Up to 1,200 patients may have died needlessly at this shambolic hospital. People were left hungry and thirsty for days. Some drank from vases, others were found fighting, some crying out in agony for lack of painkillers. But bosses were more concerned with hitting targets. How on earth could this scandal happen?
Up to 1,200 patients may have died as a result of “shocking” treatment at an NHS hospital, the health watchdog said yesterday.
A damning report by the Healthcare Commission found the Mid Staffordshire NHS Foundation Trust had an “appalling and chaotic” system of patient care.
It said...
...between 400 and 1,200 more people died than would have been expected during 2005 to 2008.
The report blasted those in charge of the trust – which runs Stafford Hospital and Cannock Chase Hospital – for being more interested in targets than looking after patients.
Families have described Third World conditions at the trust with some patients drinking water from flower vases because they were so thirsty and others screaming in pain.
The appalling catalogue of neglect “virtually at every stage” of healthcare included inadequately trained and not enough staff with junior doctors left alone in charge at night.
There were filthy, blood and excrement crusted wards and bathrooms.
Some patients were left in pain or needing the toilet, sat in soiled bedding for hours and not given their regular medication.
Nurses turned off heart monitors as they did not know how to use them.
Receptionists with no medical training were left to decide which patients coming in to A&E were the most urgent cases.
In one case a patient with a broken bone sticking out of his elbow was made to wait for more than four hours covered in blood with no pain relief.
The report also found A&E patients were “dumped” in “clinical decision units” for up to three days as a way of avoiding breaking waiting time targets.
Some patients had their operations cancelled up to four days running and were “nil by mouth” for most of those days leaving them hungry and thirsty.
In one ward, 55 per cent of patients had pressure sores when only 10 per cent had sores on arrival.
Findings were so bad, Health Secretary Alan Johnson yesterday made a personal apology to patients and families.
After her mother Bella Bailey, 86, died in November 2007, Julie Bailey, 47, set up a campaign group to highlight the plight of patients. She was so worried she had spent eight weeks sleeping in a chair at her mother’s bedside at Stafford Hospital.
Julie said: “What we saw in those eight weeks will haunt us for the rest of our lives. We saw patients drinking out of flower vases, they were so thirsty.
“There were patients wandering around the hospital and fighting. It was continuous through the night.
“Patients were screaming out in pain because you just could not get pain relief. Patients would fall out of bed and we would have to go hunting for staff. There was such a lack of staff.
“It was like a Third World country hospital. It was an absolute disgrace.”
The report said the trust was short of 120 nurses in 2007 to 2008 – about 17 in A&E, 30 in surgery and 77 on medical wards. In 2006 to 2007 the trust had axed 150 posts – most of them nurses – to meet £10million cost-saving targets.
One of the most damning report findings was that the trust board was more concerned with targets, finances and achieving Foundation Trust status – a mark of excellence – than patient care.
Despite alarm bells being rung the trust was awarded foundation status in February 2008, weeks before an investigation was launched.
The commission began its inquiry after concerns were raised about higher than normal death rates in emergency care, particularly at Stafford Hospital.
The trust argued the anomalies were due to “problems with recording data not problems with quality of care”.
Not satisfied, the commission launched a full formal investigation.
Sir Ian Kennedy, chairman of the Healthcare Commission, said yesterday: “This is a shocking story of appalling standards of care and chaotic systems for looking after patients – words I have not previously used in any report. There is no doubt patients will have suffered and some of them will have died as a result.”
Sir Bruce Keogh, medical director of the NHS, said there had been a “gross and terrible breach of patients’ trust” and a “complete failure of leadership” with the trust board being “completely out of touch with its own organisation”.
The trust’s chief executive Martin Yeates has stepped down and has now been formally suspended on full pay. Its chairman Toni Brisby has resigned.
Eric Morton, new chief executive of the trust, said “significant changes” had been made to increase accountability, staffing levels and staff training with the trust “investing substantially in new staff, equipment and services”.
He said this, and compliance with the national Hygiene Code has cut deaths, adding: “The death rate is 11 per cent lower than the standardised mortality rate of NHS hospitals.”
Apology - By Alan Johnson, Health Secretary
On behalf of the Government and the NHS I would like to apologise to the patients and families of patients who have suffered because of the poor standards of care at Stafford Hospital.
