Care home companies face harder financial checks

Large providers of care homes in England are to have their financial records regularly checked in future to spot potential business problems.Care home companies face harder financial checksUnder the government’s plans, the Care Quality Commission and local authorities will also ensure care continues if a company does go bust.

It comes after provider Southern Cross collapsed, causing distress and anxiety to its residents and their families.

Care minister Norman Lamb said the move would give reassurance to people.

The Care Quality Commission (CQC) will start to make checks on between 50 and 60 of the largest care companies in England, including those that provide care in a person’s home.

CQC chief executive David Behan said the measures – to be set out in new legislation – would provide early warning of potential company failures in the care industry.

The CQC will have the power to:

  • Require regular financial and relevant performance information
  • Make the provider submit a “sustainability plan” to manage any risk to the organisation’s operation
  • Commission an independent business review to help the provider to return to financial stability
  • Get information from the provider to help manage a company collapse

The Department of Health said the powers would bring care in to line with other services such as hospitals and holiday operators, which have procedures to check on the “financial health” of organisations.

In the case of the collapse of a national provider the effects would be felt in many parts of the country, so it would be unfair for local councils to have to deal with the problem, the department said.

Mr Lamb said: “Everyone who receives care and support wants to know they will be protected if the company in charge of their care goes bust.

“The fear and upset that the Southern Cross collapse caused to care home residents and families was unacceptable.

“This early warning system will bring reassurance to people in care and will allow action to be taken to ensure care continues if a provider fails.”

Southern Cross, the country’s biggest care provider, had thousands of elderly residents at more than 750 care homes across the UK when it collapsed in 2011.

The firm was brought down by having to pay a £250m rent bill as local authorities made cuts.

After its collapse, other operators had to step in to take over the care of more than 30,000 people.

Quarter of hospitals, clinics, care homes fail to meet basic standards of patient safety, quality of care

A quarter of hospitals, clinics and care homes in England are failing to meet basic standards for patient safety and quality of care, according to the most comprehensive study of its kind.Quarter of hospitals, clinics, care homes fail to meet basic standards of patient safety, quality of careThe Care Quality Commission’s state of the nation report based on 14,000 unannounced inspections of dentists and NHS, private, and social care run facilities reveal widespread problems with staffing levels, safe medication management and record keeping.

Nursing leaders last night said the report should act as a “wake-up” call to the government amid accusations that ministers had thus far ignored evidence of redundancies, unfilled vacancies and job cuts.

One in 10 services failed to meet legally binding standards for staffing levels which often led to compromises in the care and welfare of patients, as well as limiting training and supervision for staff, the CQC found.

Almost one in five services inspected were failing to safely administer medications with “worrying” examples of risks associated with age, side-effects and drug interactions being poorly managed.

Care homes for the elderly and adults with disabilities, which often have no trained nurses or doctors on a day to day basis, fared worst.

People with complex and multiple medical needs such as dementia or Parkinson’s disease sufferers often reside in these homes.

The deteriorating physical state and suitability of premises was also a particular concern in social care, the inspectors found.

In the private sector proper record keeping was the biggest concern.

The CQC inspectors found out of date and incomplete notes about patients, stored in insecure places which could jeopardize patients’ confidentiality.

The CQC says it has taken tough action against failing services, including some closure, and would continue to hold them to account.

Dr Peter Carter, general secretary of the Royal College of Nursing, said: “It is shocking that more than one in four locations inspected in this report have failed to meet even essential standards of quality and safety… this presents a long overdue wake-up call for the Government. Those locations in question must be brought up to standard as a matter of urgency.”

The report also includes a special focus on maternity services, emerging as a problem area for a number of NHS Trusts due to midwife numbers not keeping pace with the birth rate and increase in complex births.


More than half care home residents denied basic care

More than half of elderly and disabled people in care homes are being denied basic health services while staff are failing to to do enough to preserve their dignity, according to an official review.More than half care home residents denied basic careSome older people routinely have to wait up to three months for formal checks for painful conditions such as bed sores, according to figures from the health care watchdog.

A quarter were not given a choice of male or female staff to help them use the lavatory and more than a third of care homes surveyed admitted delays in getting medication to residents.

