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Colchester hospital problems may be a warning of winter crisis to come Colchester hospital problems may be a warning of winter crisis to come
(4 months later)
It is highly unusual, if not unprecedented, for inspectors to find evidence of patients being subjected to inappropriate physical restraint or being inappropriately sedated without proper consent. However, as the Guardian reported on Saturday, that is what the Care Quality Commission team found when it carried out an unannounced inspection of the emergency assessment unit – part of A&E – at Colchester hospital in Essex last Wednesday. They also came across evidence that at least one patient had been resuscitated despite there being a do-not-resuscitate order. All the patients involved were elderly, and some may have had dementia.It is highly unusual, if not unprecedented, for inspectors to find evidence of patients being subjected to inappropriate physical restraint or being inappropriately sedated without proper consent. However, as the Guardian reported on Saturday, that is what the Care Quality Commission team found when it carried out an unannounced inspection of the emergency assessment unit – part of A&E – at Colchester hospital in Essex last Wednesday. They also came across evidence that at least one patient had been resuscitated despite there being a do-not-resuscitate order. All the patients involved were elderly, and some may have had dementia.
Dr Lucy Moore, Colchester hospital’s chief executive, has admitted that the CQC “raised a small number of safeguarding concerns” when it gave the hospital immediate feedback at the end of last week’s visit, but declined to go into further detail. Whatever it was that the CQC found, the inspectors’ concerns – including that Colchester was struggling with “unprecedented demand” – were enough for the EAU to be closed, an emergency control centre to be set up, extra staff recruited, routine operations cancelled and patients with non-urgent ailments told to go elsewhere, all as part of a “major incident” being declared.Dr Lucy Moore, Colchester hospital’s chief executive, has admitted that the CQC “raised a small number of safeguarding concerns” when it gave the hospital immediate feedback at the end of last week’s visit, but declined to go into further detail. Whatever it was that the CQC found, the inspectors’ concerns – including that Colchester was struggling with “unprecedented demand” – were enough for the EAU to be closed, an emergency control centre to be set up, extra staff recruited, routine operations cancelled and patients with non-urgent ailments told to go elsewhere, all as part of a “major incident” being declared.
Now the hospital has admitted to a further 563 serious incidents at the hospital spanning a two-year period. These are figures that are not usually published but the severity of what happened at the hospital – they potentially include deaths, infections and abuse allegations – suggest serious problems of an unusual scale. But how isolated a case is Colchester?Now the hospital has admitted to a further 563 serious incidents at the hospital spanning a two-year period. These are figures that are not usually published but the severity of what happened at the hospital – they potentially include deaths, infections and abuse allegations – suggest serious problems of an unusual scale. But how isolated a case is Colchester?
Last year’s report on the Mid Staffs scandal, which found between 400 and 1,200 deaths potential due to neglect at Stafford hospital, prompted the CQC to significantly beef up how it inspects hospitals. The NHS care regulator’s process is now much more rigorous, inquisitive and prolonged than before, and can involve teams of up to 60 or 70 inspectors spending up to a week at a time at a particular hospital trust. It is at least as unforgiving for hospitals as an Ofsted visit is for schools, and possibly more so given that large, multi-speciality hospitals contain more things that could be found wanting. Better inspections are likely to root out problems more readily. Last year’s report on the Mid Staffs scandal prompted the CQC to significantly beef up how it inspects hospitals. The NHS care regulator’s process is now much more rigorous, inquisitive and prolonged than before, and can involve teams of up to 60 or 70 inspectors spending up to a week at a time at a particular hospital trust. It is at least as unforgiving for hospitals as an Ofsted visit is for schools, and possibly more so given that large, multi-speciality hospitals contain more things that could be found wanting. Better inspections are likely to root out problems more readily.
What Colchester has been very clear about is the pressures it is facing from increasing patient numbers. As the NHS heads into winter, events at Colchester constitute an ominous warning of what may happen in other hospitals over the months ahead.What Colchester has been very clear about is the pressures it is facing from increasing patient numbers. As the NHS heads into winter, events at Colchester constitute an ominous warning of what may happen in other hospitals over the months ahead.
Dr Clifford Mann, president of the College of Emergency Medicine, which represents A&E doctors, said: “I rather suspect there are many hospitals with very similar pressures.” By that he means too few staff, an increasingly complex caseload, especially of medically challenging older patients, and too little money.Dr Clifford Mann, president of the College of Emergency Medicine, which represents A&E doctors, said: “I rather suspect there are many hospitals with very similar pressures.” By that he means too few staff, an increasingly complex caseload, especially of medically challenging older patients, and too little money.
