Beleaguered Tameside hospital boss announces retirement!

Retiring - Paul Connellan, Chairman Tameside Hospital

Although I have been attending the Annual General Meeting (A.G.M), of Tameside Hospital, - now known as Tameside & Glossop Integrated Care NHS Foundation Trust -for a number of years, I'm not sure if I ever learn anything knew. It always seems to me that we get the same message - things are not as bad as you would believe, 'things can only get better.' Watching the hospital bigwigs perform their act, is like watching a stoat or a conjurer in a musical hall. A hospital financial deficit of £13.32m, is dismissed as being better than predicted because we were expecting a £17m deficit. A P.F.I deal that built a hospital facility - Hartshead South - is passed off as "a good financial deal", even though the  repayments are extortionate. Under this P.F.I, investors raised £77.2m and paid Balfour Beatty to build it. From October 2010 to August 2041, Tameside Hospital will have paid back £300m in charges.

At the hospital A.G.M last Monday evening, Paul Anthony Connellan, the Chairman of the Trust since October 2011, announced that he would be stepping down as Chairman, as from 31st October. This sociology graduate, with a background in the travel industry, declared back in 2011 that he had the right skills and experience to get to the root of the problems at Tameside Hospital, such as the high death rates and he was described by former hospital CEO, Christine Green, as a "perfect fit". Almost two-years later, the hospital was  put into special measures in July 2013, following a review by Sir Bruce Keogh, the medical director for the NHS, and consequently, Christine Greene was forced to resign.  The Keogh report stated:

"The Board is not effectively leading the Trust and delivering quality care and the governance and leadership has not delivered the improvements in the quality of care required."

In 2014, the health regulator, 'Monitor', declared the hospital Trust, "Clinically and financially unsustainable in its current form."  While Connellan told the A.G.M. that "What had been lacking for a long time was appropriate leadership and now we've got it," some of us,  who well remember Mrs Green's tyrannical regime at Tameside Hospital, will recognise that what Connellan says, is utter bullshit. Despite her so-called 'inappropriate' leadership, he was part of it, and he backed her up to the hilt, right up to the eleventh hour and many were amazed when he kept his own job. 

After Connellan told the meeting that Tameside Hospital had "an exceptionally bright fututure", the current CEO, Karen James, talked about 'Direction'. The hospital was now  starting to deliver integrated care and had invested £23m to deliver the new model. The hospital had received good CQC ratings and patient's were feeling very positive. It had improved its performance and had launched digital health care. The hospital had opened the Tameside Macmillan Unit and had expanded the Darnton House service. "Staff tells us how much they like working here", declared Ms James.

A number of question were asked about the efficacy of Skype consultations, which have been operating in  30 care homes in Tameside for the last four months. We were told that this had saved 300 A&E admissions at the hospital and that care homes were very enthusiastic. Listening to this, I visualised a fragile old lady in a care home being asked to stick out her tongue by a doctor, sitting miles away, looking at her on his lap top and saying:

"Oh! madam, you're tongue looks heavily pixelated, I think I'd better send for the digital doctor." 

Many of us did wonder how you would take a blood test or check a pulse or the chest of a patient, while doing a skype consultation. But we were assured, that this wouldn't be a problem, because people in the care homes would be trained to do this. Connellan told the  audience: 

"Clinicians will always err on the side of caution. If they think a person needs to be admitted, they will always do so. Elderly people don't always want to go to hospital."

Brendan Ryan, Medical Director, told the meeting that staff and patients were more happy to report incidents and that complaints were going down, with just 450 in 2017. The Trust was reducing the mortality rate - H.S.M.R and S.H.M.I measures and review all deaths at the hospital within 14 working days.

The Director of Finance, Claire Yarwood, presented the annual accounts for the hospital for 2016-2017. "We spent more money than we received", she told the meeting but things were not as bad as they seemed. Although the hospital had a deficit of £13.32m, "We had planned to have a deficit of £17.3m, so we got our deficit down." During the financial year, total operating income was £212.42m and the Trust had made efficiency savings of £8.4m against a target of £7.8m. The P.F.I. - "it's a good financial deal", had to be accounted for separately under 'Financing Costs'. The Director of Finance told the meeting that the hospital was hoping to save money following the introduction of Skype consultations. 

Tameside Hospital is planning to cut 246 beds at the hospital by 2020. If this is implemented, it would leave the people of Tameside & Glossop with 80 beds per 100,000 population against the current UK average of 300 beds per 100,000 population. Hospital management maintain that by treating patients in the community and in their own home, using five multi-disciplinary care teams, demand for hospital beds will decline because health professionals will be able to manage underlying health problems more effectively and prevent hospital admissions.

However, as Professor Michael Marmot points out in his book (The Health Gap 2015), health is related not only to access to technical solutions, but to the nature of society - the conditions in which people are born, grow, live, work and age, have a profound influence on health inequalities in childhood, working age and older age. Karen James, the CEO of Tameside Hospital, believes "We are all living longer." Yet we know, that annual rises in life expectancy, have begun to stall in England and we also know that the regional death gap has widened since 2008. In 2015, the number of premature deaths of people aged 35 to 44 was 50% higher in the north of England than in the South of England. Today, suicide is now the biggest cause of death of people under 50 in Britain and poverty, precarious work and cuts in public spending are all known to have increased the death toll and to have diminished the quality of life for many people.

