Stafford Hospital scandal NHS outcomes

Eddie Jones

In July 2014 hospitals were given strict guidelines on safe staffing levels for nurses. The aim was to ensure that if patient care is compromised due to a shortage, immediate action will be taken to make more nurses available.

Establishing safe staffing levels was one of the key recommendations of the Francis enquiry into poor hospital care in the wake of the Stafford Hospital scandal when hundreds of patients died needlessly between 2005 and 2008.

The scandal is widely regarded as one of the worst to have ever hit the NHS and was a watershed moment for the health service. Since its dark days leaders of the NHS and government ministers have set about implementing wide-ranging changes to stamp out poor care and minimise the possibility of another Stafford ever occurring.

But just what are the main outcomes of the Stafford Hospital scandal and what patient safety measures have so far been put in place? In this article I take a look at the main outcomes and measures and where they are up to.

Robert Francis report recommendations

Robert Francis QC is a barrister who specialises in the NHS and medical negligence. After an alarming number of patient deaths at Stafford Hospital between 2005 and 2008 he was appointed as the head of the public enquiry by the then Secretary of State for Health Andrew Lansley.

Mr Francis was asked to investigate the care provided by the Mid Staffordshire Foundation NHS Trust and make recommendations in a final report on what changes needed to be introduced to prevent another such scandal. A public enquiry was established which heard from relatives of patients who had died at the hospital, including Julie Bailey, who set up the organisation Cure the NHS after her mother Bella died at Stafford Hospital in 2007.

What Mr Francis found was quite appalling, even to me as head of medical negligence at JMW. Patients were reportedly neglected with some being denied help to go to the bathroom, pain relief and access to food and water. In addition he found ‘awful’ hygiene and a ‘disturbing lack of compassion’ by some staff (The Guardian).

In February 2013 Robert Francis’ final report was published, making 290 recommendations for healthcare providers, regulators and government. The report together with an executive summary can be found on the public enquiry website here and a summary of the recommendations on the ITV website.

Some of the recommendations I have gone into more detail about below but Mr Francis’ overarching concern was for a ‘culture change’ in the NHS. This is something the solicitors at JMW agree with. We find that all too often in the cases that we handle on behalf of patients and families there is a lack of honesty and openness. The culture in the NHS seems to lean towards covering up and hiding poor care and although as solicitors we can help to reveal the truth the attitude of healthcare providers can be incredibly distressing for the victims.

Sir Bruce Keogh review into high hospital death rates

As government, patients and families struggled to make sense of what had happened at Stafford Hospital, in February 2013 attention turned to others that were showing signs of moving in the same direction.

Alarm bells had rung at 14 other hospitals with higher than expected death rates, leading to an investigation by NHS medical director Sir Bruce Keogh at the request of the Prime Minister. Sir Bruce reviewed mortality rates at the hospitals and the outcome was that 11 were placed in special measures by healthcare watchdog Monitor to try to improve care, reverse worrying death rates and ensure patients were not being put at unnecessary risk.

The hospital trusts below were investigated for higher than expected mortality rates and/or placed into special measures. Some of the trusts have now been taken out of special measures, which has been achieved with intervention from Monitor and the Care Quality Commission. However some have had their special measure period extended due to continued concerns about quality of care.

  • Colchester Hospital University NHS Foundation Trust – placed in special measures in November 2013 and today the trust still being supported by Monitor-approved improvement director.
  • Tameside Hospital NHS Foundation Trust – placed in special measures in July 2013. In July 2014 it was announced that it was to remain in special measures for another six months as ‘significant issues’ remained over patient care.
  • Blackpool Teaching Hospitals NHS Foundation Trust was reviewed by Sir Bruce for higher than expected death rates but was not placed into special measures.
  • Basildon and Thurrock University Hospitals NHS Foundation Trust – placed in special measures July 2013 taken out in June 2014 after improving patient services.
  • East Lancashire Hospitals NHS Trust – was put in special measures in July 2013 but taken out in July 2014 after significant improvements were achieved.
  • North Cumbria University Hospitals NHS Trust – placed in special measures July 2013. It was announced in July 2014 that it would stay in special measures as although there were some signs of improvement the CQC called for further action.
  • United Lincolnshire Hospitals NHS Trust – placed in special measures July 2013 and announced in July 2014 that it would remain in special measures for another six months.
  • George Eliot Hospital NHS Trust – placed in special measures July 2013. News reports in July 2014 hinted that it will be taken out.
  • Buckinghamshire Healthcare NHS Trust – placed in special measures July 2013 and in June 2014 it was announced that it was being taken out.
  • Northern Lincolnshire and Goole Hospitals NHS Foundation Trust – placed in special measure July 2013. In 2014 England’s chief inspector of hospitals recommended to Monitor that it comes out although it will receive ongoing support.
  • The Dudley Group NHS Foundation Trust. The trust was investigated for higher than expected death rate but was not placed in special measures.
  • Sherwood Forest Hospitals NHS Foundation Trust – placed in special measures July 2013.
  • Medway NHS Foundation Trust – placed in special measures July 2013. In July 2014 an inspection by Sir Mike Richards, chief inspector of hospitals, found that the trust was ‘inadequate’ and must remain in special measures until urgent improvements are made.
  • Burton Hospitals NHS Foundation Trust – placed in special measures July 2013.

