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| Stafford's A&E set for closure as anger grows at 'crucifixion of a good hospital' | Stafford's A&E set for closure as anger grows at 'crucifixion of a good hospital' |
| (5 days later) | |
| It was the hospital that was dubbed by the media as the "Killing Fields" of the NHS. After a highly critical report by the Healthcare Commission in 2009, a handful of elderly-care wards at Stafford hospital and the hospital's accident and emergency unit were universally condemned as patient death traps. Reporting the findings on the now notorious Mid Staffs NHS Foundation Trust the BBC claimed in the three years leading up to 2008 "up to 1,200 people may have died needlessly due to appalling standards of care". | It was the hospital that was dubbed by the media as the "Killing Fields" of the NHS. After a highly critical report by the Healthcare Commission in 2009, a handful of elderly-care wards at Stafford hospital and the hospital's accident and emergency unit were universally condemned as patient death traps. Reporting the findings on the now notorious Mid Staffs NHS Foundation Trust the BBC claimed in the three years leading up to 2008 "up to 1,200 people may have died needlessly due to appalling standards of care". |
| The oft-quoted figure did not appear in the commission's report, but it did appear the day before in the Daily Mail, and has been endlessly repeated since. Partly as a result – and after a public inquiry and one new regulator – four years later the story has reached its denouement: it is expected that on Wednesday permanent closure of the hospital's A&E will be announced. Emergency patients in Stafford will have to travel to Stoke or Wolverhampton for care – and the economic regulator Monitor has already warned in March that the trust is "both clinically and financially unsustainable in its current form". | The oft-quoted figure did not appear in the commission's report, but it did appear the day before in the Daily Mail, and has been endlessly repeated since. Partly as a result – and after a public inquiry and one new regulator – four years later the story has reached its denouement: it is expected that on Wednesday permanent closure of the hospital's A&E will be announced. Emergency patients in Stafford will have to travel to Stoke or Wolverhampton for care – and the economic regulator Monitor has already warned in March that the trust is "both clinically and financially unsustainable in its current form". |
| But despite the furore – stoked by some parts of the media, and fanned by some politicians – the reality is more complex. The response from local residents has been first indignation and then anger at the proposed closure, while the evidence for the 1,200 or so supposed needless deaths is in fact far from certain. | But despite the furore – stoked by some parts of the media, and fanned by some politicians – the reality is more complex. The response from local residents has been first indignation and then anger at the proposed closure, while the evidence for the 1,200 or so supposed needless deaths is in fact far from certain. |
| Such has been the outcry locally that after years of patients shunning the hospital and choosing to go elsewhere, there are now a third more people using A&E than a year ago – up from 120 a day to 160. In April 30,000 people joined a mile-long march to save the local hospital in the town. The simmering resentment has also led to Julie Bailey, the woman who led the campaign to expose failings at Stafford hospital, claiming she was "run out of town" and forced to sell her cafe, where her Cure the NHS group used to meet. Some indication of where the town's sympathies lie might be garnered from the fact her cafe is now under new management and sports a "Support Stafford hospital" poster. | Such has been the outcry locally that after years of patients shunning the hospital and choosing to go elsewhere, there are now a third more people using A&E than a year ago – up from 120 a day to 160. In April 30,000 people joined a mile-long march to save the local hospital in the town. The simmering resentment has also led to Julie Bailey, the woman who led the campaign to expose failings at Stafford hospital, claiming she was "run out of town" and forced to sell her cafe, where her Cure the NHS group used to meet. Some indication of where the town's sympathies lie might be garnered from the fact her cafe is now under new management and sports a "Support Stafford hospital" poster. |
| Meanwhile, the first inkling nationally that the numbers of supposed NHS deaths may have been overblown was when doctors this month accused Jeremy Hunt, the health secretary, of attempting to "make political capital" out of hospital death rate data. | Meanwhile, the first inkling nationally that the numbers of supposed NHS deaths may have been overblown was when doctors this month accused Jeremy Hunt, the health secretary, of attempting to "make political capital" out of hospital death rate data. |
| This has emboldened staff at Stafford hospital to break cover. Heather Gough, who has spent 40 years at Stafford hospital, largely in A&E, said at the heart of the historic problem lay an overworked workforce using antiquated equipment. Nursing staff had, she says, been shrunk to cut costs so that the hospital could gain elite foundation status. "We reported these things hundreds of times to management. We warned them about equipment. I welcomed the Healthcare Commission investigators. But their results were used to beat nurses with. They said we did not care. Although it was reported that nursing staff intentionally neglected and abused patients, that was not the case," says Gough. "There was poor care in places but it was not intentional." | This has emboldened staff at Stafford hospital to break cover. Heather Gough, who has spent 40 years at Stafford hospital, largely in A&E, said at the heart of the historic problem lay an overworked workforce using antiquated equipment. Nursing staff had, she says, been shrunk to cut costs so that the hospital could gain elite foundation status. "We reported these things hundreds of times to management. We warned them about equipment. I welcomed the Healthcare Commission investigators. But their results were used to beat nurses with. They said we did not care. Although it was reported that nursing staff intentionally neglected and abused patients, that was not the case," says Gough. "There was poor care in places but it was not intentional." |
