Wednesday, 1 October 2008

Can you trust your trust

Can you trust your trust?

I would like to put some hypothetical scenarios to you regarding “your” local Hospital Trust.

1. You go into hospital for elective surgery, every thing goes well, there are no problems and you go home fitter than when you went in.

Would you

a) Tell everyone you know how great the hospital is and recommend it?

There is no “b” because it’s a no-brainer.

2. You go into hospital for elective surgery, the operation goes all right, but there is a slight problem in that you are given the wrong medication. But you are OK and there are no lasting effects.

The consultant comes to you, explains the “accident” and apologises.

Would you

a) Leave the hospital, feeling that the care you received was “proper” and that the consultant had done the right thing, and you accept the apology.

Once again a no-brainer

You go into the hospital for elective surgery, the consultant “cocks up” the operation, you are given drugs, by the wrong method, and become Septic. Because the doctors didn’t know what was wrong with you, you are left on the ward for several days, before you have to have an emergency operation. You spend three weeks in Intensive Care, get transferred to another hospital, and then brought back again to Intensive Care. The hospital then sends you home, and you discover some five months later that you have a terminal illness.

The Consultant does not approach you at all during this period. There is no communication from the doctors, dealing with your treatment. And no apology is given because the Consultant does not think that he has failed in his treatment of you. The senior management do not apologise for your “treatment” because they don’t think that they have failed in their “Duty of Care” to you. The Healthcare Commission decides that the treatment you received was acceptable and the GMC decides that the Consultant was not at fault-it was “system failures”.

Would you

a) Go home and die quietly.
b) Sue the hospital
c) Complain to the hospital, the GMC and the Healthcare Commission.
d) Recommend the hospital to all your friends.
e) Try to find out what happened.
The point I am trying to make is that “Trusts” are only as good as the Senior Medical staff and Management. Because their attitude and standards are the “Datum Line” for the junior members of the staff, both medical and administration.

Points 1, and 2 I think show that the “Trust” is competent, caring and “human”, and what we expect from a hospital.

Point 3, shows what could actually happen.

Would it make a difference if the “Trust” were a “Foundation” trust? Which has supposedly been “scrutinised” by the Healthcare Commission and declared as meeting all the “core” standards while all this was going on?

Or that the Consultant had accepted the criticisms in an “independent” report, regarding the “unacceptable” delay in diagnosing the Sepsis, and subsequent “emergency” operation? But still didn’t think that he had failed in his duty of care? And the GMC agreed with him.

Would you think that you had been ignored and treated like an idiot because you “don’t understand” the medical terminology? Or because you are persistent and keep asking questions, and the “Trust” refuses to communicate with you although they will not answer the questions you ask? the same as with the Healthcare Commission and the GMC?

And that no reasonable explanation was given, even after three years?

What would you think?

Point 3 actually happened, it is not hypothetical. It happened to someone I knew.

And the name of this “caring” and “human” hospital?

Frimley Park Hospital NHS Foundation Trust.

In my blog-

I quoted the CEO regarding his comment “why anyone would work for the NHS for thirty years”, it was quite funny then, now I don’t think it is, so I have decided to poke the Trust with a stick and see what falls off.

There is also a very interesting article by Rita Pal regarding management.

Check out the “code for NHS managers” link, it will open your eyes. And has been in force since 2002.

The Hospital became a “Foundation Trust” on the 1st of April 2005, an omen perhaps?

It currently has a £9.2 Million surplus. Why? When people are donating money-

And this sort of thing is happening in June 2008-

And this in July 2008-

And this in August 2008-

And this in January 2007-

In which he states, “we don’t want to go out of business” A hospital is NOT a business it is a service, paid for by the public and to be used by the public.

And this in November 2007-

Yet there is this in October 2007-

Where this hospital has received an excellent rating.

Or this in November 2004 (when it was being Rated by the Healthcare Commission)-

Or this from November 2003-

Or this from October 2006-

Or this from September 2006-

Or even this from May 2008-

Which are of course after the “excellent” ratings from the Healthcare Commission.

Who is responsible for these “mistakes”? The Hospital has had the same CEO and Medical Director through all these “blips”.

This is the latest Standard of Care Rating by the Healthcare Commission-2006/7-

The Hospital did not meet the required standard of care for stroke patients.

And this is where you can download the Self declaration-

And here-you can see the patients’ rating,

I could go on. There was yet another article about this hospital in the local free paper recently regarding a patient that was sent home with “man flu” when he actually had Legionnaires Disease, two care assistants went to his house by taxi to take him back to the Hospital (acceptable?) and who is responsible?

