Hospital was upgraded in spite of deaths

A Staffordshire hospital was granted flagship status despite providing such “appalling” emergency care that “there is no doubt that patients will have suffered and some of them will have died”, the health service’s quality watchdog said last week.

Alan Johnson, the health secretary, apparently failed to pass on patients’ concerns at a time when Monitor, the foundation trust regulator, was considering MidStaffordshire NHS Trust’s application to become a foundation trust.

The Healthcare Commission presented its findings as a success for its new data mining techniques, after unexplained death rates for emergency care at the hospital triggered concerns in 2007 that led to a formal investigation the following year.

But the case also raises questions about the commission’s previous assessment of the hospital, which rated Mid-Staffs’ quality of care as “fair” for the two years preceding its foundation trust application, but at a time when the commission now says patients were almost certainly dying as a result of poor care.

Between 2005 and 2008, some 400 more patients died than would have been expected on standardised death rates, although Sir Ian Kennedy, the commission’s chairman, stressed that without a detailed examination of all case notes it was impossible to say “how many of those died through bad care”.

The commission found untrained receptionists deciding the order in which patients were seen. There were also too few doctors and nurses as the trust cut staffing to create a surplus to boost its foundation trust application, an absence of essential equipment from infusion pumps to defibrillators, and some nurses turned monitors off because they did not know how to use them.

While the Healthcare Commission had growing concerns about Mid-Staffs from the summer of 2007, Anna Walker, its chief executive, said she had “no idea” that Monitor was considering the hospital’s application for foundation trust status, which was granted in February 2008. “I discovered by accident after they had taken the decision,” she said.

Monitor admitted that it did not speak to the commission during its assessment, instead relying on the commission’s published verdict that the quality of care was “fair” and accepting the local NHS view that the elevated death rates were because of “coding errors”. William Moyes, Monitor’s chairman, said it now actively consulted the commission, nationally and locally, and examined patient complaints when making assessments.

Julie Bailey, whose mother died at Stafford, in December 2007 founded a group to campaign about deaths and poor care at the hospital.

She said she had written to Mr Johnson highlighting patient concerns on January 5 2008, ahead of Monitor’s decision. A reply from his office had simply referred her back to the hospital, she said.


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