Campaigners blamed NHS bureaucrats showing a “lack of interest” and failing to provide expert assessments for conditions as basic as incontinence.

The findings emerged after almost 1,000 elderly people yesterday descended on Parliament to lobby their MPs calling for a radical overhaul of the social care system.

Paul Burstow, the care minister, signalled that a widely anticipated white paper of the future of social care had been delayed until next month insisting: “Getting it right is better than rushing it out and getting it wrong.”

Among those who addressed the crowd was the actor Tony Robinson, an ambassador for the Alzheimer’s Society, who said it was an “undeniable fact” that the system of social care is now in crisis with millions of people faced with paying large sums for care unlikely to meet their needs in old age.

The Archbishop of York also threw his support behind the lobby. Speaking during a visit to a care home he called for an overhaul of the care system to provide “dignity and peace of mind” to older people.

Fresh evidence of the failings in the system was detailed as a raft of previously unpublished data gathered by the health care regulator the Care Quality Commission (CQC) was released.

It was drawn from the first ever nationwide review of how the needs of needs of care home residents across England are met.

The CQC report discloses that people suffering from incontinence have to wait more than two weeks for an assessment of their condition in almost 40 per cent of homes for the elderly surveyed.

But a separate detailed analysis of the CQC data carried out by the British Geriatrics Society, also found that more than 40 per cent specialist providers set themselves a target as long as 90 days to carry out such assessments.

Such delays have led to elderly people being denied the treatment they need or forced to wear incontinence clothing when they do not need it.

The CQC research also says that 30 per cent of nursing homes investigated had no clear policy on when to attempt to resuscitate patients who suffer a serious deterioration in their health.

In a quarter of homes, staff admitted they were unsure about the health care needs of those in their care.

The Geriatrics Society study showed that only 57 per cent of Primary care trusts ensure that all elderly people under their responsibility have access to key services including continence assessments, physiotherapy, pressure sore checks and mental health services.

In 40 per cent of cases trusts set no specific targets to ensure the services were being delivered.

The society concluded that this showed the PCTs had “limited interest” in services for care homes.

Its president, Prof Finbarr Martin, said: “What it shows is that there is a massive disconnect between what the NHS aspires to and what it actually delivers to people in care homes and they are the most vulnerable group of people.

“The issue is there is a negative about people in care homes. There is a nihilism about care homes that is completely unreasonable and unjustified.”

Michelle Mitchell, director of Age UK, said: “The majority of people living in care homes have profound and complex health care needs.

“The British Geriatrics Society’s CQC data analysis reveals that many thousands of residents are failing to receive basic geriatric and community health care from the NHS.  Older people who live in care homes should have the same rights to NHS care as anyone else.”

In a letter to The Daily Telegraph today, the heads of a string of charities including Age UK voice their support for a move in the House of Lords to protect the human rights of all elderly people receiving care.

The Daily Telegrpah publishes a free Guide to Long and Short Term Health Care, you can order one here.

Breast screening- are women over examined?

Are women being over examined by an over cautious health nanny state?Breast screening- are women over examined?In an uncertain world, we want to believe in the certainty of medicine: that it is omniscient and operates in absolutes. In reality, this is far from the truth. The world of medicine reflects the world we live in; constantly in flux with multifarious contradictions.

Scientists relish this fact. However, for those on the outside, this can be bewildering. We are told one thing one minute, only for it to be ridiculed the next. With its definitions and protocols, medicine serves to give the illusion of stability when, in truth, doctors are all too often unsure.

The furore around breast screening perfectly illustrates this. It began when the Government’s cancer “tsar”, Prof Sir Mike Richards, announced that he is setting up an independent review of the NHS programme.

He has also ordered that patient leaflets, which explain the screening programme, be rewritten to take into account claims by some experts that the benefits have been exaggerated.

Understandably, this has prompted widespread confusion. The issue of breast cancer is always emotive. When I worked in breast surgery, I saw first hand the horrors of this disease on sufferers and their families, and it is vital that we do everything we can to treat and prevent it. But the debate over screening has been raging for some time within the medical community. I remember attending a lecture on this issue when I was at medical school more than 10 years ago.

The NHS screening programme was introduced by the Thatcher government following the 1987 Forrest Report, which recommended a national screening programme for breast cancer for women aged between 50 and 74. The report was based on the most up-to-date research.

