Weekend staffing problems in NHS trusts could lead to higher fatality rates

The Dr Foster Hospital Guide 2012 has once again been investigating the worrying issue of high mortality rates in NHS trusts all over the country, and they have published their results with regards to weekend staffing levels. While some have performed well in the past year, others – such as The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust – have raised concerns over the quality of care in their hospitals at the weekends.

There is an undeniable relationship between the HSMR (Hospital Standardised Mortality Ratio) and the ways hospitals are staffed at the weekends. In the 2011 guide, it was discovered that this mortality rate decreased when there was a bigger number of senior doctors working at the weekends, and they decided to investigate how it had changed in 2012 by looking at 105 different trusts.

There was some good news with several trusts showing an increase in senior staff members since 2010/11. The following hospitals have at least 2 additional senior staff members per bed:

• Croydon Health Services

• Dartford and Gravesham

• Great Western Hospitals

• Imperial College Healthcare

Isle of Wight

• Sandwell and West Birmingham Hospitals

• Rotherham

• West Middlesex University Hospital

• Wirral University Teaching Hospital

The bad news is that five NHS trusts didn’t perform so well. The following hospitals had a Hospital Standardised Mortality Ratio that was higher than expected during the weekends (compared to the within expected or lower than categories during week days):

• Buckinghamshire Hospitals

• Mid Yorkshire Hospitals

• Oxford University Hospitals

• Royal Cornwall Hospitals

• The Royal Bournemouth and Christchurch Hospitals

The reasons for these poor results are wide ranging, with staffing levels of senior doctors being just one explanation. The mortality rates could also be related to patients being inappropriately admitted due to lack of social care or community services, as well as many procedures such as scans and other medical tests not being frequently available on Saturdays and Sundays. The Dr Foster Hospital Guide will continue to monitor the relationship between weekend mortalities and the number of senior staff on the wards in the future.

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The Francis report – what will be its effect on internal NHS culture?

Further to my earlier blog [ which dealt with its effect on public perception of suing the NHS] on the Francis report on Stafford Hospital, there has also been much discussion on the impact of the report on internal NHS culture.

In his report, QC Robert Francis described the NHS as having a “culture of fear”. As part of his recommendations, Mr Francis called for a duty of openness. The NHS really does need to accept that it simply not okay for them to routinely deny responsibility for medical mistakes. Of course, genuine accidents do occur, but the growing number of medical negligence claims shows that many medical errors are not down to accidents, but to professional negligence.

Our medical negligence lawyers have seen for far too long, an almost knee-jerk denial from the NHS in the most  negligence claims – which is, to a significant degree, responsible for the subsequent massively increased legal bills. Rather than accept responsibility for negligence where there is clear medical evidence to that effect, this seems to be an inbuilt and deep-rooted fear within our health service of being frank about any failings in levels of medical care. It’s only when the NHS itself accepts that it’s not perfect and that mistakes can be made, that they can look to address the significant problems that exist – especially in certain failing hospitals.

Any reader of this blog will know that we are a big fan of the Dr Foster website – and it’s been clear for years, according to the rigorous clinical standards set by. excellent Dr Foster research unit based at University College in London, that certain hospitals insistently fail to adopt good practice – and they are the ones who have a much lower level of patient care, often produce a significantly higher number of facilities and prompt a vastly disproportionate number of medical negligence compensation claims made against them.

Let’s hope, therefore, that there is a seismic shift in NHS culture, and a growing acceptance that openness about levels of patient care is desirable and that staff whistle blowing should encouraged rather than penalised.

Perhaps that will lead to a reduction in the unnecessary number of medical errors that continue to take place in British hospitals on a daily basis.

The Francis report – will it produce an increased number of medical negligence claims?

Following last month’s publication of the report by Robert Francis QC into Stafford Hospital, and in particular the quality of care that took place between 2005 and 2009, there has been much debate about the likely increase in the number of medical negligence claims.

A number of healthcare professionals and medical negligence solicitors have suggested that Francis report may well mark a watershed – by bringing the reality of life for patients at some underperforming NHS hospitals into the light, and taking the first step in removing the whistle blowing culture that is all too prevalent within our healthcare system.

The Francis report ascertained that Stafford hospital had seen a minimum of 1200 deaths of patients – and that this was down to poor standards of care and management at the hospital.

Our medical negligence team have noted for a number of years that people are somewhat reluctant to consider a the NHS – in contrast to other types of accident claims – such as road traffic accidents, where there is much less reluctance in suing for compensation, where the paying party is just a faceless insurance company.

We’ll have to wait and see – but the shocking findings of this public enquiry may well produce greater public awareness and a significant increase in the number of victims of medical negligence who come forward.

It’s only too early to tell – as yet there’s been no noticeable spike following the report, but there has been a steady rise in medical negligence claims against the NHS over the last few years.

High mortality rates at 9 NHS trusts to be investigated

Amidst growing pressure in the wake of the Francis inquiry into failures at Stafford Hospital, the NHS has moved to tighten its monitoring of mortality rates in hospitals. Te failure to notice high death rates at the Stafford hospital led to widespread criticism of the NHS and it has responded by publishing a list of 9 hospitals which will be investigated due to high mortality figures.

The George Eliot Hospital NHS Trust, Burton Hospitals NHS Foundation Trust, United, Lincolnshire Hospitals NHS Trust, Medway NHS Foundation Trust, Sherwood Forest Hospitals NHS Foundation Trust, Buckinghamshire Healthcare NHS Trust, Northern Lincolnshire Hospitals NHS Trust, The Dudley Group NHS Foundation Trust and North Cumbria University Hospitals NHS Trust will all be investigated.

These hospitals were found to have mortality ratios higher than the Hospital Standardised Mortality Ratio and as a result the NHS Commissioning Board was compelled to take action. This is just one of many improvements which must be made at the NHS though.

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