There was a complete failure of management to address serious problems and monitor performance. This led to a totally unacceptable failure to treat emergency patients safely and with dignity.
Local patients will want absolute certainty that Stafford Hospital has been transformed since this investigation began. To that end I have asked Professor Sir George Alberti, National Clinical Director for Urgent and Emergency Care to lead an independent review of the trust’s current A & E services.
I have also asked Dr David Colin-Thomé to review the standards of care and treatment at the trust between 2002 and 2007.
The new leadership of the Trust will respond to every request from relatives and carry out an independent review of case notes.
Analysis - By Niall Dickson, Chief Executive of The King’s Fund’s Health Think Tank
This is a damning indictment of the quality of emergency care in Mid Staffordshire.
It raises serious questions about how the hospital was managed.
There has been a breakdown in the systems and standards patients have a right to expect.
The Healthcare Commission says the Board was too focused on money, targets and achieving foundation trust status. Meeting targets should never be at the expense of delivering care. Running an efficient hospital within budget and offering high quality services are not mutually exclusive – hundreds of NHS Trusts are doing just that.
Safety and quality is the priority. Hospitals must ensure they have the right numbers of staff with the right skills and training and they must be deployed effectively.
Well managed finance, governance and safety are all vital and each depends on the others, but the greatest of these is safety.
CASE 1: Wife left in soiled sheets
Jeff Guest believes his wife Irene would be alive today if she had not gone to Mid-Staffordshire General.
He said the early Alzheimer’s sufferer, 73, received appalling care during her five-week stay with a suspected water infection.
He claims she was never cleaned, left in soiled sheets, given no medication and not fed properly.
The ex-builder, 79, said: “I’m dis-gusted. They totally let her down.
“Irene had early Alzheimer’s but in my opinion some of the staff did not know how to deal with her.
“I also noticed they didn’t wash their hands between patients.
“What I want to know is, is it just this hospital or is this a problem found further afield?
“Her official cause of death was listed as dementia and respiratory problems but she never had any problems with her breathing before she went there.
“Sometimes I blame myself, thinking I shouldn’t have taken her there but at the time I thought it was the one place she’d be safe.”
Mrs Guest was discharged in February last year and transferred to Cannock Hospital for three days before going to another care home. She died two weeks later.
CASE 2: No record of my mum’s fall
When patient Dorothy Mountford died just days after being admitted, her daughter was convinced Stafford Hospital was to blame.
The cause of the 78-year-old’s death was recorded as pneumonia but Jenny Goring believes it was due to a fall the night before.
She thinks it damaged her mum’s lung and restricted her breathing.
She also claims the gran – who was originally diagnosed with shingles – had a lump on her head and her eyes were rolled back. But she said the hospital kept no record of the alleged fall and wonders how it may have happened and why Dorothy may have been left unattended.
Convinced her death in November 2007 was due to lack of care, Jenny said: “She didn’t go to hospital to die.”
In a separate case, a family claims Stafford Hospital transformed Desmond Tonks from an active
77-year-old to a frail OAP before he died there.
He was admitted twice but died in December 2007 from chronic obstructive pulmonary disease.
Suffering from kidney problems and other complications, wife Brenda claims he was left without food and decent care for weeks. She said: “I kept on to them to get him on a drip. In the end they did get him liquid food but he was a little, frail old man. My husband died unnecessarily.”
What I saw shocked me to the core
Julie Bailey was so disgusted at the care her mum received at Stafford General she set up a campaign group to highlight patients’ plight.
Her mother Bella, 86, died there in November 2007 after being admitted for an enlarged hernia.
Julie said the OAP endured eight weeks of disgraceful care and what she saw shook her whole belief in the NHS.
She said: “My mum was supposed to come out after six weeks but she was dropped by one of the nurses and she never recovered.
“My mum would not let go of my hand after that because she was so afraid of the staff.
“Things were so bad on the ward that I had been feeding, watering and taking to the toilet all the other patients.
“It felt like it was not just my mum I watched dying but all the others as well.”
This spurred Julie, 47, of nearby Lichfield, to launch her campaign to highlight the conditions. Yesterday the investigation report supp-orted many of her concerns.
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