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."

Tameside Hospital to cut 246 beds. Surgeon condemns the plan!

Milton Pena - NHS Whistle-blower

A former consultant surgeon who retired from Tameside Hospital in October 2014, after working for forty-years in the NHS and specializing in orthopaedic surgery, has slammed Tameside Hospital for its plan to close 246 beds by 2020, which he says will put patients at serious risk.

At a public meeting held in Stalybridge last week, Milton Pena, who worked for seventeen-years at Tameside Hospital as a consultant orthopaedic surgeon, told the meeting that such a massive reduction in bed capacity would lead to a drastic deterioration in the quality of care offered to patients at Tameside Hospital. “Safety, effectiveness, and patient experience, will be significantly affected”, he declared.

Mr Pena told the meeting that with a population in Tameside & Glossop of 250,000, the proposed cut in bed capacity from 449 to 203 beds in acute care, would mean that there would only be 80 beds per 100,000 people. He added: “When I arrived at Tameside Hospital in 1997, it had more than 600 beds for in-patients.”

In a letter that he wrote to the ‘Care Quality Commission’ (CQC), in August, Mr Pena said that the idea that losing 246 beds at the hospital could be compensated for by the creation of five multi-disciplinary care teams, is misguided and not based on evidence. He also says in the letter that there were 531 incident reports by nurses regarding lack of nursing staff at the hospital in the year from May 2015 to 2016 and yet,

“No one at the Board meeting (which he attended) questioned the Financial Director on how the Trust efficiency program savings can be delivered in full without affecting quality of care, clinical effectiveness, patient experience and safety.”

Speaking of the Board at Tameside Hospital, Mr Pena told the CQC:

“I attended two Board meetings as a member of the public, the latest on Thursday 28 July. With few exceptions, I did not observe challenging questions from the Chair, executive and non-executive directors, when reports were presented to the Board. The approval of the Board of the ‘Contingency Planning Team Report’ by PwC, without any reservations, regarding the plan to close 246 beds by 2020, shows the Board has not fully considered the impact of decisions being taken…There was not a single medically qualified director at the Board meeting on 28 July."

In September 2013, Tameside Hospital Foundation Trust, was declared financially unsustainable by ‘Monitor’ the regulator, three-months after the resignation of former CEO, Christine Green, who left following the review by Sir Bruce Keogh, NHS England Medical Director. Recently the hospital has come under fire for poor standards of cleanliness and for its high mortality ratio.

Mr Pena is calling on people to write to their MPs requesting that the planned bed cuts be rejected and he says that the integration of care, does not have to incorporate such massive bed cuts. Since retiring in 2014, he has published his memoirs entitled, ‘The Flight of the Black Necked Swans’, which details his effort to improve standards of patient care at Tameside Hospital.

Keogh mortality review ' Risk Summit video' - Tameside Hospital.

We thought our readers might be interested in watching this NHS choices video about Tameside Hospital, presented by the panel set up by Sir Bruce Keogh, which met on 1 July 2013. The 'Risk Summit' was chaired by Richard Barker, NHS England North.

Gill Harris, who chaired the 'Rapid Responsive Review Panel', describes  the hospital as an "organisation that was failing to learn (from previous reviews/action plans) and embed changes in practice." She also says the hospital was an organisation that couldn't give full assurance regarding the quality of care provided.

The lay representative on the panel, Margaret Hughes, says in the video that the hospital governor's lacked basic knowledge of their role and therefore were unable to carry out their statutory responsibilities.

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."