But, since then, by comparing countries that have a screening programme with those that don’t, evidence has emerged suggesting that the steady fall in mortality in Western countries is not due to the screening programme, but to improved treatment and service provision.

If this is shown to be true – and it’s still a big if – then this would mean we are needlessly screening thousands of women. And there is an argument that many of the tumours detected by screening would not actually have developed into a life-threatening cancer.

For every screening test, whatever the disease, there is a margin of error. How good a test is can boil down to two things. The first is sensitivity, which measures how good the test is at giving a positive result in those who have the disease. The second is specificity, which refers to how many of those tested are disease-free and test negative.

Now, if you act on the results every time a test records a positive – in the case of breast cancer by doing invasive surgery or giving radiotherapy or chemotherapy – the sensitivity and specificity has to be very high (as near to 100 per cent as possible) to warrant a national screening programme. If it’s not sensitive enough, you’ll be giving women false reassurance when, in fact, tumours are being missed. Similarly, if it’s not specific enough, you’ll be needlessly treating people, with all the associated risks that treatment brings. It is this that is concerning some experts.

They argue that women are being over-diagnosed and over-treated because screening is not specific enough. It can pick up breast abnormalities that may look worrying when biopsied but are actually harmless. It’s a balancing act between saving lives and not causing harm by needless treatment. While doctors are used to adapting to changes in evidence, this is little consolation to women who worry about the disease.

It is perfectly sensible to have an independent review of the research, but I can’t help but think of the women who have had treatment,or are facing treatment, or those who are deciding if they should go for screening. The fact that the current debate waging in the medical establishment is part of the reflexive process that underpins science is of little comfort to them.

Let’s deal firmly with those who fail in patient care

Health Secretary Andrew Lansley should be congratulated – and it’s not often I say that – for his announcement last week that widespread spot checks on hospitals and care homes will be introduced in a drive to improve standards.

The checks will be undertaken by the Care Quality Commission (CQC). It comes after the Government reviewed the findings of the first wave of unannounced visits to care of the elderly wards in the summer. Over half the hospitals inspected had problems, particularly in relation to issues around patient dignity.

Spot checks are the way to tackle this and weed out bad practice and serious failings. But, they will only have any meaning if the CQC – often felt by those campaigning for improved standards as toothless – act on what they find. We don’t need endless reports and bureaucratic stalling. If it will work, the CQC will have to use its muscle. Those in charge of wards and hospitals found to be failing must be held accountable and dealt with firmly.


Health regulator raises elderly care concerns as three hospitals fail reviews

Serious concerns have been raised by the NHS care regulator about the way some hospitals in England look after elderly patients.
Health regulator raises elderly care concerns as three hospitals The Care Quality Commission said three had failed to meet legal standards for giving patients enough food and drink and treating them in a dignified way.

The CQC, which carried out unannounced inspections, also raised concerns about three other NHS hospitals.

The commission has published the first 12 results of 100 such inspections, called for by the health secretary Andrew Lansley after a long campaign by the Patients Association, which highlighted poor care for the elderly.

While its inspectors said there had been many examples of people being treated with respect and given excellent care, in other cases people had not been helped to eat and drink, “with their care needs not assessed and their dignity not respected”.

All six hospitals about which concerns were raised must now say how and when they will improve. The worst three offenders will have to improve or face action from the regulator.

The inspections looked at nutrition and found cases of patients not being helped to eat, poor monitoring of patients’ weight and people not being given enough to drink, with water being out of reach for long periods of time.

In one case, a member of staff at Worcestershire Acute Hospitals NHS Trust said they had to prescribe water on medical charts to ensure patients got enough to drink.

Inspectors also looked at dignity and respect, noting that elderly patients were sometimes not involved in their own care and were given no explanation of the treatment they were to receive or asked for consent.

Staff also treated people in a disrespectful way, spooning food into their mouths without engaging them.

The reports acknowledge examples of excellent care where treatment was explained in a way patients could understand and they were treated with respect and dignity.

Jo Williams, chair of the CQC, said the inspections had built a detailed picture of the care being received by elderly patients in NHS hospitals in England.

