Watchdog called in over safety fears at ailing NHS trust

Lack of equipment and staff, and surgeons 'tricked' into operating when there are no beds for patients

Nina Lakhani
Sunday 18 July 2010 00:00 BST

One of England's largest NHS trusts has been reported to the health watchdog after senior doctors revealed that equipment shortages, dirty linen and a lack of staff are compromising patient safety.

James Brokenshire, Tory MP for Old Bexley and Sidcup, said it was his duty to contact the Care Quality Commission (CQC) about South London Healthcare NHS Trust last week amid doctors' fears of another major patient safety scandal.

The consultants, too frightened to be named, fear the trust is spiralling towards a Mid-Staffordshire-scale tragedy, where hundreds of patients died after savage financial cuts. Surgeons say they are tricked into operating on patients when there are no beds for safe post-surgical care. Doctors have been warned by managers that further such incidents could not be ruled out because of the trust's dire financial situation.

A letter from doctors at the trust's hospitals stated that confidence in the chief executive and medical director had been "shaken" by their failure to deal properly with these concerns. The doctors wrote: "None of us wants to find ourselves in the same situation as Mid Staffs... the consultants are very concerned... you two are the only ones in a position to actually change these issues... and ensure that management processes do not cause further serious clinical risks to the patients."

Pressure is mounting on the CQC to investigate the trust after a list of recent "near misses" involving cancer patients was passed to The Independent on Sunday. Shortages of clinical staff and poor communication between departments have led to cancellations and delays in the treatment of life-threatening conditions.

The revelations come just three months after the IoS was assured in writing by the trust's chief executive that patient safety had improved after complaints from a whistleblower. Mr Ramon Niekrash, a urologist at Queen Elizabeth Hospital in Woolwich, was suspended in 2008 after he persisted in reporting poor care caused by a ward closure and shortages in specialist nurses and doctors.

Since then, however, numerous incidents have come to light as the trust has tried to balance its books by ordering a recruitment freeze, a ban on agency staff and restrictions on new equipment.

Patient services at two of the three hospitals are rated as "fair" by the CQC, while the third, Queen Mary's in Sidcup, is "good".

The trust, which serves one million people, is sixth bottom of the Dr Foster Good Hospital Guide, scoring less than five out of 100 on 13 different safety measures. It has an estimated deficit of £35m – half the total NHS debt in London.

Katherine Murphy, from the Patient's Association, said: "If evidence from patients, professionals, relatives, MPs, and Dr Foster data isn't enough for the regulator to launch an independent inquiry, what is? Senior managers are walking around the hospital fully aware of the appalling standard of care, allowing it to continue."

The doctors say the "cash flow" problem at the trust has led to shortages in epidural packs in labour wards and fracture repair kits, as well as a refusal to replace essential endoscopic camera equipment. They say one patient may have died when a hospital ran out of ventilation masks. Orders are cancelled or refused by suppliers because bills have not been paid. The trust claims that it is down to an ordering error.

Confidential, but redacted, patient notes seen by The IoS show one young man whose treatment for testicular cancer was delayed by five months despite a request for an urgent appointment. In another case, a young woman narrowly escaped total kidney failure after notification of an appointment to assess multiple kidney stones failed to arrive.

Mr Brokenshire said that he reported the trust to the Department of Health and the CQC after being unnerved by the doctors' revelations and unconvinced by management assurances that patient safety was its "absolute priority".

The CQC has not yet responded to his letter, but said it was monitoring the trust closely.

A trust spokesman said: "Some consultants at the trust have raised concerns recently about the ordering and shortage of some medical supplies... We have put in place a mechanism where all consultants can report any further issues directly to the medical director and so far none have... We are getting to grips with the issues around quality, safety and financial management."

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