Tameside Hospital placed into 'special measures' by Keogh. CEO resigns!

TAMESIDE Hospital has been placed into special measures following a review by Professor Sir Bruce Keogh, Medical Director of the National Health Service in England. Sir Bruce Keogh and his team, were instructed by the government to investigate 14 hospital trusts with high death rates - Tameside Hospital being one of them, following publication of the Francis Report, into Mid Staffordshire NHS Foundation Trust.

An interim Chief Executive and an interim Medical Director, have been brought in by the regulator 'Monitor', to replace £150,000 per year, Chief Executive, Christine Green and the £160,000 per year Medical Director, Dr Tariq Mahmood, who resigned before publication of the report. MPs, doctors and NHS regulators, said they had lost faith in Green's ability to overhaul the hospital's poor record of care, which had "caused anxieties at the highest level of the health service." The Guardian newspaper disclosed that the GP-led Clinical Commissioning Group (CCG), was so concerned by lapses in care and the hospital's failure to act on multiple previous warnings that it believed Green and Mahmood had to go. Mahmood said that he was resigning for 'family reasons' but would be staying at the hospital working as an obstetrician.

The 55 page report on Tameside Hospital, notes that Tameside falls within the most deprived quartile of counties in England. That teenage pregnancy and alcohol-related hospital stays for under-18-year-olds are particularly common and violent crime and long-term unemployment, relatively more common than in England as a whole. Children's and young people's and adults health is significantly lower than the national average. Tameside life expectancy for both men and women is significantly lower than the national average.Chronic obstructive pulmonary disease (COPD), in particular, asbestos-related lung disease is common in Tameside. The report also says:-

The number of actual deaths at the hospital is above the expected range. A score of 100 indicates that the observed number of deaths matched the expected number. The hospital had an overall 'Summary Hospital-level Mortality Indicator (SHMI) of 116 between Dec 2011 to Nov 2012. Elective admissions (those patients who arrange to go into hospital) was also above the expected range for SHMI, with a value of 166. According to figures published by Professor Sir Brian Jarman, on excess deaths at failing hospital trusts, there were 833 excess deaths at Tameside Hospital between 2006-2012, than would have been expected.

The report says there is an acceptance of sub optimal standards of care across the organisation.

The hospital had the seventh highest rate of MRSA superbug infections out of 141 national trusts from 2010-12. It had the second highest infection rate in the country over the same period for Clostridium difficile.

Response to complaints is brief, slow and lacking in compassion and accountability.

The staff sickness rate is almost twice the average and the three-month vacancy rate over 50% higher the national average. More money is spent on agency staff (9.4% of total staff costs) than the regional median average of (3.5%). Nursing levels at the hospital are 'dangerously low' - 1.31 nurses per bed as compared with a national average of 1.96.

Junior doctors and patients are not being adequately supervised by consultants, particularly at night. The Board is not effectively leading the the Trust in delivering quality care and governance. Hospital governors appear disengaged, have limited information about the Trust's quality and safety priorities and do not feel they can hold the non-executive directors to account.

The report says that hospital staff are apprehensive about speaking out or asking questions in monthly briefing sessions. According to one hospital consultant, who is not quoted in the report, "Many nurses simply do not report understaffed shifts for many reasons; tiredness, fear of reprisals or simply because they believe it will not change anything." Only "A few brave nurses continue to file incident forms, reporting that the wards are unsafe as a result of understaffing. The Trust categorises these incidents as of low priority."

According to the  report, Board members did not feel they could effectively challenge at Board meetings because the chief executive's response was unpredictable. The Chief executive's approach is described as 'overly operational' and the report adds, "the Chairman had not fully considered the impact of this leadership style on the executive team's ability to fulfil their functions." Others have described her leadership style as 'bullying', 'bossy and domineering'. The Chairman (Paul Connellan) was not able to confirm that he was fully assured of the quality of services provided in the hospital. At interview, he described being 60% assured and 40% reasssured. The senior independent director, could not decribe what was on the Chairman's 'worry list'.