“Many of these reports describe people being ‘cared for’ in the truest sense. Sadly, however, some detail omissions which add up to a failure to meet basic needs – people not spoken to with respect, not treated with dignity, and not receiving the help they need to eat or drink.

“These are not difficult things to get right – and the fact that staff are still failing to do so is a real concern. These are the basics that help ensure every patient is treated like an individual – not a nuisance to be ignored or a task that must be completed.

“This is what we expect for ourselves and for our own families, and what every patient should expect from the people who care for them.”
Enforcement powers

Health Secretary Andrew Lansley said that everyone admitted to hospital deserved to be treated as an individual, with compassion and dignity.

More CQC reports will be published over the summer with the findings of the programme of inspections released in the autumn.


NHS hospitals where high death rates are failing the National Health Service patients

Nineteen hospital trusts were exposed as having alarmingly high death rates in a major report that also reveals how hundreds of people are dying needlessly because of substandard NHS care.
NHS hospitals where high death rates are failing the National Health Service patientsThe Dr Foster hospital guide, which the Observer published exclusively yesterday, disclosed that tens of thousands of patients were harmed in hospital last year when they developed avoidable blood clots, suffered from obstetric tears during childbirth, had objects left inside them after operations or were not given immediate treatment after a stroke.

The authoritative study also identifies four hospital trusts where an unexpectedly high number of patients died after developing complications following routine operations. It names Hull and East Yorkshire Hospitals NHS Trust as the place where patients have the highest risk of dying in these circumstances – 66% above the average.

Last year that equated to 33 deaths more than expected there, although it is not possible to say how many of these deaths could have been prevented. Dr Foster says the mortality rate is too high to occur by chance and is a warning sign of potential issues in the quality of care provided.

The Care Quality Commission – the NHS watchdog for England – will now investigate the trust.

Andrew Lansley, the health secretary, welcomed the report last night and increased the pressure on the NHS to improve patient safety by warning that lax procedures were costing lives.

He wrotes in the Observer: “Safe care saves lives and saves money. Adverse events like high levels of infection, blood clots or falls in hospital, emergency readmissions and pressure sores cost the NHS billions of pounds a year. There is a serious human cost, too, with patients ending up injured, or even killed. Most are avoidable with the right care.”

The minister sets out plans to eliminate what he calls a “culture of blame and secrecy in the NHS that can compound the initial mistake and stop lessons being learned”.

Dr Foster’s report reveals that, despite recent improvements, in 2009-10:
¦ Almost 10,000 patients suffered an accidental puncture or laceration.
¦ More than 2,000 had post-operative intestinal bleeding.
¦ More than 13,000 mothers suffered an obstetric tear while giving birth.
¦ Some 30,500 patients developed a blood clot.
¦ 1,300 patients contracted blood poisoning after surgery.

Naren Patel, who chaired the National Patient Safety Agency (NPSA) until June, said some patients were dying because – as the report confirms – the NHS was still failing to provide high enough quality care in key areas, despite many initiatives from influential bodies.

“It [the report] identifies three or four key areas, such as with strokes, blood clots and prostate care, where there’s evidence that optimum care is still not being delivered,” said Patel. “Therefore some people do die unnecessarily because they haven’t received the best possible care.”

The NHS Confederation, which represents hospitals, conceded more action was needed. “There are still parts of our health system where particular services are having problems, and for the hospitals concerned this report presents an opportunity to learn and improve,” said acting chief executive Nigel Edwards. “There will always be variations in any nationwide system but the golden principle must be that our NHS is safe for the patients who rely on it. This report shows where we can do better.”

Peter Walsh, of patient safety charity Action against Medical Accidents, said: “This report confirms that far too little progress has been made on patient safety. Our system of regulation is failing to deliver consistently good quality care across the country or pick up on unacceptable variations and intervene.”

He also accused ministers of recently backtracking on a pledge to require hospitals to always tell a patient or relatives when a blunder occurs, which could let mistakes be covered up. “Mr Lansley and the coalition government say almost all the right things about patient safety, but now is the time to see them put their money where their mouth is. The worry is that political correctness about not regulating and the financial cutbacks will mean patient safety loses out,” Walsh warned.

