I’ve received a copy of a letter that a consultant from the Accident & Emergency Dept at Stafford hospital has sent to the British Medical Journal (BMJ). He doesn’t know whether the BMJ will publish it, but has given permission for it to be shared.
I’m publishing it, in full, here without further comment from me, in order to ensure that he gets a public hearing:
It must be made clear at the very outset that many patients suffered unacceptably in Stafford Hospital during the last decade and I sympathise with them. Some died and their deaths were considered avoidable. To their families and friends I can only extend my deepest condolences. But equally, many tens of thousands of patients attended Stafford Hospital during 2005-9 and found no cause to complain. Many of these would have been on the brink of death but were successfully resuscitated, treated and discharged. Must these patients and their families now see the hospital that saved them being maligned and prepared for closure? Do their positive experiences count for nothing?
I commenced work in Stafford Hospital only a year ago and am on the verge of retirement, with no axe to grind and little to fear in this new age of candour. Working in the A&E department, I meet local people on a daily basis and many of them recount how well they were cared for during their previous admissions. So it is with considerable angst and much concern that I watch the reputation of a locally much-liked institution being slurried in the dog-eat-dog world of the general media.
Whilst there is little I can do to encourage balanced coverage in the national press and politic, there is, surely, room for more sanguine consideration of the facts in professional journals such as this one.
1. How has it come to be that Stafford Hospital is commonly associated with 400 to 1200 deaths from 2005 to 2009? I am not being complacent when I question the derivation of these figures. It’s my training. I instinctively question ranges of 300%. And if I find even one avoidable death distressing, what do I make of a thousand? That’s carnage! People must have been dying in droves. No! As expected, the numbers are projections and estimates based on opinion, best scenario-worst scenario arguments and grossly inexpert coding. I sympathise with the view that when coding is corrected and is accurate, the death rate in Stafford during 2005-9 actually falls substantially and possibly below the national average:
“The idea that 400-1200 ‘excess’ deaths took place during a period from 2005-2009 has been repeated so often, with such a complete absence of dispute (unless you knew where to look), that in the public consciousness it has become, to all intents and purposes, a fact. But it is an idea without any basis in fact.”
Further analysis of this subject and the fallibility of mortality ratios (HSMRs) is available here: http://skwawkbox.org/2013/02/26/the-real-mid-staffs-story-one-excess-death-if-that/
2. Unlike death, Care is a perceived quality. If people don’t feel cared for, that’s the end of the argument. It’s unacceptable. Standards of care did lapse significantly in Midstaffs. But how significantly? We don’t know, because to measure such parameters objectively we need to study an unselected sample. We need to look at representative groups, not only a group of complainants. To exclude the silent majority is to select to the point of a foregone conclusion. It’s like asking 100 patients with headache whether they have headache.
3. Many myths have grown out of the Midstaffs saga. A large section of the British population, for example, still believes that patients drank out of vases, even though Francis is clear that he heard no such evidence. ( Final report: Independent Enquiry into Midstaffs pg 48. Vol 1) And what of the more-recent mudsling about a baby who had a dummy taped to the mouth? It’s a story now known to be highly questionable, but the mud’s been slung and it has stuck. The media have walked away. Job done.
4. Is Stafford Hospital financially insolvent? Like all small Trusts Midstaffs does indeed have its back to the wall. However, its losses and rate of financial degradation are small compared to its much larger neighbours and broadly comparable to foundation hospitals of comparable size (Bolton, Kettering, Milton Keynes, Peterborough, Sherwood Hospitals) as well as non-foundation hospitals (Burton, Nuneaton and Lichfield). http://www.monitor-nhsft.gov.uk/about-nhs-foundation-trusts/nhs-foundation-trust-performance/actual-performance/risk-ratings . If the Dept. of Health acting through its henchmen wishes to close Midstaffs on financial grounds, so be it. I hope they are brave enough to be candid with the local population. To my mind it makes no sense at all because all the surrounding hospitals are in similar financial jeopardy and none has the capacity to take on Mid staffs workload.
5. Is Stafford underperforming ? After its latest unannounced visit the CQC found the hospital to be performing very well on all standard criteria. The A&E department in particular was found to be meeting all its targets satisfactorily. http://www.cqc.org.uk/directory/rjd01.
