Board members at the Mid Staffordshire NHS Trust received pay rises running to thousands of pounds a year after successfully steering Stafford Hospital to Foundation status.

But an independent report into the catastrophic failings at the hospital has revealed how managers knew about the crisis at the same time as they were approving the increases.

Patients’ groups last night said the idea they were giving themselves rewards as the elderly and vulnerable were dying was “sickening” and added insult to injury.

As part of the Trust’s efforts to gain Foundation status a remuneration committee was established which oversaw the salary increases awarded to the Executive Directors.

The Chief Executive of the Trust, Martin Yeates saw his £145,000 salary rise to £169,538 between 2006 and 2008 at the same time as patients were suffering appalling standards of care.

Mr Yeates, who stepped down following a damning Health Commission report last March, was allowed to leave without any disciplinary action, a pension pot worth in excess of one million pounds and six months severance pay.

Julie Bailey, founder of the Cure the NHS campaign group, which helped bring the scandal of Stafford hospital to light said: “It is disgusting and sickening that while our loved ones were being treated so appallingly and hundreds were dying unnecessarily, the hospital bosses responsible were rewarding themselves with pay increases.”

A spokesman for the Mid Staffordshire NHS Trust said Mr Yeates’s pay increase had been agreed by the Remuneration Committee and said the rise had reflected the change in his responsibilites when the hospital changed to a Foundation hospital.

Last week’s report, published by Robert Francis QC, revealed how patients were left unwashed for up to a month, were wrongly diagnosed, were abused and neglected by hostile uncaring staff and were often not fed properly.

During the same period several non-executive members of the board also received massive bonuses which saw their salaries more than double.

Toni Brisby Chairman of the NHS Trust, who worked three and a half days a week, increased her salary from – £18,000 to £40,000

Gerald Hindley, who was Vice Chairman of the Trust went, and worked two and a half days a week saw his salary rise from £5,900 to £15,000.

Other non-executive members of the board also got increases from £5,000 to £12,000.

The figures were revealed as a new report suggested that patients are still unhappy with levels of care at the Trust.

In a survey of outpatients, Mid-Staffordshire scored in the bottom fifth of trusts for general cleanliness, the level of respect and dignity with which patients were treated and their overall care.

Patients also complained of doctors and other staff talking as if they were not there, of a lack of privacy when they were being examined and when their condition was being discussed, and of not being told how long they would have to wait.

The newly released survey, published by the Care Quality Commission, was carried out between March and May last year.

It also found that the Trust scored in the lowest 20 per cent when patients were asked if they had received copies of letters between the hospital and their GP.

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With the role of choice and competition in the National Health Service still highly controversial – the British Medical Association is currently running a large campaign against the commercialisation of the NHS – the research provides “clear cut evidence that competition between hospitals produces benefits,” Carol Propper , one of the study’s authors, said.

The study interviewed managers and clinicians at 100 big NHS hospitals, using a mildly adapted version of a standard measure of management performance that is widely used to assess private sector companies.

It compared the quality of management with a small range of clinical outcomes – such as deaths from heart attacks and emergency surgery, or hospital-acquired infections – and the scores given to hospitals for quality of care and financial management by the NHS inspectorate, the Care Quality Commission. It then looked at how many local rivals the hospitals had.

The conclusion, Professor Propper said, is that “better management produces better hospitals and competition between hospitals produces better management”.

Hospitals “with higher management scores have better clinical outcomes, shorter waiting times, better financial performance and higher staff satisfaction,” the study concludes.

Management was better where senior managers have some clinical training – a finding that reinforces repeated government attempts over recent decades to involve clinicians more in management. But it also concludes that “competition has a large effect in improving managerial quality in hospitals”.

How it does so remains open to question, the study says. It may be that the market reforms in the NHS, with money attached to each treatment, mean “hospitals now have an incentive to provide better care to attract patients”.

In areas with a relatively large number of competitors, it may be easier to assess performance by comparison with neighbours. Or it may be that a competitive environment provides an attractive market for good managers.

“With more hospitals nearby, it is easier for managers to look out for better employment opportunities.”

The Care Quality Commission’s (CQC) annual report on health and social care services in England said a predicted 1.7 million more adults will need care by 2030, putting pressure on already stretched public finances.