John Healey, Labour’s shadow health secretary, welcomed Dr Foster’s disclosure that 30% fewer hospitals than in 2008-09 have unexpectedly high death rates. But he claimed the coalition’s NHS reforms would worsen the problem. “The health secretary should make patient safety and care top of his in-tray, instead of forcing the health service through a £3bn internal reorganisation.

“Andrew Lansley has to drop his hands-off attitude to problems in the NHS and tell people in Hull [and other areas] what he’s going to do to make their hospitals safer and better.”


Almost 100 victims of Staffordshire scandal receive £1 million payouts after unprecedented group claim

Nearly 100 bereaved relatives and victims of the Stafford NHS scandal are to be paid a total of more than £1 million following Britain’s largest ever group claim against a single hospital.
Almost 100 victims of Staffordshire scandal receive £1 million payouts after unprecedented group claimIn total, 97 families of patients who died and victims who survived “appalling” standards of patient care will receive compensation payments, of up to £27,500.

Lawyers for the victims said the failings of Stafford Hospital left patients degraded and humiliated, and amounted to human rights’ abuses.

The trust has offered a total compensation settlements of £1.1 million, which the families are expected to accept, and apologies in each case. It did not accept the failings were breaches of human rights.

A public inquiry into the worst hospital scandal in more than a decade opens next week.

Last year, inspectors found that hundreds more patients died than would have been expected at the hospital between 2005 and 2008, amid “appalling” conditions.

Dehydrated patients were forced to drink out of flower vases, while decisions about treatment for Accident and Emergency patients were left to receptionists.

Up to 1,200 patients may have died needlessly over the period, as managers attempted to cut costs and hit targets.

The settlements for the group of 97 cases, including 84 deaths, covers failings as recent as this year, and dating back to 2002.

Among those to receive a payment is Heather Wilhelms, 55, who lost her mother, father, and husband at the hospital in the space of 18 months.

Her mother’s ovarian cancer was missed, while her father was sent home without treatment days before he died, after blood poisoning went undetected.

Nine months later, her husband died from lung disease in wards which his widow described as “filthy”. She told how her loved ones went to hospital for treatment and one by one, came out in their coffins.

The compensation payouts range from £1,000 to £27,500, with an average payment of just over £11,000 for bereaved relatives and those who survived failings in care.

Emma Jones, from lawyers Leigh Day & Co, which represented the families, said the action was believed to be unprecedented, with the 97 cases representing the largest group to be offered payouts by one hospital.

She said lawyers argued that the hospital’s failings were so basic and substantial, that they amounted to breaches of patients’ fundamental human rights.

Miss Jones said: “This was about basic neglect; food and drink placed out of reach, buzzers unanswered, people left after soiling themselves.

“In some cases we argued that the poor treatment caused the deaths – in many, the argument was that basic fundamental human rights were being denied – that people were being degraded, neglected and humiliated.”

Often, when elderly people die following failings in hospital, compensation is low, especially if no spouse is bereaved.

The lawyers said the case was significant because the arguments had centred on how badly patients had been treated, rather than proving their deaths had been hastened.

“For the relatives it was never about the money but more a recognition that their mum, or dad should never have been left to suffer in that way,” said Miss Jones.

She added: “We don’t know of any bigger group claim against any one hospital, we think this is unprecedented.”

The Labour Government refused to hold a public inquiry to find out what went wrong, and to prevent a repeat of the scandal.

Since taking power, the Coalition Government has ordered such an investigation – one of the key demands of The Sunday Telegraph’s Heal Our Hospitals campaign – which is due to start taking evidence next week.

On Saturday an inspection report revealed that the hospital is still failing to meet most basic standards of patient care.

The Care Quality Commission said it had concerns about the care and welfare of patients, and respect shown to them, its safeguarding of patients from abuse, the management of medicines, the safety of premises and equipment, staffing and complaints.

Inspectors said the trust had made progress, and that some of the concerns involved changes which would take time to “bed in”.

Last week it emerged that the trust had paid a locum Accident & Emergency doctor more than £5,000 to work a single 24-hour shift, in response to a sudden staffing crisis.

Julie Bailey, who founded local campaign group Cure the NHS as a response to the standard of care given by the hospital to her own mother, who died in 2007, said: “The size of the group exposes the scale of this crisis; it is an absolute disgrace that in the 21st century, the most vulnerable people were treated so appallingly.”