| However, today medics and nurses say the hospital is on the way up, with the Healthcare Commission's successor, the Care Quality Commission, withdrawing all its concerns in July 2012. | However, today medics and nurses say the hospital is on the way up, with the Healthcare Commission's successor, the Care Quality Commission, withdrawing all its concerns in July 2012. |
| The health statistics and research service Dr Foster now rates the hospital as one of the best performers in the West Midlands, in terms of its mortality rates. | The health statistics and research service Dr Foster now rates the hospital as one of the best performers in the West Midlands, in terms of its mortality rates. |
| In an activist's kitchen, which doubles as the office of the Support Stafford hospital campaign, Mark Saville, a grade 5 nurse, told the Guardian that many of the familiar condemnations were misinterpretations of events inside the hospital. Take the repeated criticism of patients "so desperate for water that they were drinking from dirty flower vases" – an assertion made by David Cameron to MPs in February. But Saville, 53, said that flower vases were kept in a cleaning room and mostly empty. "Only a deranged patient might go in there looking for water. Or else someone who was kept off fluids for medical reasons." | In an activist's kitchen, which doubles as the office of the Support Stafford hospital campaign, Mark Saville, a grade 5 nurse, told the Guardian that many of the familiar condemnations were misinterpretations of events inside the hospital. Take the repeated criticism of patients "so desperate for water that they were drinking from dirty flower vases" – an assertion made by David Cameron to MPs in February. But Saville, 53, said that flower vases were kept in a cleaning room and mostly empty. "Only a deranged patient might go in there looking for water. Or else someone who was kept off fluids for medical reasons." |
| Both Saville and Gough say contrary to persistent claims that in A&E "initial assessments were carried out by receptionists with no medical training" in fact all the front desk did was input in the doctor's notes onto the hospital computer but when they could not read who had signed in patients they simply entered their own name. "Otherwise you could not admit patients," said Saville. However, most damaging of all is the link made between the idea that there was poor care in Stafford with the notion that there were between 400 and 1,200 preventable deaths at the hospital. The man who calculated the figure was Sir Brian Jarman, a professor at London's Imperial College who co-founded Dr Foster. | Both Saville and Gough say contrary to persistent claims that in A&E "initial assessments were carried out by receptionists with no medical training" in fact all the front desk did was input in the doctor's notes onto the hospital computer but when they could not read who had signed in patients they simply entered their own name. "Otherwise you could not admit patients," said Saville. However, most damaging of all is the link made between the idea that there was poor care in Stafford with the notion that there were between 400 and 1,200 preventable deaths at the hospital. The man who calculated the figure was Sir Brian Jarman, a professor at London's Imperial College who co-founded Dr Foster. |
| It was Jarman's "hospital standardised mortality ratio (HMSR)" that suggested at Mid-Staffs there were 1,197 "observed minus expected deaths" over the course of a decade and 492 equivalent deaths between 2005 and 2008. Crucially, though, Jarman's HMSR is a measure of how many "excess deaths" there were in a hospital compared to a national average, but not how many "preventable" ones took place. | It was Jarman's "hospital standardised mortality ratio (HMSR)" that suggested at Mid-Staffs there were 1,197 "observed minus expected deaths" over the course of a decade and 492 equivalent deaths between 2005 and 2008. Crucially, though, Jarman's HMSR is a measure of how many "excess deaths" there were in a hospital compared to a national average, but not how many "preventable" ones took place. |
| To put this in perspective, in 2009 an independent review into 50 contentious patient deaths at Mid Staffs found one that could be described as "avoidable". Jarman, however, used the data to conclude that it set a potential upper limit of 300 preventable deaths a year at Stafford, given the number of admissions at the hospital a year. However, the academic does concede this is the worst case scenario however. | To put this in perspective, in 2009 an independent review into 50 contentious patient deaths at Mid Staffs found one that could be described as "avoidable". Jarman, however, used the data to conclude that it set a potential upper limit of 300 preventable deaths a year at Stafford, given the number of admissions at the hospital a year. However, the academic does concede this is the worst case scenario however. |