“A Frimley Park spokeswoman said the hospital was unable to comment on Mr Dorman due to patient confidentiality rules.
She confirmed that a letter received on September 10 was formally acknowledged on September 12 in line with the complaints procedure, and advising that the hospital had initiated an investigation.
She added: In line with this procedure, the hospital will provide a detailed written response to Mr and Mrs Dorman within 25 working days of receipt of their letter of September 10”

But what is the criterion that is used to judge the “problems”?

If you take your car into the garage, and the mechanic forgets to tighten the wheel nuts, and you drive off then the wheels fall off. Whose fault is it? The mechanic? - Partly because he was careless. The manager? - Definitely because he is in charge and obviously didn’t train the mechanic properly and failed to ensure that safeguards were put in place. The company? –Even more so because they didn’t ensure that the manager was properly trained and-so on.

Doesn’t the same logic apply to the Trusts? If something goes wrong, the junior doctor treating the patient is at “fault” but the consultant in charge of the doctor bears more responsibility because he should have trained the junior doctor better and put safeguards in place to prevent or catch mistakes as soon as possible. But the medical director and CEO are most responsible because they have not ensured that the necessary “systems” were in place to prevent the “mistake” happening in the first place. And if the system was in place it is even worse because they failed to ensure that it was adhered to.

And who takes the blame and is referred to the GMC? - The junior doctor.

If there are “system failures” it is the fault of the senior management for not ensuring that the systems are followed. And action should be taken against these people, not the doctor in training because it is not their responsibility to make arrangements for cross checking treatment or ensuring that safeguards are in place. That is the role of the consultant and senior management.

To blame “system failures” is unacceptable. We are not talking about cars but Patients, with families. The “cop out” of system failures has been used and accepted by the Healthcare Commission, and the GMC for far too long.

What we are talking about here is “responsibility” and “accountability”, and having the guts to accept it, and admit that the “buck stops here”.

But it seems that the “management” is bullet proof, it doesn’t matter how many terrible things happen to patients. The “management” just walk away.

From Frimley Park Hospital accounts-

For 2006/2007

Clinical negligence costs………£ 2,011,000

Executive directors costs………£ 957,000

For 2007/2008

Clinical negligence costs……...£1,918,000

Executive directors costs………£1,007,000

Check out your Trust

Or their “risk rating”

I know that the hospital treats thousands of patients, and these examples may only be a small percentage, but what was the Senior Managements reaction? Did they contact the patients’ concerned and explain? Did the Senior Medical staff concerned do the same?

Anyone care to place a bet?

The management of this hospital only seem to make an effort when somebody makes a complaint, not when things go wrong with patients. And that effort seems to be denial. They become defensive; “medical records are not to be used for defensive purposes”, or just “ignore” when asked “difficult” questions, and insist that they are complying with the “rules”. Whose rules? Not ours.

It seems that the “Management” expects Frimley Park to become a Major General Hospital and almost considers that it already is. If this happens it will of course attract many more patients. What about the local population? More patients mean fewer facilities per patient.

And will mean even larger surpluses, for what? Shouldn’t this money be used to provide better treatment for the patients that it already serves?

It also seems that “The Management” are not satisfied with the Hospital as it is, but want to keep expanding it, and increase the number of patients by expanding the “Catchment Area” Isn’t it supposed to be a “Local” Hospital” for “Local People”?

The attitude seems to be “Bigger is Better”, more power, more surplus, more esteem, have the Trust asked the people who pay for the service whether they want thousands of extra patients using “their” hospital?

“The Management” have now decided that it “needs” a Helipad for accident and emergency, about a mile down the road is Farnborough Airport, with excellent road access to the hospital. Another “look at me” plan?

The plan has now been approved.

How much money will it cost that should be used for patient care.

The government keep telling us that more houses need to be built, fair enough, but do they tell us how many new hospitals or schools or health centres will be built to accommodate all the people that will inhabit these houses? Because the “system” is overloaded now, what will happen then?

If there is not enough health coverage for the population (and there isn’t) then more hospitals should be built, so that “our” hospitals don’t become overloaded because of the “ambition” of the “Senior Management”.

Have they even considered the ramifications of the local peoples’ reaction to this? By using their “vote” and going to another hospital where Patient care is the primary factor? Because if people have to wait longer to see “experts” and get treatment this is what they will do, especially as these “experts” work at several different hospitals due to “specialisation”.

Hospitals are called “Trusts” but trust has to be earned. And so does respect.

What do you think?

Can you trust your Trust?

Angus Dei


No comments: