17 Jan 2013

Mid Staffordshire health scandal: a question of trust

The public inquiry into care standards in Mid Staffordshire delivers its report shortly. Channel 4 News describes how events there touched even those at the top of the NHS.

The public inquiry into care standards at Mid Staffordshire NHS foundation trust delivers its report shortly. Channel 4 News describes how events at the trust touched even those at the top of the NHS.

A catastrophic failure in patient care at the Mid Staffordshire General Hospitals NHS Trust and Mid Staffordshire NHS Foundation Trust (the NHS trust became a foundation trust in February 2008) has prompted a series of inquiries into what happened, and why.

According to a report, up to 1,200 more people may have died between 2005 and 2008 than would be expected.

In March 2009 the Healthcare Commission published the results of an investigation into “apparently high mortality rates” at the trust. February 2010 saw the publication of a report into the care provided by the trust between January 2005 and March 2009, delivered by Robert Francis QC.

In June 2010 the then secretary of state for health, Andrew Lansley, announced the establishment of a full public inquiry, also headed by Robert Francis, into “the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire NHS Foundation Trust”. That inquiry is due to deliver its final report around the start of 2013.

All three investigations have focused attention on those running the Mid Staffordshire NHS Foundation Trust (MSNHSFT) and Stafford Hospital – only one of whom has been subject to any disciplinary action. The connections, though, go beyond the Black Country to the top of the NHS.

Much anger on the part of relatives of those who died at Stafford Hospital has focused on the trust’s board of directors. Martin Yeates, who became chief executive in September 2005, presided over a trust whose failings had been documented as early as 2002 by the Commission for Health Improvement.

But Robert Francis’s February 2010 report noted that, having identified a range of problems, he failed to act effectively. Mr Yeates stood down as chief executive in March 2009, just before the Healthcare Commission’s report. On medical advice he declined to attend the first Francis inquiry. He also refused to give evidence to the public inquiry, saying he was suffering from stress.

His trust denied reports that he received a £400,000 pay-off when he stood down. The trust told Channel 4 News: “Mr Yeates did not receive any remuneration over and above his contractual and statutory entitlement, which was six months’ salary on notice of resignation; nor did he receive any pension enhancements.” Mr Yeates’s salary at the time was £169,538.

On 8 January 2013 it was announced that Mr Yeates had resigned as CEO for Impact Alcohol and Addictions Services.

Toni Brisby became trust chairman in 2004, working three and a half days a week. Her chairman’s statement, contained in the 2007-08 Mid Staffordshire NHS Foundation Trust annual report, is grist to the mill of critics who say the trust, in its preoccupation with achieving foundation status, ignored patient care.

Like Martin Yeates, Ms Brisby’s reputation has suffered in the wake of the Stafford Hospital scandal. Like the former chief executive, she stood down from her position in March 2009. And like him, she was criticised in the February 2010 report for failing to act effectively to remedy problems at the trust. At the time of her resignation, her salary for working three and a half days per week was between £40,000 and £45,000.

The Mid Staffordshire annual report for 2007-8 also lists Ms Brisby’s “relevant interests” as the Toni Brisby Associates consultancy.

Dr Helen Moss, director of nursing at the trust between December 2006 and November 2009, has also faced accusations that she did not act – in her case to rectify dangerously low nursing levels. The Francis report says that “staff shortages were highlighted to her as an issue” shortly after she began, but her review of the subject was not completed until March 2008.

A Mid Staffordshire NHS Foundation Trust report stated that Ms Moss had left the trust and was with East Midlands Strategic Health Authority. However, a spokeswoman for NHS East Midlands announced towards the end of 2009 that “her salary, terms and conditions will remain the responsibility of her current employer”. MSNHSFT subsequently confirmed to Channel 4 News that Helen Moss was on secondment and would be paid by the trust until the end of November 2010.

That the trust’s problems were chronic and existed before 2005 has not been questioned. Jan Harry, Helen Moss’s predecessor, was chief nurse and clinical standards director between 1998 and 2006, during which time she presided over staff cuts and an overhaul of the wards. Her claim to the February inquiry that it was not her job to monitor ward standards was dismissed by Royal College of Nursing General Secretary Dr Peter Carter as “absurd”.

