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Wide ranging problems highlighted in CNHSLincs respose to review

July 4, 2013

RESPONSE TO REVIEW TEAM

We summarise below our response to the ULHT Review team.  We consider the problems in Lincolnshire to be wide ranging and so we covered four issues.  First patient experience and then three issues which we think need to be tackled if there is to be sustainable safe care into the future.  Those three issues were funding, governance and fixing the whole health system.

Patient Experiences

We appreciate that ULHT has circa 700 or so complaints each year and that any analysis of our complaints will not be as reliable as any analysis that the Review Team carry out, via ULHT’s own complaints unit.  However it is worth noting that a number of the complaints submitted to us had not been made to the Trust either at the time of the alleged incidents or subsequently.

The following pattern emerged:

  • Relative to its size there were a disproportionate number of complaints about Boston Pilgrim Hospital;
  • Complaints spanned from incidents in 2005 through to those which arose in recent weeks;
  • Many of the complaints were about poor care generally or neglect which did not lead directly to deaths;
  • A small number did include specific allegations that that the lack of care resulted in death or contributed toward an earlier death and a feeling of an uncaring attitude to terminally ill patients;
  • A common factor was that there was an alleged uncaring attitude to patients above a certain age;
  • A relatively high proportion of complainants stated that they (or their relative) were put on the Liverpool pathway without their knowledge with DNR notices but survived suggesting that the Liverpool pathway was being misused.  Some of these complaints post date the recent publicity about that pathway and the need for informed consent;
  • The lack of openness and transparency and complexity of the complaints system was a major issue of concern.
  • Few complainants seemed motivated by the desire to gain financial compensation; their motivation was to get to the truth and prevent similar issues arising again;
  • There were widespread perceptions of the Trust being less than honest and of cover ups.

Cure the NHS Lincolnshire is concerned that the Review Team may focus on mortality.  The feedback we have received suggests that to focus on mortality would be to overlook deep concerns about the consistency of high quality care including to those who were admitted for relatively routine non-life threatening procedures or non-life threatening conditions.

Finance

Increasingly hospitals are paid per procedure.  Under the national funding formula, by which hospitals get paid, there is a market forces factor (MFF) applied to a national tariff according to which geographic area the hospital is in.  This MFF completely ignores rural issues; indeed worse, its assumption on labour and land costs means that ULHT is the 5th worst funded trust in the country out of around 250 trust.  This means that 245 Trusts get paid more per procedure than ULHT.

The problem can be emphasised by two local examples where the hospitals have higher MFF’s than ULHT (ie they get paid more per procedure than ULHT):

  • Peterborough Trust, an adjoining Trust to ULHT, is threatening to close Stamford Hospital due to issues of financial viability;
  • Hinchingbrooke Trust has had severe financial problems and has recently been taken over by Circle Health

For the same workloads these hospitals are paid circa £20m pa more than ULHT.  If they struggle financially it is hardly surprising that ULHT struggles.

It is our view that a key risk to patient safety in Lincolnshire is that the continuing historic underfunding of the local NHS, whilst expecting the same performance standards and compliance with targets will mean that the local acute sector remains, and will continue to remain, under pressure.

Safety may be the focus at the moment and staffing etc may be improved as a result but as and when the focus becomes money, perhaps in pursuit of FT status, service standards and staffing levels will slip back and the cycle of poor care will repeat itself.

It was this twin pressure of service and financial targets which contributed to the problems at Mid Staffordshire.

Governance

The NHS is not renowned for its high commitment to governance as evidenced by the frequent allegations about ‘cover ups’.

Locally we have received allegations that the ambulance trust has been using First Responders in a wholly inappropriate way in order to manipulate its own performance data and improve its reported performance against standards in rural areas.

As far as ULHT is concerned it’s Board decided to invest circa £0.5 million in gagging its former Chief Executive in 2011.  The Trust, through what has become known as a ‘super gag’, also sought to extend the gag to Mr Walker’s witnesses at his pending employment tribunal.  Such action is unprecedented.

When this became public there was then a systematic attempt by ULHT to mislead the public and its own staff.  In spite of assertions that there was no intent to prevent Mr Walker speaking out on issues of safety there clearly was.

This has been exacerbated by a number of refusals to respond to FOI’s on patient incidents and other allegations about gagging of staff.

There can be little public confidence in a Trust led by those who effectively sought to mislead the public and their own staff. Furthermore if this is the way its leaders act it will not encourage an open culture in ULHT.  Indeed the reverse.  Without an open culture many of the issues raised by patients cannot be resolved and this lack of openness is a significant risk to safe care.

NHS Leadership

For many years there has arguably been a lack of leadership from both the former SHA and the PCT who showed more concerns about competition rather than the delivery of effective integrated healthcare.  The PCT did not manage demand, indeed worst still its plans to divert demand from the acute sector launched in 2007 failed, with even higher admissions to ULHT.

It also failed to properly performance manage the Ambulance Trust and the public confidence in that service is now at an all-time low.

The new commissioning groups will not find it easy to fill the leadership vacuum but there is a need for a fundamental reappraisal of the role of all parts of the health system in Lincolnshire backed up by effective funded plans for the delivery of change.

Cure the NHS Lincolnshire is not confident that left on its own the NHS in Lincolnshire has the leadership capacity or resources to overturn years of neglect.  Without some radical transformation being delivered in practice the local acute sector will continue to be the refuge of last resort for too many patients, putting the quality of their care or the quality of the care for others at risk in overcrowded hospitals.

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