She added: “For relatives who have gone through this, no amount of money can ever compensate for what happened to their loved ones.”

Mrs Bailey said there were many more relatives and victims who had never received a penny. “Every day, someone comes to me who has never even spoken before about what they went through.

“There are so many people suffering as a result of this scandal, and no one has been held to account for what we are going through.”

Antony Sumara, Chief Executive of Mid Staffordshire NHS Foundation Trust, said: “As always, I offer our sincerest apologies to the families concerned, for the distress caused by the poor care their relatives received at our Trust in the past.

“We have made a lot of progress over the last year in improving the care for our patients and will continue to focus our efforts on building on these improvements and making sure that they are sustained.”


Nearly 1,000 care homes without Registered Manager finds health quango

The Care Quality Commission (CQC) health quango warned that nearly 1,000 residential care homes do not have a registered manager in place, despite this being a requirement of the new Health and Social Care Act 2008.
Nearly 1,000 care homes without Registered Manager finds health quangoAlthough it does not present a direct risk to the safety of residents, care homes without a registered manager may be less able to identify potential concerns and address them quickly, said the commission. It has placed conditions on the operators of all the care homes in question requiring them to put managers in place.

Under the provisions of the Act that came into force at the beginning of the month, many care homes must have a registered manager who is appropriately experienced and qualified. This was also a requirement under the old legislation, the Care Standards Act 2000.

CQC announced that so far it had newly registered the care providers operating about 20,000 adult social care service locations under the Health and Social Care Act. Just over 15,000 of these locations are residential care homes.

Most of the others are home-care agencies and nurses agencies. However, around 1,000 care homes (operated by more than 500 different providers) had a condition placed on them that they appoint a registered manager by 1 April 2011.

Not all care homes need to have a registered manager – CQC said that registered providers who manage their own services on a day-to-day basis do not need to also register as managers.

Cynthia Bower, CQC’s chief executive, said: “It has been recognised in the care sector for some time that there is a shortage of experienced and qualified managers. While we have been undertaking the enormous task of re-registering thousands of care services, the scale of this has become clearer.

“The lack of a registered manager does not necessarily mean that people are receiving poor care, but we know from experience that care services without leadership can struggle to address any problems that may arise. Good-quality care is led by good management.

“We know that some providers struggle to find suitably qualified people to take on this role. The sector as a whole needs to take a robust approach to seeking solutions to the shortage of registered managers. It cannot be allowed to continue indefinitely.

“We will use our enforcement powers in the best interests of people who use services. If a care provider is genuinely trying to appoint a registered manager and the quality of care is good, it might not be in the service users’ best interests for us to take enforcement action immediately. But if we find that people are being put at risk because there is no registered manager, then we will take action.”

Under the new Act, CQC has registered about 9,400 providers of adult social care (with a total of 20,000 different service locations), and 600 providers of independent healthcare (with 1,500 locations such as hospitals and cosmetic surgery clinics).

The extent of the quango’s red tape also revealled that a further 600 providers across adult social care and independent healthcare are resubmitting their applications after their original applications were incomplete or it was unclear which registered activities they needed to register for.

A further 430 have not yet been asked to apply, because they were registered near the end of the old system under the Care Standards Act 2000 and consequently are the last to transfer to the new one.

A further 1,300 providers have not yet applied for registration. CQC said they included those who had proved difficult to contact, some of whom may no longer be operating; all of them would be followed up to establish whether they needed to register or not.

In addition to the conditions relating to the lack of a registered manager, providers of about 200 adult social care and independent healthcare service locations have had conditions placed on their registration in relation to various other compliance issues.

The names of providers with conditions on their registration will be published in due course, after they have had the opportunity to exercise their legal right to make representations to the commission.

Ms Bower thanked care providers for their co-operation: “This has not been an easy process for providers or for CQC. We were set a very tough challenge by government to get everyone into the new system in a very short space of time. Now we can move onto the crucial and continuing task of monitoring the quality and safety of care across the sector.”

NHS trusts came into registration last April under the new Act, which CQC says is an important step forward in ensuring that people receive joined-up care. It is the first time that healthcare and adult social care services have been regulated under the same legislation and the same essential standards of quality and safety.