The first Francis report notes that witnesses described her style as “forceful” and that she was viewed by some as “bullying”. Toni Brisby told that inquiry she had been instrumental in arranging for Ms Harry’s departure from her post “by mutual agreement” in 2006 because of her management style. She went on to work in a part-time capacity with Salisbury NHS Foundation Trust between December 2008 and May 2009.

In 2010 Jan Harry was suspended from working as a nurse for two years by the Nursing Medical Council.

At the heart of the Stafford Hospital scandal is the fact that, according to the Healthcare Commission report, up to 1,200 more people may have died between 2005 and 2008 than would be expected. One of the victims was John Moore-Robinson, who died as a result of internal bleeding following a mountain bike accident in 2006.

His case was highlighted when it emerged that Kate Levy, board secretary and head of legal services at MSNHSFT, had asked senior consultant Ivan Phair to delete a paragraph of his report into the treatment Mr Moore-Robinson received. The memo, which was leaked to Mr Moore-Robinson’s parents by a lawyer at the Francis inquiry, said: “With a view to avoiding further distress to the family and adverse publicity I wish to avoid stressing possible failures on the part of the trust.”

MDNHSFT commissioned an investigation of Ms Levy’s actions in 2010 and the trust’s current chairman, Sir Stephen Moss, announced on 12 June 2010 that she had been summarily dismissed.

Karen Morrey was the trust’s chief operating officer from May 2006 until July 2009, when she was put on paid leave. She left the trust later in the year, reportedly to set up her own company. The first Francis report draws attention to her preoccupation with the need to meet targets. Fellow board member John Newsham, who was director of finance with the trust from 1992 until June 2008, presided over the trust’s push to cut costs as part of its application for foundation status.

Many believe those on the board of directors at the Mid Staffordshire trust bear a significant degree of responsibility for what happened to patients. But the mandate of the public inquiry which began in November 2010 was to look more broadly at the role of the supervisory and regulatory bodies in failing to deal adequately with the situation at the trust.

In 2005 the Shropshire and Staffordshire Strategic Health Authority (SHA), which had responsibility for the Mid Staffordshire trust, began the process of amalgamation with West Midlands South SHA and Birmingham and Black Country SHA (BBCSHA).

David Nicholson, now head of the NHS but then BBCSHA chief executive, took overall charge of the three SHAs prior to their amalgamation as West Midlands SHA. Following a brief stint as head of the London Strategic Health Authority from May 2006, Nicholson moved on to become NHS chief executive in September of that year.

The amalgamation coincided with a period of political and financial turmoil for hospitals in the Black Country – a state of affairs which, according to critics, meant the focus was moved away from patient care. In December 2005 the then health secretary, Patricia Hewitt, forced the resignation of the entire board at the University Hospital of North Staffordshire after it emerged it was running a projected deficit of £18.1m.

By contrast, the Mid Staffordshire Hospitals NHS Trust appeared to be thriving, and was focused on achieving foundation trust status. In April 2006 the trust announced it had moved back into the black. In the annual report for 2006-7 Martin Yeates observes: “A trust of our size does not reduce its cost base to that extent without impacting on individuals.”

In December 2005, the boards of the Shropshire and Staffordshire SHA and the Stafford NHS trust conducted a board-to-board challenge, with a view to preparing the trust’s application for foundation status. Significantly, though, it emerged on day two of the public inquiry that David Nicholson had written to the trust in January 2006 stating that it was “at least two years from being ready for foundation trust status”.

In May 2006, Cynthia Bower, a colleague of David Nicholson at BBCSHA, became interim chief executive for West Midlands SHA. In July 2008 it was announced she was to become chief executive of the newly-formed Care Quality Commission, set up to replace the Healthcare Commission.

It meant the person in charge of the body which regulates and inspects health services in the UK is a former close work colleague of the person who runs the health service.

Ms Bower’s appointment also prompted criticism in regard to her failure as West Midlands SHA chief executive to question the Mid Staffordshire trust’s account of its actions in relation to mortality. The then shadow health secretary, Andrew Lansley, suggested she should not have been entrusted responsibility for ensuring there was no repeat of events at Mid Staffordshire.

Little more than a year later, on 9 July 2010, Mr Lansley, by now health secretary in the coalition government, announced that there would be a full public inquiry into the failings in patient care at Mid Staffordshire NHS Foundation Trust.

Cynthia Bower resigned as chief executive of the Care Quality Commission in February 2012 following a critical government report into the CQC’s work.