 2014, the Treasury promised most public sector workers a rise of one per cent in 2014-15, but said the most senior managers would see pay frozen, amid efforts to put the nation’s finances on a sustainable footing.
 
The NHS is facing the worst financial crisis in its history, with three quarters of trusts forecasting deficits, which are expected to reach £2.2  billion across the service by March.
The vast majority of overspending has been fuelled by a reliance on agency doctors and nurses, some on rates of more than £3,500 a day. Hospitals are also struggling to cope with rising demand from an ageing population.
 
Janet Davies, chief executive of the Royal College of Nursing, said: “Nursing staff have been repeatedly told that there isn’t enough money to improve their pay, even after years of pay restraint. To learn that many senior NHS staff are enjoying pay rises and bonuses while nurses struggle to make ends meet is immensely demoralising.”

The trusts with the most highly paid chief executives defended the sums paid, saying they were among the largest trusts in the country, with rates in line with those for similar roles in other NHS organisations.
 
A spokesman for Frimley Health said: “Recent salary adjustments in executive pay at Frimley Health were a reflection of the added responsibility associated with the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust. These were independently assessed by the Hay Group and set by a committee of non-executive directors.”

When Frimley Park took over Heatherwood and Wexham Park Hospitals the trust doubled in terms of staff, infrastructure, and patient numbers.
 
The 5 Boroughs Partnership NHS Foundation Trust said its chief executive had received a 1 per cent pay increase, plus a performance-related bonus which recognised that the trust had achieved quality and financial targets.
 
A spokesman for the Royal Free said it became one of the largest trusts in the country after taking over Barnet and Chase Farm hospitals in July 2014.
It said pay was agreed by a committee of non-executive directors based on value for money.
 
Lewisham and Greenwich trust said salaries were reviewed after a hospital merger, with the director of nursing taking on added responsibility as deputy executive.

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

Home: helpmesortoutthenhs.blogspot.com
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The Parliamentary Ombudsman condemns the NHS failure to investigate deaths properly.

This Guardian article highlights a report by The Parliamentary Ombudsman. However I would point out that my own complaint to her was dealt with very unsatisfactorily.

The Patients Association has recommended against complaining to The Ombudsman due to the ineffectiveness of her organisation.

  
The Guardian

Denis Campbell Health policy editor

Tuesday 8 December 2015

 

Three out of four investigations by hospitals into complaints that patients suffered avoidable injury or death fail to identify serious failings in care, leaving distraught families in the dark, the NHS ombudsman has warned.

Inquiries by hospital staff are so often inadequate that many complainants seeking to understand what went wrong are met with “a wall of silence from the NHS”, according to Dame Julie Mellor.
Mellor, the parliamentary and health service ombudsman, has demanded an urgent overhaul of how hospitals examine serious complaints made against them, in which mistakes allegedly led to patients being harmed or even killed.

Frontline staff in the NHS and public services shouldn’t fear complaints            

Organisations should welcome complaints as it shows they are open to feedback. But people need to feel their concerns are acted upon.

             

Her review of the quality of internal hospital investigations uncovered a series of major weaknesses. In 73% of cases in which she found evidence of clear failings, the NHS hospitals trust concerned had concluded that no failings occurred.
“Parents and families are being met with a wall of silence from the NHS when they seek answers as to why their loved one died or was harmed,” said Mellor.
“Our review found that NHS investigations into complaints about avoidable death and harm are simply not good enough. They are not consistent, reliable or transparent, which means that too many people are being forced to bring their complaint to us to get it resolved.”

In just over half (52%) of the cases she examined, the investigation had been led by a doctor who was not independent of the events complained about.

For example, when a baby girl was left with brain damage after a blood transfusion went wrong, the hospital appointed a close colleague of the paediatrician at the centre of the complaint to investigate. The girl’s family had to wait three years before learning what mistakes had been made.

Hospitals also failed to categorise 20 out of 28 cases of avoidable harm examined as serious incidents, which meant they were not properly investigated.

NHS investigations into care complaints 'appalling'

More than a third of investigations into deaths or avoidable harm at hospitals found to be inadequate in ombusdsman’s review 

           

Mellor said hospitals’ inquiries into serious injuries or deaths too often fail to gather enough evidence, are inconsistent in how they look for proof of errors, and do not look closely enough at material to see what went wrong and why.

Almost a fifth (19%) of inquiries did not gather important evidence such as the patient’s medical records, statements and interviews, Mellor found.

In investigations that found there had been failings, more than a third (36%) failed to get to the bottom of why they had occurred, even though 91% of complaints managers said they were confident they could find out what happened.

Hospital bosses admitted that too many investigations are substandard.
“We know we don’t always get this right and it’s crucial that we learn and improve every time,” said Rob Webster, the NHS Confederation chief executive.
“The Care Quality Commission, ombudsman and others are highlighting major inconsistencies and shortcomings in the handling of complaints and those problems cannot be allowed to continue. So we urgently need to learn from what is working and fix what doesn’t, to ensure patients have complete confidence in the National Health Service.”