Ministers, notably the health secretary, Jeremy Hunt, are aware that although the weather is still mild, with frost and snow yet to come, metaphorical red lights are already flashing above A&E units. Hospital A&E departments performed worse in August, September and October than they did last winter, which bodes ill for their ability to handle any further demand that arises in December, January and February. Delayed discharges – the inability to get patients out, usually because social care arrangements locally are inadequate – are running at record levels. The numbers of trolley waits – patients who have been treated in A&E and are waiting to be admitted to a ward – are almost as bad.Ministers, notably the health secretary, Jeremy Hunt, are aware that although the weather is still mild, with frost and snow yet to come, metaphorical red lights are already flashing above A&E units. Hospital A&E departments performed worse in August, September and October than they did last winter, which bodes ill for their ability to handle any further demand that arises in December, January and February. Delayed discharges – the inability to get patients out, usually because social care arrangements locally are inadequate – are running at record levels. The numbers of trolley waits – patients who have been treated in A&E and are waiting to be admitted to a ward – are almost as bad.
“Unfortunately this year we didn’t get any lull in the summer – that is, last winter didn’t really stop, it kept going all year round,” says Mann. His profession is dealing with an ever-rising tide of the unwell. “And there’s no realistic prospect of a reduction in the number of patients turning up. We are expecting pressures to keep on building this winter.”“Unfortunately this year we didn’t get any lull in the summer – that is, last winter didn’t really stop, it kept going all year round,” says Mann. His profession is dealing with an ever-rising tide of the unwell. “And there’s no realistic prospect of a reduction in the number of patients turning up. We are expecting pressures to keep on building this winter.”
Mann’s worry is that last winter the NHS avoided experiencing a crisis partly because there were unusually low levels of norovirus, the winter vomiting bug. While there is little flu around just now, norovirus is behaving normally this winter. It closed 17 wards in different hospitals in England in October and has already led to further closures this month, including an outbreak that led to three wards at Stoke University hospital being sealed off to new admissions. When that happens, there are fewer beds for patients who need to be admitted, so hospitals get clogged up, planned operations postponed and waiting times for treatment become longer. And the virus is still in the early stages of a cycle that usually affects three million people between October and April.Mann’s worry is that last winter the NHS avoided experiencing a crisis partly because there were unusually low levels of norovirus, the winter vomiting bug. While there is little flu around just now, norovirus is behaving normally this winter. It closed 17 wards in different hospitals in England in October and has already led to further closures this month, including an outbreak that led to three wards at Stoke University hospital being sealed off to new admissions. When that happens, there are fewer beds for patients who need to be admitted, so hospitals get clogged up, planned operations postponed and waiting times for treatment become longer. And the virus is still in the early stages of a cycle that usually affects three million people between October and April.
Norovirus, the deepening difficulty of ensuring hospital rotas are fully staffed and the potential for bad weather producing a surge in patients with breathing trouble – the scenario the NHS fears worst – underlie why Hunt last week increased the extra money available to the service to cope with winter from £400m to £700m. In the spring, NHS bosses debated privately whether the lack of a winter crisis was due to good luck (mild weather) or Hunt’s emphasis on being better prepared than ever. Their verdict then: he got lucky. What they’re wondering now is whether he will get lucky again. On current trends, that looks unlikely.Norovirus, the deepening difficulty of ensuring hospital rotas are fully staffed and the potential for bad weather producing a surge in patients with breathing trouble – the scenario the NHS fears worst – underlie why Hunt last week increased the extra money available to the service to cope with winter from £400m to £700m. In the spring, NHS bosses debated privately whether the lack of a winter crisis was due to good luck (mild weather) or Hunt’s emphasis on being better prepared than ever. Their verdict then: he got lucky. What they’re wondering now is whether he will get lucky again. On current trends, that looks unlikely.
• This article was amended on 9 February 2015. Because of an editing error, an earlier version said a report on the Mid Staffs scandal found between 400 and 1,200 deaths potential due to neglect at Stafford hospital. The Francis report of February 2013 did not make that finding. It concluded that it would be unsafe to infer from mortality statistics that there was any particular number of avoidable or unnecessary deaths at the trust.