Safe staffing levels for nurses

Ensuring healthcare providers have a safe number of medical workers available to ensure good and safe patient care was one of the key recommendations from the Robert Francis enquiry. In response to this, in July 2014 hospitals were given strict guidelines from the National Institute for Health and Care Excellence (NICE) on safe staffing levels for nurses (BBC).

Although there was no minimum staffing levels for wards announced, as it was decided that there was no ‘one size fits all’ number for the whole of the NHS, NICE’s system aims to ensure that if patient care is suffering due to a shortage of nurses that immediate action is taken.

To achieve this NICE has issued hospitals with a set of ‘red flag events’ which should trigger them to ensure extra nurses are put in place. Red flag events include nurses not having enough time to take patients to the toilet or patients not being given pain relief.

According to some of the news reports which abounded about this development, the impetus will be on nurses, as well as patients, to raise the alarm about red flag events. However as a medical negligence specialist I believe it is vitally important that adequate plans to support nurses in speaking up about staffing issues are put in place. If they are not then the initiative could fail. In addition it is crucial that patient concerns are heeded as all too often on the cases we handle at JMW they are not.

Duty of candour

The need for a statutory, or legal, duty of candour was another key recommendation of Robert Francis’ report. Candour is about informing patients and families when something has gone wrong and also apologising, something which can help to prevent additional stress and upset being caused.

The Medical Defence Union (MDU), which provides insurance to doctors in the event that they injure a patient with poor care, says it has previously advised doctors that they should give patients an explanation if something goes wrong. There is already a contractual duty of candour in place and Michael Devlin, head of advisory services at the MDU, believes this goes far enough (The Guardian).

However after the recommendation from Robert Francis that a statutory duty of candour for healthcare organisations should be introduced, Health Secretary Jeremy Hunt launched plans to put this in place. Due to come into law in October 2014 it would make being open and honest with patients a legal requirement.

In the medical negligence cases the team at JMW handles we find that too often mistakes are not admitted at the earliest opportunity. Although we are still able to secure compensation to help the patient and/or family to cope with their injuries the lack of honesty on the part of the healthcare system can compound an already distressing situation. This is why we welcome a statutory duty of candour as patients deserve and need this level of openness.

Read Action against Medical Accidents response to the Health Secretary’s plans for a statutory duty of candour here.

Publishing of staffing levels

In November 2013 we heard that one of the government’s responses to the damning Francis enquiry report would be to force hospitals in England to publish monthly details about their nurse and midwife staffing levels and how they compare to national guidelines.

The requirement came into force in June 2014 with hospitals publishing their staffing details on the NHS Choices website. These should show what the planned number of nurses and midwives was alongside the actual number on duty.

With a clear link between staffing levels and patient safety, it is hoped the publishing of staffing levels, together with the new guidelines that have been issued will improve patient experience and care. You can read more about the publishing of staffing levels outcome from the Stafford Hospital scandal on the BBC website.

Named doctor and nurse for every hospital patient

In another response to the Stafford Hospital scandal and ensuing Francis report, in December 2013 Health Secretary Jeremy Hunt announced plans to give each hospital patient a named doctor and nurse who is responsible for their care. Mr Hunt said at the time that this was to stop patients being ‘passed from pillar to post’ and to ensure that the ‘buck stops’ with someone.
The announcement led the Academy of Medical Royal Colleges to publish the ‘names over beds’ guideline in June 2014 to help the NHS to implement the plans.

This initiative could play a particularly important role for patients with complex needs that span several hospital departments or even different healthcare organisations. The solicitors at JMW have seen the catastrophic consequences for patients when their care is not joined up and no one takes responsibility for them. When a patient’s care is not consistent and they are allowed to fall between the cracks it can lead to avoidable tragedies.

Having someone with them every step of the way and ensuring they have the care they need could make a huge difference to their outcome. However, as Catherine Murphy of the Patients Association told the BBC the plans will only work if the named person has regular contact with the patient and is not just a name on a board.

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