Anna Bradley, the chair of Healthwatch England, a patient group, said: “Hundreds of thousands of incidents of poor care go unreported every year across the NHS precisely because people fear they either won’t be taken seriously or that nothing will change as a result.”

 

Peter Walsh, the chief executive of the patient safety charity Action Against Medical Accidents, said the new independent patient safety investigation service, set up by Jeremy Hunt to promote airline-level safety in the NHS, should improve investigations.
“The ombudsman’s findings are doubly worrying, as they were only reviewing cases where there had already been a complaint under the NHS complaints procedure. If this is how the NHS investigates when there is a formal complaint, one has to wonder how it investigates when it is left entirely to its own devices,” said Walsh.
“Unfortunately, in our experience it is not uncommon for NHS bodies to carry out investigations without even informing the patient or family affected by an incident.”

Neil Harris
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A failure to investigate deaths at the Southern health NHS Foundation Trust.

Yesterday I posted a story about a disabled man who was given a 'Do Not Rescusitate' notice by Doctors because he was..... disabled.

This is a 'Guardian' article about the scandal at "The Southern Healthcare Trust", where deaths of vulnerable people in the Trusts care have not been properly investigated;

The Guardian 9/12/15.

An NHS hospital trust failed to properly investigate the deaths of more than 1,000 patients with learning disabilities or mental health problems over four years, an independent inquiry has found.

A leaked copy of the inquiry’s report severely criticises a “failure of leadership” at Southern health NHS foundation trust and accuses senior managers of not looking into and learning from deaths.

NHS England commissioned Mazars, an audit firm, to examine the 10,306 patient deaths which occurred at the trust between April 2011 and March 2010.

While most of those deaths were expected, 1,454 were unexpected.

The Mazars report, obtained by the BBC, concludes that failures by the trust’s board and senior executives meant that no “effective” management of deaths or investigations took place and there was a lack of “effective focus or leadership from the board”, the BBC said.

The Mazars inquiry team found that when trust board members did ask questions, executives reassured them that investigations were thorough. However, the report concluded: “This is contrary to our findings.”

It also found that the culture of the NHS trust, which is led by chief executive Katrina Percy, “results in lost learning, a lack of transparency when care problems occur, as well as assurance to families that a death was not avoidable and has been properly investigated”.

Of the 1,454 unexpected deaths, the trust regarded 272 as critical incidents but classed only 195 of them – or one in seven – as a serious incident that needed to be investigated.
But while it looked into 30% of the deaths among adults with mental health problems, it did so with only 1% of those with learning disabilities and 0.3% of over-65s with mental health problems.

 

Patients with a learning disability died at an average age of 56, which is seven years earlier than the usual life expectancy.

“These are shocking revelations that if proven, reveal deep failures at Southern health NHS foundation trust,” said Luciana Berger, Labour’s shadow minister for mental health.
“For there to have been so many unexpected deaths in one trust is of deep concern itself, but for so many of those deaths not to have been investigated is extremely alarming. It raises serious questions about the leadership and culture of care at the trust.”

NHS England ordered the inquiry after Connor Sparrowhawk an 18-year-old with learning disabilities, drowned in a bath at the trust’s Slade House unit after suffering an epileptic seizure. Coroners had also criticised the trust at inquests for producing reports into deaths that were inadequate or very late, but that had failed to prompt the improvements that were needed and staff often made little effort to engage with the relatives of those who had died, the Mazars report found.
Sara Ryan, Sparrowhawk’s mother, told the BBC: “There is no reason why in 2015 a report like this should come out. It’s a total scandal. It just sickens me.”

The trust provides community services, mental health, learning disability and social care services to about 45,000 people in Hampshire, Dorset, Wiltshire, Oxfordshire and Buckinghamshire.

The Mazars report said that the trust was unable to show that it had a good system in place for learning from deaths and did not use effectively the extensive data it collected on deaths.

It also found that the trust looked into too few deaths involving either those with a learning disability or older people with mental health problems and failed to involve relatives in almost two out of three of the investigations it did undertake.
Southern accepted that its response to patient deaths was not good enough but denied that its death rate was higher than would be expected.

“We fully accept that our reporting processes following a patient death have not always been good enough. We have taken considerable measures to strengthen our investigation and learning from deaths including increased monitoring and scrutiny,” it said in a statement.

“We would stress the draft report contains no evidence of more deaths than expected in the last four years of people with mental health needs or learning disabilities for the size and age of the population we serve.”

The trust has “serious concerns” about the way Mazars had
interpreted the evidence. It added that while it had “had one or more contacts” with the patients in the previous 12 months, “in almost all cases referred to in the report, the trust was not the main provider of care”.

Jan Tregelles, the chief executive of the charity Mencap, said: “Twelve hundred people with a learning disability are dying avoidably in the NHS every year. This is a national scandal.”

All such deaths need to be properly analysed so that other avoidable deaths can be prevented, she added.

Neil Harris
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The South east Coast Ambulance Trust Scandal.

For the best part of 18 months I've been highlighting problems with the 111 non-urgent phone line which replaced the much loved NHS Direct advise line.