The Government’s Personal Care at Home Bill, which would provide 400,000 vulnerable elderly people with free care in their homes, was criticised by council leaders earlier and Tory leader David Cameron accused Gordon Brown of using it to promote “cheap dividing lines” between the parties ahead of the general election.

Mr Cameron demanded to know where the funding was coming from and insisted the Prime Minister wanted the “benefits” of the policy before the election, leaving the costs to afterwards.

But as Speaker John Bercow struggled to keep the noise down, Mr Brown hit back, attacking the Opposition leader for breaking cross-party “consensus” on the policy.

Mr Cameron asked the Prime Minister if he could rule in or rule out a compulsory levy on the elderly to pay for care, but Mr Brown sidestepped the question and said developing a “full social care system” would take time and needed consensus.

The CQC report, which was published yesterday, said tailoring services to meet people’s individual needs would help save money while allowing people to remain independent.

CQC chairwoman Dame Jo Williams said: “We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.

“This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health.”

The Government has said around £2.7 billion could be saved every year by helping patients avoid making unnecessary hospital visits.

But the CQC said this would require “a fundamental cultural shift” allowing patients to control their own care.

Stephen Burke, chief executive of the charity Counsel And Care, said “an honest and serious” debate was needed about funding.

He said: “Politicians, nationally and locally, owe it to older people, their families and carers to prioritise care reform and funding. As the University of Birmingham has highlighted this week, there are massive economic and social benefits to be gained from a new, properly funded care system.

“Older people and their families want to know what care they will get and how much they will have to pay.

“One way to fund better care would be a care duty on estates but it must be done fairly through a percentage on all estates above a certain value. For example, 2.5% on estates above £25,000 would raise enough to meet the current shortfall in care funding. And it would help older people and their families who currently face losing their home to pay for care.”

Director of the Patients Association Katherine Murphy said she welcomed the report’s “clear direction” that the NHS and social care services had to start working more closely.

She said: “It is vital this approach becomes widespread if we are to make the most of increasingly restricted budgets and ensure users get a responsive service.”

Simon Lawton-Smith, Head of Policy for the Mental Health Foundation, said: “There has been a lot of talk about person-centred services and joined-up health and social care over the last 20 years, so in a way it’s disappointing that the CQC still has to make these arguments.

“The hope now is that the likely need to reduce funding might concentrate minds on reform. An often-overlooked benefit of treating people as individuals and focusing on maintaining their independence and health is that it has the potential to save money.”

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But new research and a survey among staff and patients at the Royal Brompton Hospital and the Chelsea & Westminster Hospital, both in London, found there is little evidence to support some of the concerns around the presence of blooms on wards.

In a study by Giskin Day and Naiome Carter of Imperial College London, and published in bmj.com, it was even claimed flowers could help improve a patient’s health and recovery.

One of the reasons given to support the ban was that flower water contained high levels of bacteria, but subsequent research has found no evidence to suggest that it has ever caused a hospital acquired infection.

Southend University Hospital recently imposed a ban on flowers on the grounds that they posed a health and safety risk around high tech medical equipment.

But the report argues that flower vases are no more risky than having crockery containing drinks or food around bedsides.

Interviews with staff in this study however found that nurses were generally more concerned about the practical implications of managing flowers than risks of infection.

Other studies report that flowers have immediate and long term beneficial effects on emotional reactions, mood, social behaviours, and memory for men and women alike.

One trial found that patients in hospital rooms with plants and flowers had reduced systolic blood pressure and heart rate; lower ratings of pain, anxiety, and fatigue; and had more positive feelings.

The authors of the report said given that flowers and herbs have been used as remedies in the earliest hospitals, and as a means of cheering up the hospital environment for at least 200 years, it seems remarkable that flowers still tend to be treated in an ad hoc fashion in hospitals.

Although flowers undoubtedly can be a time consuming nuisance, the giving and receiving of flowers is a culturally important transaction, the report concludes.

In an accompanying editorial, Simon Cohn, a medical anthropologist at Cambridge University argues that flowers have fallen victim to new definitions of care.

Describing the decision to ban flowers, he said: “[The decision] seems to reflect a much broader shift towards a model of care that has little time or place for more messy and nebulous elements.”

Katherine Murphy, director of the Patients Association, said: “Most patients love flowers. The job of nurses is to be the patient’s advocate and carer. Surely it is not beyond management capabilities in a trust to ensure that the needs of patients and staff are accommodated.

