Sunday 24 February 2013

A story of a hospital - high mortality rates

It has not been an easy time for hospitals in Buckinghamshire.  Not that it has been easy for any hospital recently.

In 2005 two previously independent hospital merged to become the Buckinghamshire Hospitals NHS Trust.  One was Stoke Mandeville Hospital in Aylesbury and the other was Wycombe General Hospital in High Wycombe, 18 miles away on the other side of the Chiltern Hills.  Suddenly the management team had to look after three sites, three PFIs and work with a Primary Care Trust that was struggling to keep within budget. The budget was one of the lowest per head in England.

In 2005 the trust closed down the A&E in Wycombe and created a minor injuries unit, much to the disgust of the local population.  Trauma services were also moved while earlier the consultant led maternity unit and children's services had also been moved.

In 2010 the trust took over the management of community services, previously managed by the PCT.

In 2012 there was a big reconfiguration of services with some moving to one hospital and others being centralised at the other. So Wycombe Hospital now has a very good Hyper Acute Stroke Unit and a cardiology department while inpatient care for emergency medicine, respiratory, gastroenterology and medicine for older people have all moved to Stoke Mandeville Hospital.

Two mergers and a major reconfiguration within 5 years must have an effect on the effectiveness of a hospital. 

At the same time as all this merging and shifting of services, not forgetting the scandals & investigations, the trust has been trying to become a Foundation Trust. 

There is more!

 Now it is one of the hospital trusts being investigated for high mortality rates.

According to the data from Prof Brain Jarman's website http://brianjarman.com  trust has been reporting higher than expected death rates in 9 out of the last 11 years. The last four years have been higher than 110. So now they will be investigated by the Department of Health.

The trust, now called the Buckinghamshire Healthcare NHS Trust, has said that it has been examining the deaths of patients for the last 2 years in an effort to understand why the rates are so high. See their press release here

The trust  has in the past been quite successful in improving the quality of care it provides. Following the hospital acquired infection outbreaks the board saw the Infection Control reports at every board meeting. Now the trust is one of the better performing trust in this area.

Yet after two years of an in-house investigation the mortality rates are still high. Why?

What could be the causes for the high death rates. The Francis report on the Mid Staffs high death rates found that there were many causes but meeting targets, keeping to budget and getting foundation status were some of the primary causes.

In Buckinghamshire the health and social care economy has been under stress for many years. There have been the merger of the two hospitals and then the integration of the hospital and community services. There has been the Foundation Trust application. 

Is the fact that the PCT has been managing referrals and diverting patients to alternative providers before referring to the hospital meant that patients are sicker when they do get into the hospital?

Is it that they have been poor at coding patients in the correct way?  They have had two years at least to sort that one out. 

Is the reporting and analysis of the data flawed. Not so, says Prof Jarman and Dr Foster.

So is it that the hospitals are providing poor quality care?The patients are not reporting great concern, as far as I know, to the Trust, their GPs or the Local Involvement Network, or even Patients Opinion.

So what is happening  here? Why are the mortality rates still so high?

When will the investigation start and who will be on the team representing local people?

We need a swift and effective investigation so that the patients and the public can be re-assured that the trust is providing good quality care and is a safe place for us to go to when we need to use the hospitals

A story of Stoke Mandeville Hospital

This is a story about my local hospital. Well, its more of a history than a story.

It is quite well known.  Famous almost.  The original hospital, built in 1940 for casualties from the war, consisted of two long corridors of pre-fabricated wooden huts. It was not meant to last long.  My father-in-law tells the story of coming out to the site as a quantity surveyor to cost a tender for building it. (They did not get the tender.) It was green field site then, outside the small market town of Aylesbury. 

Those original wooden wards stayed with us until the new PFI funded hospital was built recently.  There were miles of corridors and there had to be two 'crash teams' as it took so long to get to the wards in an emergency.

I can see the hospital from my house.  I have been a patient there and I even worked there for a while.   I was a patient on the famous wooden wards.  When I was on the local Community Health Council we campaigned for years for a new hospital.  We were pleased when the new one was built.  Little did we know of the consequences of the way it was funded.

So this is our hospital and we are proud of it.  It is Stoke Mandeville Hospital. 

You have probably heard of it. 

In 1944 Ludwig Gutttman came to work here and created a new way of treating patients with spinal injuries. An amazing man!

In 948 the first Stoke Mandeville Games were held and in 1952 they became the international games. Thus was born the Paralympic movement.

The National Spinal injuries Centre (NSIC) moved into a purpose built building in 1983.  One of the chief fundraisers for this great facility was Jimmy Savile.  This is another reason the hospital is famous as it is currently in the middle of an investigation into his activities while associated with the hospital.

The hospital has had more than its fair share of scandals. 

In 2001 the Chief Executive and Chairman resigned because the Waiting Lists were fiddled. 

In 2003 and again in 2005 it was at the centre of the hospital acquired infection outbreaks when over 30 people died in two C. Diff outbreaks.

Now, in 2013, it is one of the nine hospitals being investigated by the Department of health for high mortality rates.

Is it an unsafe hospital?  In the next blog I will write about the recent history of this famous hospital.

Saturday 23 February 2013

Healthwatch - enagaging with the public

Our band new Healthwatch Buckinghamshire recently advertised its first public meeting.

Here is part of the advert:

"Do you use any of the health and social care services in Bucks? Or do your friends or family use them?

Do you want to see them improved in some way? If so then this event is for you.

Healthwatch Bucks is the new consumer champion for our county. It will give users and communities a stronger voice to influence and challenge how health and social care services are provided in Bucks.

Come along to find out about Healthwatch, the concept, context, vision and structure. Find out about the many different ways that you could get involved. Together we can improve things – see where you fit in and how your contribution could make a difference.”   

It seems to me that the new organisation has not learnt the lessons from previous efforts to engage with the public on health care.  Public meetings do not work unless there is a specific topic of interest.  

If they want to engage with the public in a meaningful and effective way then they should hold meetings with clear objectives and achievable outcomes.  They need to think inventively and smarter.  They need to do things differently.

If they want to publicise the "concept, context, vision and structure' they could do that more effectively by circulating information by email, post or even using social media!

How about this as a topic for a meeting: What are your concerns about the high Mortality Rates at Buckinghamshire Healthcare NHS Trust? What are your experiences of being a patient at the hospitals?

That might create some interest and they could then show us how Healthwatch Buckinghamshire could influence the care provided locally and how we could provide input into the investigation.

So this is a plea to Healthwatch Buckinghamshire to do things differently. Be innovative. Be bold.