Tameside Hospital became the first NHS hospital in the UK to set up a permanent food bank collection centre on site, after medical staff reported a significant increase in the number of 'malnourished patients' turning up for treatment and care. This sort of thing is a sad indictment of the type of society Britain has become. We live in the fifth richest country on earth and yet, some of our citizens cannot afford to feed themselves properly. As Michael Marmot says - "health is far too important to be left solely to doctors."

Banned but not Gagged!

Health campaigner - Paul Broadhurst

A local pensioner and health campaigner from Dukinfield, in Greater Manchester, has received an invitation to a 'community open day' at 'Tameside and Glossop Integrated Care NHS Foundation Trust', despite being banned from entering hospital premises since November 2016.

Last September, Paul Broadhurst, received a letter from Weightmans solicitors of Liverpool- who act on behalf of Tameside Hospital - advising him that he was banned from entering any Trust premises unless his attendance was for a medical emergency or a pre-arranged medical appointment.

In October 2016, Mr. Broadhurst, who suffers from a serious heart condition, was escorted off the hospital premises by security staff while accompanying his wife who was attending the hospital for emergency medical treatment. He was told by hospital security staff that he'd been 'ASBO'd' and would have to leave the premises immediately. The CEO, of Tameside Hospital, Karen James, subsequently apologised for the way Mr Broadhurst and his wife had been treated, but the ban was not lifted. The letter form Weightmans solicitors, warned him:

"If you attend for any other purpose then you would be trespassing and action could be taken to remove you from the site and/or legal action could be brought against you."

To justify their actions in excluding Mr Broadhurst, the hospital alleges that he had called for the resignation of Paul Connellan, the Chairman of the hospital Board, and had disrupted meetings and intimidated staff. While Mr Broadhurst acknowledges that he's called on Connellan to resign, he says that many of the allegations made against him by the hospital are malicious, defamatory and unsubstantiated.  He says that in spite of seeking specific details about the nature of any complaints that have been made against him, neither the hospital or their solicitors, have been able to provide him with any "hard evidence." He also points out that his membership of the hospital Trust, has never been rescinded, although he cannot attend hospital meetings because of the ban.

It has often been cited in official reports on Tameside Hospital that hospital staff frequently feel bullied and harassed, not by Mr Broadhurst, but by Tameside Hospital management. Even though the hospital as a policy of "if in doubt speak out", many hospital staff have indicated in these reports that they feel at risk if they speak out about their concerns. Mr Broadhurst, alleges that one public governor from Droylsden, was forced to resign in February 2016, after raising concerns about "NHS Improvements." In his own particular case, he feels that the ban imposed by Tameside Hospital, is a crude attempt to silence him and to stop him asking awkward and critical questions and attending hospital meetings.

Tameside Hospital is massively in debt and this is a major reason why it was recently announced that Shire Hill Hospital in Glossop, is to close. The hospital are also planning to cut 246 beds at Tameside Hospital by 2020. Although the official spiel from the hospital is couched in terms of 'improving services' and 'reconfiguration', the financial considerations are inescapable. In 2010, the official regulator 'Monitor', declared the hospital to be "Clinically and financially unsustainable." In 2015/16 compensation claims hit £9m and we understand that five hospital board members, have recently "jumped ship."

Last year, the Trust balance sheet showed a deficit of £14 million plus a loan from the NHS for hospital improvements (including the new Darnton Unit at the Hospital) of £55 million. By  the end of the current financial year the estimated deficit will be £24 million and the loan will have risen to £78 million. At the declared interest rate of 3.6%, the repayments on the loan alone, will be at least £2.8 million per year.

At the Annual General Meeting of the Tameside and Glossop Clinical Commissioning Group (TGCCG), held at Dukinfield Town Hall on 26 July,  Mr Broadhurst - who was the only member of the public to attend the meeting - asked if the debt of the Trust would affect the ability of the TGCCG when funding or setting up with other service providers for the needs of the community. Kathy Rose, the Chief Financial Officer for TGCCG replied that this would have no bearing on money that the TGCCG allocates, as the hospital deal was directly with NHS Improvements. We understand that Paul Connellan, the Chairman of the Board at Tameside Hospital, who was at the meeting, declined to comment.

While Paul Broadhurst may have been banned from attending meetings at Tameside Hospital, it doesn't appear that the hospital have managed to gag him. He can now be found most weeks at the hospital car park, with placard and T-shirt proudly proclaiming, "THE TRUST THAT HIDES THE TRUTH!"

We understand that after receiving the invitation to attend the Tameside Hospital AGM and the "Open Day", Mr Broadhurst sent an email to the hospital on 23rd August, asking if his ban had been lifted. At the time of writing, we gather that the hospital have yet to respond.

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.