“If flowers on wards pose such a problem, it’s no wonder that critical patient safety issues appear to be insoluble.”

Flowers are just one of the items to have fallen foul of strict hospital health and safety regulations.

Mobile phones have long been forbidden on many hospital wards, even though a government report in 2007 said there was no justification for a blanket ban.

Doctors were banned from wearing watches and jewellery last year because of fears that they were an infection hazard.

An NHS Trust in Sheffield also banned nurses from wearing Crocs shoes at work, as the static electricity they generated could disable hospital equipment.

Perhaps the strangest ban, though, was at the Fazakerly Hopsital in Liverpool, where the controversial ITV television programme The Jeremy Kyle Show has been banned after complaints that it was upsetting patients. Well you win some, you lose some.

Previous research has suggested rates in England may be levelling off. But the University College London team found this was happening most in children aged two to 10 from wealthier backgrounds.

Researchers said obesity rates among the lower classes were likely to be significantly higher by 2015 – for girls the levels may even be double.

They analysed data gathered by the government-funded Health Survey for England.

Currently 6.9% of boys and 7.4% of girls are obese – with the difference between the lower and higher classes 0.6% and 1.5% respectively for boys and girls.

But using historical trends, they predicted that by 2015 obesity rates could be above 10% for boys and 8.9% for girls.

Depending on the extent of the “levelling off” reported last month, the overall rates could be even lower.

However, it is the findings for social class that have shed even more light on the obesity problem. The obesity rates for girls are likely to diverge from now on, the team said.

Among those from lower classes it is expected to keep rising to 11.2%, while for those from professional backgrounds it is likely to fall to 5.4%.

Among boys, both groups are likely to see a rise, but it will be faster in the lower class group, meaning 10.7% of this class boys will be obese compared with 7.9% of those from wealthier backgrounds.

Similar trends will also be seen in older aged children, the report in the Journal if Epidemiology and Community Health found.

Lead researcher Dr Emmanuel Stamatakis said: “This highlights the need for public health action to reverse recent trends and narrow social inequalities in health.”

“The widening socio-economic gap may be partly due to difficulties to reach and communicate health messages to families from lower socio-economic groups.”

Tam Fry, of the National Obesity Forum, agreed awareness was more likely to be greater among wealthier families.

But he added: “It is also often quite expensive and time-consuming to buy healthy food and that puts wealthier parents at an advantage.”

He said it was not clear why the differences were so marked in girls, although he said he suspected it was partly to do with the fact that boys tend to be more active generally.

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http://news.bbc.co.uk/1/hi/health/8412796.stm

The increase– the seventh successive quarterly rise in NHS employment taking it to above 1.6m people for the first time– took even seasoned observers by surprise following an 18,000 rise in the second quarter.

Most had been predicting at least a levelling off in the workforce despite continued growth in spending, as health authorities and hospitals prepared for the real-terms freeze that is to come.

Nigel Edwards, policy director for the NHS Confederation, said: “We suspect this is the last stage before the tanker slows down and finally turns.”

The confederation runs a website on which most NHS jobs are advertised and the numbers on it at any one time have fallen from 10,000 at the turn of the year to 7,500. “People still do have growth money this year,” he said, “and they are pursuing targets and other government objectives. 

The increase, however, leaves the NHS across the UK employing 1,601,000 people, according to the Office for National Statistics: 400,000 more than when Labour took office. The growth follows a study in England by McKinsey, which said the NHS might need to shed 10 per cent of its workforce to keep the books in balance.

The bigger the workforce when the money starts to run out in 2011, the greater the efficiency gains that will be needed if it is not to shrink in the face of a real-terms freeze in spending.

The NHS in England has 5.5 per cent revenue growth for this year and next. However, David Nicholson, NHS chief executive, has ruled that at least 2 per cent of next year’s money must be spent on capital and other projects to transform the way care is delivered in subsequent years.

The rise in staff numbers was the driver for an overall rise of 23,000 in public sector employment in the third quarter of this year to 6.093m. Local government shed 3,000 jobs and public corporations employed 5,000 fewer people.

Civil service employment rose 4,000, driven chiefly by a rise of 7,000 in the numbers employed by Jobcentre Plus to deal with rising unemployment.

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