CQC has tough enforcement powers to drive improvements where it finds standards are not being met, including issuing a warning notice, carrying out a prosecution, and suspending or even closing a service.


NHS fails to curb lethal painkiller errors

Health workers made more than 1,300 mistakes involving the use of strong painkilling drugs in less than a year, resulting in at least three deaths and severe harm to two other patients.
NHS fails to curb lethal painkiller errorsNearly one in five dosage errors involving morphine, diamorphine and similar opiate drugs resulted in some harm to NHS patients.

Figures released under a Guardian Freedom of Information request show mistakes in England and Wales continue at a high level despite the publicity that followed the Guardian’s revelation in May last year about the death of David Gray.

The 70-year-old died at his home in Cambridgeshire when he was injected with a tenfold overdose of diamorphine by Daniel Ubani, a locum GP who had flown in from Germany that day.

The official report into the incident last month revealed two other GPs hired, like Ubani, by Take Care Now – a now-defunct company that was then providing some out of hours services for the NHS – had been involved in non-fatal diamorphine overdoses the year before.

The breakdown of the new figures suggest lessons have not been learned, with little change in the numbers of people harmed by medication errors involving this class of drugs despite several official safety warnings.

David Gray’s son, Rory, called the new figures “unbelievable”. “Taken at face value [they] suggest nothing has been made safer with regards to opiate medicines at all. Whilst there is no accountability then it seems there will continue to be no effective measures put in place to stop these unnecessary and avoidable deaths.”

The charity Action against Medical Accidents (AvMA) said the statistics were shocking and “confirm our worst fears about not implementing patient safety alerts”.

In its own research, coincidentally being published at the same timetoday, the organisation accuses hospitals and other care providers of killing and injuring patients by not complying with official directives from the National Patient Safety Agency (NPSA) intended to protect those receiving care.

However, safety experts point out that the numbers of patients being treated by such drugs is rising, so the proportion of mistakes may be going down.

Both the NPSA, established in 2003 to help the NHS learn from its mistakes, and the Care Quality Commission (CQC), the health service regulator, insisted things were improving, although notifying the two bodies over drug and other errors that resulted in death or severe harm only became mandatory on 1 April this year.

The NPSA received a total of 4,223 cases involving opiate drugs between November 2004 and June 2008. Of these, 3,338 were recorded as causing no harm, 629 low harm, 242 moderate harm and four severe harm. Five patients died. There was insufficient data on five other cases. Figures from May 2009 to April this year show 1,329 cases, 1,078 said to have resulted in no harm, 179 low harm, 67 moderate, and two severe. Three patients died.

Linda Hutchinson, CQC director, said: “Unfortunately we will never be able to eliminate human error from healthcare, but the risks can be minimised. That is why it is so important that NHS trusts and other health providers report incidents, thoroughly investigate them and make changes to stop the same mistakes happening again. They should also implement changes as a result of safety alerts. Had Take Care Now done this, it is possible that Mr Gray would still be alive today.

“The increase in reporting is a good thing. We often find it is the NHS trusts reporting a high number of incidents that are doing a better job of investigating them and taking action to prevent them happening again.”

The NPSA said its reporting system was one of the most sophisticated in the world: “We gather patient safety incidents, analyse them for trends and use these as a platform on which to produce patient safety alerts and guidance for the NHS.

“It is evident the reporting culture in the NHS has improved with over 1 million incidents [relating to drugs, medical and surgical procedures] reported each year. The majority of incidents reported to us in relation to diamorphine and other opiates result in low or no harm to the patient. In addition, most of these do not relate to mis-selection of injectable diamorphine or morphine.”

The agency believed it was now told of the “vast majority” of serious incidents.

The revelations come as hospitals and other providers of care are accused by AvMA of killing and injuring patients by not complying with official directives from the NPSA intended to protect those receiving care. Dozens of hospitals, mental health trusts and primary care trusts are failing to implement patient safety alerts from the agency, despite the Department of Health writing to them reminding them to do so.

Some 29 NHS organisations had not put at least 10 alerts into action by 7 June, on issues such as drugs and oxygen, even though with some, the deadline for compliance was several years earlier, according to AvMA: “It is impossible not to conclude that lives are being put at unnecessary risk and it is likely that avoidable injuries or deaths are still being caused as a result of trusts not complying,” it says.