Little did I ever imagine that Ambulance chiefs would decide to secretly change the rules on response times to get themselves out of a hole; they were missing Government targets.

The answer?
Fiddle the books.

This is an excellent piece of investigative reporting by the Daily Telegraph and all the more important because whenever anyone in NHS management does something wrong the first response is to cover it all up.


DailyTelegraph

How trust made secret 111 plan to hit all-important NHS targets
The deaths of up to 25 patients have come under investigation, after
whistleblower reveals extent of policy that delayed help for seriously ill patients

By  Laura Donnelly, Health Editor
31 Oct 2015

In December last year, South East Coast Ambulance trust was facing major problems.

Key NHS targets - to send an ambulance out within eight minutes for all cases designated as “life-threatening” were slipping far out of reach, with too few crews to send out to meet growing pressures as winter drew in.

The creation of the controversial 111 phone line was supposed to ease demand for ambulances, making sure those with more minor needs could get help without an ambulance being dispatched.

“The executives knew, there were people warning directors and senior managers in January and February that this was happening and it was extremely dangerous."

Instead, the phoneline was adding to pressures on services, with fears that “risk averse” call handling were too often sending out ambulances.
 
And so a plan was hatched.

Behind closed doors, senior managers at the ambulance trust devised their own protocols.
 
Any “life-threatening” calls which were sent their way would no longer get an automatic ambulance response.

• NHS 111 scandal: 25 deaths blamed on ambulance delays

Those which had been categorised as “Red 2”– life-threatening, but not the most immediately time-sensitive – would be allowed an extra ten minute delay, while the 999 service “re-triaged” them to decide on the best response.

Such cases would still be counted as hitting the all-important NHS targets, implying that a response had still been received within eight minutes.
 
In some ways, the policy appeared successful.

A meeting of the trust’s clinical committees was told that “pro-active” management of the cases meant up to one quarter of the ambulances called were being stood down.
 
Meanwhile, staff working in the trust’s own 111 call line had no idea that when they had ordered an ambulance to be dispatched, the case could be put aside for up to 10 extra minutes, despite its urgency.

At the start of this year, a series of clues began to fall into place.
111 call handlers from Ashford working occasional shifts in the 999 centre in Maidstone stumbled upon the policy – which had never been discussed at the trust’s board meetings, let alone announced publically.

Then a string of serious incidents occurred.

One, on January 28th, involved the death of a man, aged 60.
His wife called 111 when her husband was short of breath, clammy, vomiting and suffering pain high in his chest, towards his shoulder.

During the call, the man began to suffer signs of cardiac arrest, and his wife began attempts to resuscitate him.

Incredibly, under the system, the call passed on to the 999 centre was categorised as “Red 3” – meaning it remained unassigned to an ambulance crew for 10 more minutes.

Crews finally reached the man 39 minutes after the call was made, but could not save him.

The details are contained in a safety report, sent from senior NHS managers to the trust’s chief executive and other senior managers, on 4 February which concerns were raised.

Another email, sent by a senior NHS 111 manager two days earlier, warns of the potential of “severe” reputational damage if the truth came out.

In the correspondence, the health official says he has “personally amended” official reports to remove references to the controversial policy, but warns that “it is inevitable that this process will filter through to a wider audience at some stage”.

Yet the policy – described as a “rogue operation” by those outside the trust – remained in place.

Two weeks later, one of the trust’s senior managers became so fearful that he decided to contact health officials outside the trust, to warn them what was going on.

The man, who spoke to the Telegraph on condition of anonymity said: “The executives knew, there were people warning directors and senior managers in January and February that this was happening and it was extremely dangerous. “

“They simply did not listen. “

In emails seen by the Telegraph, he contacted two senior managers at local NHS commissioning groups – who are responsible for monitoring safety of the services – warning them of a string of deaths which had not been included in official serious incident reports.

The disclosure caused immediate panic: within two days, orders came from the clinical commissioning groups to close down the scheme. An NHS investigation was then opened, and handed information suggesting that up to 25 patients might have died after being subject to the deliberate delays.

But in public, there was nothing. No board papers have been published about the concerns, nor any public statement issue.

Meanwhile there were furious disputes within the trust about how many patients covered by the policy had come to any harm, and whether any such harm was explained by the delay waiting for an ambulance, or would have happened anyway.

But it was not until this week that NHS watchdogs suddenly announced that the protocols were under investigation, with a major review by regulators about how many patients had come to harm under the rules.

Health officials at NHS England said the trust had acted “unilaterally and inappropriately” while Monitor – the regulator for foundation trusts – said it would now hold its own investigation to establish levels of harm to patients.
 
The trust has refused to say who introduced the policy and whether any managers have been disciplined.

On Friday a trust spokesman said: “We will now work closely with Monitor as they undertake the reviews outlined in their recent media announcement and therefore do not feel that it is appropriate to comment further on specific points at
present.

The spokesman queried any suggestion that 25 people had died as a result of the policy. He added: "Our investigation and our own internal processes to date have not found that the process impacted negatively on patients."

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

Yeah right, if you believe that you'll believe anything.

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

Home: helpmesortoutthenhs.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com

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