The West Midlands Deanery seems quite happy if the JEST surveys are anything to go by. Again, the A&E department, now tagged for closure, has actually received very upbeat reviews from F2 interns.
http://www.westmidlandsdeanery.nhs.uk/FoundationProgramme/FoundationSchools/Staffordshire/TraineeComments.aspx
And even when it comes to lofty work such as Research and Innovation, the hospital has received some recent accolade. ( Prof Wallwork 2010 para 13.3).Given the above, it is clear that downgrading Stafford Hospital is not going to be an easy call. Monitor has labeled it unsustainable on clinical grounds despite positive Deanery and CQC reports. It has also been labeled as ‘financially non-viable’ even though its finances are in a better state than those of many hospitals in the Midlands.
To close such a hospital will only serve to deprive good, decent, local folk of their local hospital, and it will further over-burden adjacent hospitals. It will save nothing but fools’ gold because the neighbouring Trusts have no additional capacity and are already in the red.
But allow me to embrace the new age of candour and think out loud: Perhaps all of this was avoidable. It is possible that if Midstaffs’ management had come out fighting at the outset and rejected the flawed methodology, a more balanced outcome would have prevailed. It seems to me that Management was petrified in case it was seen to be complacent and conniving.
Compare and contrast the robust defence Sir David Nicholson mounted when he felt he was being unfairly attacked. He kicked. The HSJ printed articles in his favour: http://www.hsj.co.uk/opinion/nicholson-does-not-deserve-the-mails-vilification/5055404.article?blocktitle=Opinion&contentID=141
He mobilized his support in the Civil Service and the DoH and it is possible he has prevented his own burning at the stake of pseudo-science by the popular press. In any event, he introduced a degree of balance. Should Midstaffs not have done the same?
Yes, more evidence & support for SKWarkStats..!
Isn’t the UK press now ashamed of their previous lazy parrot journalism? Aren’t they embarrassed to have been nudge nudged into a lobotomic state by no.10?
PS: Love the ironic ‘new age of candour’ with ‘little fear’ – we can already predict axes being ground ready for any new staff who dare to question anything openly, despite Jeremy Hunts oft-quoted new love for whistleblowers..
Good to see that a consultant is speaking out! If only all would, but not after a lot of publicity, and an official inquiry, but on the wards, where daily they may observe poor care which may, or may not be down to understaffing.
I have observed over a period of years poor care, and complained and complained and complained, but the only result is I have a reputation as a complainer. Perhaps your consultant, or any of his colleagues, might like to publish their names so that people who are concerned about the care of someone they love, can contact them.
Greta Young
If the BMJ don’t publish this in their print edition, that would be very worrying.
Powerful argument from someone who probably can’t be accused of any self interest – I sincerely hope he or she is prepared for personal media and pressure group scrutiny (including communication from the GMC) if this is the spark that creates a mainstream media discussion of these important issues (both Health and Journalism!)
It is certainly true that everyone in the Trust and probably the Town as well have been treading on eggshells for some years. The march was a turning point in this respect.
I wanted to thank the person who has written this. Because I have observed what has happened in Stafford since 2007 I have a pretty good idea of how much courage this will have taken.
Whilst growing numbers of people in Stafford do understand that there are difficult questions to be asked, the national press remains oblivious. They did not see the astonishing 50,000 people who marched, they probably do not see the threat to our services. They do not see why we would wish to say “NO”.
The writer asks why were the figures not questioned at the time of the HCC report. I think I can answer that. In the weeks before the publication of the report the town square was dominated by the pressure group demanding the head of the CEO, The media campaign was in full flow, Monitor, and the DoH settled on giving the campaigners what they wanted. This meant that when the leaked figures and the HCC report were published there was no one who had the knowledge or the authority to speak out.
I know it took me a week to read the report four times and get second opinions to satisfy myself that the excess death figures were not there and were not implied – by that time it was far too late. No one would have listened to me anyway, why would they, I am no one.
I do feel that the SOS – Alan Johnson should have raised the issue, but he probably did not feel secure in this. It might have been true? No one had the knowledge at that time to be certain. He settled on sending in Alberti to check that things were safe.
