Damning state of care found at ‘safe’ NHS trust

Chronic shortage of doctors, nurses and porters – and patients fainting from pain

A damning report into care at two hospitals has revealed security guards caring for patients, old and broken equipment, and patients fainting from pain in A&E because of seven hour waits – in an NHS trust authorized by regulators as safe less than two years earlier.

University Hospitals of Morecambe Bay NHS Foundation Trust, which serves 365,000 people in South Cumbria and North Lancashire, was given a clean bill of health by two regulators in 2010, despite a spate of serious problems being recorded dating back at least two years.

The Care Quality Commission (CQC) launched a full investigation into the trust in January after a series of damning inquiries and reports into widespread failings in maternity, A&E and medical wards came to light. This included the “bloody mindedness” of one father whose baby son died at the trust in 2008, which led to a damning coroner’s report into the maternity services.

The report should make uncomfortable reading for the CQC itself, Monitor and the department of health as it echoes many of the clinical and regulatory failings at Mid Staffordshire hospital where hundreds of people needlessly died. It makes clear that serious problems extend across the hospital departments. 

Investigators found chronic shortages of nurses, doctors and even porters with as many as one in four A&E staff were agency or casual employees. Nurses regularly asked security guards to step-in and carry out duties such as observing vulnerable patients at risk of falling.

Emergency patients encountered A&E waits of seven hours, with ambulances backed up and patients left in corridors unattended - problems which date back to at least 2009.  One man said he told A&E staff that he “wanted to die” after being left in pain for hours without relief. In another case a suicidal patient was left to wander outside alone despite a previous incident led to serious consequences. 

Some patients and relatives said staff laughed, taunting or were rude to them. Bullying and aggressive exchanges took place between staff leading to culture of “shared helplessness” and complete disconnect between clinicians and managers. Seven whistleblowers came forward to CQC – apparently too scared of recriminations to report concerns to their managers.

Bed shortages, poor community services and old fashioned ways of recording who was admitted where, meant too many patients ended up languishing in inappropriate wards. One man waited five days for a doctor to tell him he had suffered a fractured spine.

Old, broken, out of date and ‘not fit for purpose’ equipment meant operations were cancelled, blood pressures not taken, and patients had to sleep on “condemned mattresses”. In one case, there was no resuscitation equipment for a very sick child.

Last night, local MP John Woodcock said: “The regulators are in the dock again over what has happened and time it has taken to properly establish the problems and put in place a programme for recovery.”

“He added: “We would not be here today if wasn’t for the bloody mindedness of one father who was determined to get to the truth.”

Peter Walsh from the charity Action against Medical Accidents said: “This is depressingly familiar to what we’ve seen at Mid Staffordshire. There have now been so many serious failings by various bodies, that there is a pressing need for a full independent inquiry to look at role of regulators, commissioners, and the trust.”

Despite a spate of deaths in the maternity unit in 2008/09, and a host of other care problems stemming from chronic staff shortages, broken relationships between clinicians and managers, and no clear strategy, the CQC registered the trust in April 2010 (noting only minor staffing concerns) and gave the maternity unit a clean bill of health shortly afterwards. It issued a series of warnings and enforcement actions in 2011.

Monitor authorized foundation trust status in October 2010 but was forced to intervene a year later after it became apparent the trust was in serious breach of standards, including thousands of out-patient appointments being lost on the system.  Consultants KPMG carried out a “learning lessons” report on behalf of Monitor and recently concluded that the multiple, serious problems must have been going on when the trust was approved.

The CQC insists that it took appropriate, robust action based on the information they had and what they saw, and the trust had not made the promised improvements in response to their earlier warning. “Had the trust provided us with important information earlier, we could have escalated our actions earlier… As we learned more and became more concerned, we took increasingly robust action, culminating in this full-scale investigation.”

But one senior CQC official, who asked to remain anonymous, said the regulator must take a hard, honest look at why it failed to pick up such serious concerns earlier when others did. The official told The Independent that many questions about the regulator’s performance remained unanswered and they feared similar mistakes could happen again. 

The trust’s new chair, Sir David Henshaw, last night apologised to patients and said immediate and long-term action to improve safety and quality for patients were underway.   

The CQC said improvements were being made under new leadership and that it would formally review progress after six months.