Health Education threatened to pull out trainee doctors at Tameside Hospital!

ALTHOUGH senior management at Tameside Hospital have been dropping like flies since publication of the Sir Bruce Keogh (NHS Medical Director) report in July, the Chairman of the Board, Paul Connellan, remains in his post despite calls for him to go. He recently told a local newspaper that he was “in for the long-haul.”

The report led to the resignations of the Chief Executive, Christine Green, Medical Director, Tariq Mahmood and David Wilkinson, the Director of Human Resources. An interim Chief Executive, Karen James and Medical Director, Brendan Ryan, were brought in by the regulator ‘Monitor’ to take over.

The Annual Members’ Meeting of Tameside Hospital, which took place on 18 September, was the first members meeting since the hospital was put into ‘Special Measures’ following publication of the report.

In his ‘Welcome and Introductions’, Connellan tried to accentuate the positive by stressing that more patients “than ever come to us both for non-elective and elective surgery.” According to the Chairman, the number of patients being referred to the hospital by GP’s, is on the increase. Seemingly, the hospital had made £9m of savings which we are led to believe, doesn’t affect patient care at the hospital. On another up-beat note, we were told the hospital now had 18,000 members and 48 of the hospital’s staff had received an “NHS hero award.” While acknowledging that the Keogh report had been hard for people working at the hospital he stressed that “staff had come through it.” He expressed his thanks to all the staff across the hospital and “Karen and Brendan” who he’d, asked for assistance.

The new Director of Nursing, John Goodenough, told the meting that monthly performance reports had been introduced by the hospital to ensure that things were kept on track and to highlight when remedial action was necessary. When asked by Milton Pena, a consultant orthopaedic surgeon, about ‘appalling nursing/patient staffing ratios’ at the hospital and what he was doing about it, he told the meeting that they were aiming at one qualified nurse for every eight patients and one supernumerary nurse per ward in addition to a minimum of two qualified nurses on each ward. Asked by a member of the public about improvements in infection control, he replied: “We still have a long way to go on infection control, but we’re improving.”

Karen James, the interim C.E.O. talked about the need for change and improvement and the dedication of staff. How it was necessary to learn from the past but also to “move forward”. “Moving forward”, seems to be the latest buzz word among management types and Ms. James talks a lot about it. She talked about the ‘listening event’ that the hospital have launched and how they’d already had a lot of positive feedback from stakeholders. She ended her speech by saying: “I look forward to going forward.”

Rod McCord of the Tameside Hospital Action Group (THAG), pointed out that in his view, listening wasn’t an event but ought to be continuous. He asked Ms. James if this was how she envisaged it. He explained that every year the Care Quality Commission (CQC), had said that the failure to communicate in hospitals was a recurring problem. Patients needed protection in hospital and they needed advocates, somebody who knew them. He told the meeting that families should have the automatic right to be present in hospital when consultants visited a patient.

Responding to his question, Ms. James said that she totally agreed that listening should be continuous exercise but while patients had rights, the hospital had to take the wishes of the patients into account.

In a question from the floor, Paul Broadhurst, asked about a report from the Deanery that had threatened to withdraw trainee doctors from the hospital because of concerns over patient’s safety and the inadequate training of junior doctors.

Interim Medical Director, Brendan Ryan, confirmed that Health Education North West, which oversees the training of post-graduate medical students, had threatened to withdraw trainee doctors form the hospital but that he’d asked the Dean to give the hospital a “fighting chance”. He told the meeting that he’d agreed that there concerns were valid particularly about the coverage for junior doctors at weekends. Coverage had now improved and there had been listening events with the junior doctors who were speaking to them. He felt that the hospital was best judged not by its problems but how it responded to them. He told the meeting that the Dean hadn’t carried out her threat to withdraw trainee doctors in August but added:

“They’re still telling us things we don’t like to hear but we’re listening and working with colleagues to put things right. We’re not out of the woods yet! I’m reasonably confident as we keep going forward, we can make a convincing case.”

Speaking from the floor, Rod McCord told the meeting that nobody should have been surprised at the findings of the Keogh report. THAG had been complaining about these things for years – unreliable clinical audits, poor care, bad practice, lack of clinical governance. There had been instances of patients who had been left festering in their own faeces and urine which was not the fault of nurses, but a lack of nurses. The problems at the hospital were visceral. A trust Board that was uniformed and unable to hold non-executive board members to account. Governors who had inadequate understanding of what was required of them and who couldn’t hold the former Chief Executive (Christine Green) to account. He told the meeting:

“In my life I have never heard anything more feeble as that.” He added that the hospitals action plan was barely adequate to meet the enormity of the challenges ahead and that one of the aims of the ‘Charter for Change’ (compiled by THAG and the ‘Campaign for Change’) was to empower patients and their families and the nursing staff at the hospital. Addressing the Chairman, Mr. McCord asked: “Is that aim shared by you as Chair, the Board, and the Council of Governors”?

Responding to his question, Paul Connellan said that the Keogh report had identified potential things that can go wrong or non-events. That the hospital was under extensive scrutiny by the regulator and that the board had not a chance to talk about the ‘Charter for Change’ but that they hoped to embody much of it in various other documents. However, he didn’t want staff to have to work throughout a multiple tick box, check box. He concluded by saying that the hospital would be holding regular press conferences for people to ask about the progress that was being made.

Although the hospital has recently launched a ‘listening event’ since being put into ‘special measures’, to obtain feedback, it was rather obvious that apart from Milton Pena, nobody from the hospital staff, the Board or the Council of Members, asked a single question or offered any criticism whatsoever, throughout the duration of the meeting. However, having attended four of these highly staged managed annual events, this is not unusual. The Keogh report revealed that hospital staff are apprehensive about speaking out. Had it not been for the awkward squad who turn up for this annual event on a regular basis, one can safely say, that no questions would get asked. Needless to say, there was no mention of the former Chief Executive, Christine Green, who appears to have been flushed down the collective memory hole. 

To what extent the Chairman values feedback from the public is open to question. Before the meeting started, a rather anxious and agitated Mr. Connellan was seen objecting to the document the ‘Charter for Change’ being distributed inside the annual members’ meeting and was heard to say to Rod McCord:

 “This should be done outside the meeting. This is not an official document, this is a members meeting; you’re not allowed to pretend this is a hospital document.”

As it is clear from reading the document who the authors are, it is less clear, why Connellan should think it was being presented as a hospital document. It looked quite farcical to see one of his minions scurrying around the lecture room collecting the document so staff couldn’t read it.

Turning to Milton Pena, who for over a decade has fought a courageous, committed and determined campaign, to improve patient care at the hospital, Connellan was heard to say:

“I’m not accountable to you, as I know you would like me to be. I’m accountable to the Board and its members.” Mr. Pena told Connellan: “You’re accountable to everybody.”

Just how long Mr. Connellan keeps his job, remains to be seen. But judging from a recent report in the Manchester Evening News, Connellan and the Board could all be getting the chop very soon if they fail to make the required progress. Two years ago, when he was appointed Chairman, he vowed to both improve the image of the hospital and to get to the bottom of the hospitals high death rate. He has failed miserably on both counts.