There is some indication that the DoH may have learnt something useful from all of this. The quick turn round at Leeds is clearly preferrable to the five years of torment we have been through here.
If the excess death figures are finally accepted to be deeply misleading then this is going to be very uncomfortable for a great many people, not least because it shows that it would be very unwise to see MidStaffs as a one off, and that we should expect that poor care may occur in many places, when staff and managers are not sufficiently well supported..
Here last week in Stafford something astonishing happened. 50,000 took a walk together, to put our arms around the nurses and the staff and to say thank you for all that you have done. I believe that there is now a deep bond between this town and its hospital, and that this may serve us well in the future.
Yes indeed. The progress in the hospital has been astonishing when you think of the pressure the staff have been under (no other group will ever experience it). There has been a change of higher management almost every year as well. I suppose the national press particularly are oblivious to the deep hurt and harm they cause to individuals and groups by such partisan and lazy reporting. The real story here may yet emerge; perhaps it was really one for Levison not Francis.
With the current uncertainty (created by the assumption that you can deal with Health provision for a population in a similar way to a widget factory fallen on hard times) you may be wondering why health professionals, especially those in shortage specialities, aren’t leaving in their droves. Well it’s quite simple really. They know that they are working in one of the best DGHs in the UK and one that isn’t satisfied even with that. They also know that the case for removal of all acute services doesn’t stand up and the people of Stafford, Cannock and surrounding areas are determined to keep them, preferably as an independent entity serving Mid-Staffordshire and negotiating with others to network and help as needed. Consequently they are not going to give the Administrators the satisfaction of having a self-fulfilling mass exodus (one of the many things HMG and Monitor may have expected of this “process” that isn’t happening). A good many staff have expressed a determination to work for the people of Mid-Staffordshire until the bulldozers appear – and may very well throw themselves in front of them if they do arrive, such is their resolve!
🙂
Fantastic comments. One only hopes the BMJ publishes.
NEWS: Chaos at Stafford.
The Administrators have postponed the dates and venues of the Public Meetings organised for this week In Stafford and Cannock. Although the venues hold 500 each, there seemed to be a fair chance that large crowds would be turned away – this would not have looked good from their point of view (those inside would have been irritated that all they were being told about was the “process” and those outside would have been irritated at not getting in!)
You are now imagining that much larger venues in Stafford and Cannock will have been arranged for suitable dates in the future.
er …NOT.
Instead of 29th and 30th April in Stafford and Cannock they will be at the County Showground (well out of Stafford) on 30th April and 1st May. The venue holds 700 – not much more than the others. [NB: Both towns have substantial theatres with banked seating holding over 900 that are unlikely to be utilised in the morning or afternoon].
Could it be that the men in suits are minimising the numbers by changing the venues at the last minute, substituting an out-of-town venue so that transport is needed and giving flop-all notice of the new meetings? (Public order, safety etc – what a heaven-sent excuse!)
Yes it could!
More changes to dates etc. I’m wondering when they are going to get the message that divide and rule, that must have seemed a dead cert in Stafford/mid Staffs is not going to happen.
What, they’ve changed tomorrow’s meeting?
Meeting went ahead. Apparently impassive, management-speak, “this is the process, we’re not involved in X, Y, Z” style of administrator (are they trying to shift the blame to the CCGs? – well certainly they haven’t helped!). 700 one night, 2-300 the next – frustrated – unclear whether Administrator team listening or not (ie or just making sure “consultation” is watertight). All to do with financial viability, no concept of needs. Depressing but …. on the other hand, massive determination on the part of a very united public. Whatever the Administrators suggest on the back of their envelope, it’s going to be a tricky political decision for Mr Hunt and Mr Cameron (the latter, interestingly, having already stated that he wants acute services to continue in Stafford).
well put my friend. do you think it will ever change though?
If enough people wake up to what’s going on and to the accelerating erosion of the NHS, yes. But that’s a big ‘if’ at the moment.
Administrator (been around a lot but not Healthcare before now) apparently said in one of the public meetings that he’d never met such a driven workforce (the whole meeting is on line so the exact quote would be available). It is also rumoured that the running total of staff who have left on account of the uncertainty is zero. Given what has happened to them and the pressure they are still under – is this the most heroic workforce ever in the NHS?
And the most maligned!