Public health minister Anne Milton said: “Across the NHS there must be a culture of patient safety above all else. We have set out how we intend to free NHS staff from central control and targets that are not clinically justified to allow them to focus on what really matters – reliable, effective and above all safe care for each patient.”


Quarter of NHS trusts failing hygiene tests

A quarter of health trusts failed to meet standards over hospital infections while five were warned over blood-spattered walls and mouldy instruments under a toughened regulatory regime.

Of particular concern was the state of ambulances, which were inspected for the first time. Investigators found dirty forceps stored in some vehicles as well as bloodstains.

The Care Quality Commission (CQC) used its sweeping powers last year to assess how well NHS trusts were coping with hospital infections – which affect 300,000 patients a year.

Of the 167 trusts inspected, 42 were found by the commission to be in “breach” of NHS registration requirements by not meeting standards.

All 11 ambulance trusts in England were assessed – and four found to have violated the terms of their NHS contracts.

Things were so bad that ambulance services in the north-west, east of England and east Midlands received formal warnings for the state of vehicles and stations.

The CQC, derided by critics as a toothless watchdog for “naming and shaming but not paining”, revealled that it has been granted the power to impose tough sanctions that could see failing hospitals warned, prosecuted, fined up to £50,000 and ultimately closed down if they fail to comply with the regulator’s edicts.

As a test-run of this regime the commission was authorised to examine the risks in the NHS of healthcare- associated infections and the results revealed that a minority appeared to take a cavalier approach to safety.

The reasons for failure were worrying: 36 trusts were not providing areas to decontaminate instruments; in three trusts there was a failure to regularly flush unused water outlets – crucial for the control of legionella infections; and 13 trusts were criticised for not keeping clinical areas clean.

Nigel Ellis, the CQC’s head of national inspection, said: “Good infection control takes constant vigilance – and meeting that every day, for every patient, is an ongoing challenge for the NHS.

“We have found evidence of a direct risk to patients and have intervened using our new enforcement powers to ensure swift improvements were made.”

Of these failing trusts, five had to be issued with a warning notice – the first step towards losing the right to operate in the NHS. Investigators pinpointed several serious transgressions, especially in ambulances.

In the north-west vans were stocked with dirty neck braces that were continually reused despite health guidelines urging disposal after one patient’s use.

At Stockport ambulance station, vehicle interiors were “seen to have stains (which appeared to be bloodstains) on the walls as well as visible dirt on the floor and walls”.

In Essex “hand wipes were not available” and “poor levels of cleanliness” were found in 22 out of 23 vehicles inspected. Ambulance equipment in the East Midlands was singled out for being “visibly dirty, including suction units, defibrillators and the tips of forceps”.

The hospitals highlighted for poor practice were both foundation trusts: Basildon and Thurrock university hospitals, and the world-famous Alder Hey children’s foundation trust in Liverpool.

In Basildon, where the commission’s old ratings system had come under fire last year for labelling the hospital “good” weeks before it emerged that dozens of patients might have died after receiving substandard care, investigators found a dismal scene: “Procedure trays used by staff to carry equipment when they take blood samples or give injections had blood spattered on them … a commode soiled under the seat.” Out of date equipment was also found in the emergency stores.

In Alder Hey, one of Europe’s largest children’s hospitals, the inspection revealed dirty toys, hair stuck to medical equipment and “nappy changing mats stored on the floor next to a toilet … and a dirty baby bath was inside the full-size bath”. The water “ran brown” from taps in rooms ready for patients to be admitted.

The commission said the threat of further measures had pushed the offenders into cleaning up their act. Hospitals and ambulance trusts were forced to set up better procedures, buy new equipment and “deep clean” wards and vehicles – or face a rolling wave of inspections. The last of the conditions imposed for infection control was removed only last December.

Under the new regime CQC can send teams of investigators, accompanied by groups of patients, to hospitals to see whether they match “client” expectations. The bolstered regime is capable of 2,000 unannounced visits a year – three times the current level. “We want to put the patient at the heart of what we do,” said Dame Jo Williams, acting chair of the commission. “Doesn’t matter if it’s the health service, the banking system or Tesco, there is something about the way you are treated as a patient or a client or a customer.”