| Jarman has appeared regularly in television and print warning that NHS hospitals had high death rates, but he also points out that some newspapers and broadcasters have consistently misconstrued his figures to claim erroneously that 1,200 patients died unnecessarily at Stafford. This is exactly the point Sir Bruce Keogh, the NHS's medical director, made last month. He warned: "It is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths." | Jarman has appeared regularly in television and print warning that NHS hospitals had high death rates, but he also points out that some newspapers and broadcasters have consistently misconstrued his figures to claim erroneously that 1,200 patients died unnecessarily at Stafford. This is exactly the point Sir Bruce Keogh, the NHS's medical director, made last month. He warned: "It is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths." |
| Standing in his black clinical smock Dilip Dacruz, Stafford hospital's A&E consultant, is fuming about the way "a fictitious number of deaths have been produced to crucify Stafford hospital, which today is as good as anywhere else in the NHS". He says that the figures had been used to close Stafford's overnight emergency service back in 2011. "The end result is that when the A&E now opens at 8am on Monday morning there is a queue of people like at a post office waiting outside to get in. Boys who have injured their ankle playing football. An old person holding his tummy. It's completely unacceptable". | Standing in his black clinical smock Dilip Dacruz, Stafford hospital's A&E consultant, is fuming about the way "a fictitious number of deaths have been produced to crucify Stafford hospital, which today is as good as anywhere else in the NHS". He says that the figures had been used to close Stafford's overnight emergency service back in 2011. "The end result is that when the A&E now opens at 8am on Monday morning there is a queue of people like at a post office waiting outside to get in. Boys who have injured their ankle playing football. An old person holding his tummy. It's completely unacceptable". |
| Underlying the controversy is that HMSR is also extraordinarily sensitive to the way a hospital records its mortality data. Jarman says Mid Staffs brought in a "Texan coder" – Sandra Haynes-Kirkbright – to "flatter" its poor HMSR reading, which in 2007 made it the fifth worst hospital in the country. | Underlying the controversy is that HMSR is also extraordinarily sensitive to the way a hospital records its mortality data. Jarman says Mid Staffs brought in a "Texan coder" – Sandra Haynes-Kirkbright – to "flatter" its poor HMSR reading, which in 2007 made it the fifth worst hospital in the country. |
| What is true is that at Mid Staffs the proportion of deaths coded as "palliative care cases" – those patients effectively dying or dead on arrival at A&E – rose. The trust recorded 0% (just one patient) in the fourth quarter of 2007 to a third (72 patients) in the third quarter of 2008. Meanwhile the trust's HSMR dropped from 116 – above average – to 86 – below average – between the first and third quarters of 2008. Jarman told the Guardian that "the Texan turned Stafford hospital into a morgue". | What is true is that at Mid Staffs the proportion of deaths coded as "palliative care cases" – those patients effectively dying or dead on arrival at A&E – rose. The trust recorded 0% (just one patient) in the fourth quarter of 2007 to a third (72 patients) in the third quarter of 2008. Meanwhile the trust's HSMR dropped from 116 – above average – to 86 – below average – between the first and third quarters of 2008. Jarman told the Guardian that "the Texan turned Stafford hospital into a morgue". |
| However Haynes-Kirkbright told the Guardian that before she started in 2007 the hospital had not been coding patients correctly. That year the department of health recommended that hospitals specifically begin coding for palliative care. She said: "All we did was set up the system correctly and follow the rules. Before that in Stafford they were coding dead bodies as patients." She also says the number of "palliative care cases" can be put down to the fact that 14 care homes were closed down and the hospital was "having bodies dumped on them". Bizarrely this mathematical puzzle is now in the hands of law enforcement. Councillors at Stafford borough council claimed the former chairman and chief executive of Stafford hospital had misled its health scrutiny panel and that they committed misconduct in public office by giving false information about death rates. When contacted, the council said the "matter is in the hands of the police". | |
| However Michael Poulter, a former Labour chair of Staffordshire police authority, has written to the chief constable to complain that the inquiry has been prompted by "distortion of facts". He added: "You are asking for a criminal level of proof for statistical misinterpretation. Seems a little far-fetched to me." | However Michael Poulter, a former Labour chair of Staffordshire police authority, has written to the chief constable to complain that the inquiry has been prompted by "distortion of facts". He added: "You are asking for a criminal level of proof for statistical misinterpretation. Seems a little far-fetched to me." |
| David Cameron and his health secretary have both called to bring the guilty to book in the troubled case of Mid Staffs. But it may prove hard to establish any guilt amid the claims and counterclaims made by those who follow the mortality statistics. | David Cameron and his health secretary have both called to bring the guilty to book in the troubled case of Mid Staffs. But it may prove hard to establish any guilt amid the claims and counterclaims made by those who follow the mortality statistics. |
| • This article was amended on 2 August 2013. The original said that " the number of "palliative care cases" can be put down to the fact that 14 hospices were closed down. This has been corrected. |