There is poor infection control at the hospital. In one instance, a patient admitted with Clostridium difficile, was put on a six-bedded bay in the Medical Assessment Unit (MAU) which was in breach of Trust policy and which put, the five remaining patients at risk. According to the report there is insufficient clinical cover, particularly out of hours, which is leading to a lack of timely investigations and poor management of deteriorating patients in some areas. At the unannounced visit (2nd/3rd June), the most senior surgical doctor in the hospital was a Foundation Year 2 doctor. The doctor said that her registrar was on call at home and described being supervised during the day but not at night.

Although hospital management told the panel that they did not fully understand what the factors were behind the high death rate at the hospital nor were they clear, as to what were the best actions needed to address it, the report says that there is a commonly held belief amongst hospital management that the 'Shipman effect' - a reluctance to allow ill patients to stay in the community, and external factors - poor community care, social deprivation and underlying health problems, are the main reasons for excess mortality. The report notes that emphasis on the 'Shipman effect' and other external factors, could reduce focus on improvements to reduce excess mortality.

The report also says that mortality (deaths) are monitored by a paediatrician who looks at a random choice of of 8-10 patient deaths per week. But a report by Milton Pena, a consultant orthopaedic surgeon, at Tameside Hospital, which was sent to Andrew Lansley, Secretary of State for Health in 2010, had this to say about the process:

"The Review of contemporary deaths in adults has been carried out by a consultant paediatrician. This is worrying because he is outside his area of expertise."

During the unannounced visit in June, it was noted that 8 out of 14 sets of notes viewed, did not have the basic patients details recording appropriate monitoring of fluid input and output, even in a patient who had undergone a transfusion. On ward 45, 'Do Not Resuscitate' (DNAR) forms did not contain the consultants name or sign-off as required by Trust policy. One of the forms examined was signed-off by a Foundation Year 2 doctor. None of them had a consultant signature. It was also noted that the Women's Health Unit, was being managed by an agency nurse contrary to Trust policy.

The panel concluded that they were not convinced that the Board had the capability to fully address the cultural change required in the Trust. They also noted that although the hospital had launched an 'Everyone Matters' initiative, there was no clear evidence that the board was listening to patients and familiies to improve the quality of patient experience. (Some patients and relatives who did complain to the hospital and joined action groups such as the Tameside Hospital Action Group (THAG), were branded by the hospital management as individuals with psychological problems).Three years ago (June 2010), the consultants Korn/Ferry/Whitehead Mann, had this to say about the Board: "The Board meetings are not discussing urgent clinical matters in depth and not conducting rigorous debate on key issues...The Chairman and CEO lack the leadership qualities required."

It's almost two-years ago that Paul Connellan was appointed Chairman of the Board at Tameside Hospital Foundation Trust. He was described by the chief executive Christine Green as "a perfect fit" and he vowed that he would improve the culture and image of the hospital. He also claimed that he had the right skills and experience (30 years experience in the travel industry) to get to the root of problems, such as the high death rates. But far from improving the culture and image of the hospital, the report has found a lack of leadership and capability at Board level and serious failings in the hospital's patient care. The hospital have been told to take urgent action and to ensure that no patients are at immediate risk of unsafe care.

This collective failure of governance and responsibilty at Tameside Hospital and the deficiencies in patient care, have led to calls for a public inquiry. Amongst those who are demanding a public inquiry, are health campaigner, Liz Degnen, from Hadfield. In 2009, her 79-year-old mother, Betty Dunn, died from the superbug C Difficile while she was a patient at Tameside Hospital. Liz collected 8,000 signatures on a petition calling for hospital bosses to resign. In a recent interview in the Manchester Evening News, she said that she was "thrilled to bits" to hear of Christine Green's resignation. "I think she should hang her head in shame. She should not receive a payout because there should be no reward for failure in the NHS." Referring to the Keogh report, she told the newspaper: "I really welcome the findings of the report. We've waited far too long to reach this day. It has vindicated everything we campaigned for. We need to move forward now. I hope we can now get a public inquiry with total transparency, but we've got to look to the future and be optimistic."

Tameside Hospital have said that all recommendations in the Keogh report will be implemented in full by the end of February 2014. They have also launched 'Tameside Listens', which will ask staff, local people, stakeholders, for their views and ideas about how improvements can be made at the hospital to deliver high quality care for patientsand families."