A criminal investigation has been launched into the death of a woman at scandal-hit Mid-Staffordshire NHS Foundation Trust following a public inquiry, which concluded patients had suffered “appalling” care.
The Health and Safety Executive is to investigate the death of Gillian Astbury, who was diabetic and died aged 66 in 2007 at Stafford Hospital after nurses forgot to give her insulin.
If charges are brought, it would represent the first time that anyone has faced criminal prosecution over the Mid-Staffs scandal.
Robert Francis, who chaired the inquiry into the trust, was so shocked by the case he cited it in a seminar before writing his report. He said that despite its gravity, the gross error that led to Mrs Astbury’s death had failed to trigger remedial action. “It never registered with the Trust board or the strategic health authority leading one to ask: what about accountability?”
Ron Street, 79, Ms Astbury’s “close friend, soulmate and carer”, said there was a “lack of responsibility” in the NHS. “I am not a vindictive person but I would like the people at Stafford held to account. I don’t necessarily want them clapped behind bars but I do want a message sent out across the NHS that you cannot do this with impunity,” he said.
Ms Astbury was admitted to Stafford Hospital with a fractured hip following a fall at home on 1 April 2007. After repeated instances in which Mr Street had found her lying in soiled bed linen, with meals left out of reach and bloody tissues discarded on the bedside table, she died 10 days later in a hypoglycaemic coma after she had been transferred to a new nursing team who had not read her notes and failed to realise she needed regular injections of insulin for her diabetes.
A police investigation was launched but no prosecution was ever brought. The HSE was due to investigate but put its inquiries on hold until the conclusion of the Francis inquiry in February.
At the inquest into Mrs Astbury’s death in September 2010, the jury found “serious shortcomings” in the running of the hospital. “Nursing facilities were poor, staff levels were too low, training was poor, and record keeping and communications systems were poor and inadequately managed,” its verdict said.
An HSE spokesman said: “Our focus will be on establishing whether there is evidence of the employer [the Trust] or individuals failing to comply with their responsibilities under the Health and Safety at Work Act.”
Julie Hendry, director of quality and patient experience at Mid Staffordshire NHS Foundation Trust, said in a statement: “I would like to offer our sincere condolences to the family of Gillian Astbury for their sad loss and apologise for the appalling care Ms Astbury received at our hospital in April 2007.
“Ms Astbury’s death was reported as a serious untoward incident at the time and a full investigation into her care and treatment was carried out. The recommendations from that investigation were implemented. Actions included raising staff awareness about the care of diabetic patients and improving the information and system for nurse handovers. In 2010 we reviewed Ms Astbury’s dreadful care and, as a result, disciplinary action was taken.”
The Francis inquiry highlighted “appalling and unnecessary suffering of hundreds of people” at the Trust between 2005 and 2009 and concluded it had put “corporate self-interest and cost control ahead of quality and patient safety”.
As many as 1,200 patients may have died needlessly after they were “routinely neglected” at the hospital.
Many were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.