The chief executive of a trust where thousands of records were changed to make it appear that accident and emergency patients were treated within four hours has said it was not done deliberately to distort the hospital’s performance.
Nottingham University Hospitals Trust chief executive Peter Homa said the staff involved believed they were following the rules on reporting, but had not been given clear guidance.
The advice that I would give my colleagues elsewhere is to ensure that there are appropriate audit systems in place to ensure proper reporting
No staff member will be disciplined and no one has left as a result of the errors.
Mr Homa said the discovery of the misreporting had come as a “tremendous shock” to him and the trust.
“The advice that I would give my colleagues elsewhere is to ensure that there are appropriate audit systems in place to ensure proper reporting,” he said.
The misreporting of patient waits went on for at least four years before it came to light last summer, an independent report revealed last week.
During that time management had concentrated on reducing the number of breaches of the four hour target but had failed to uncover the thousands of cases where patients waited more than four hours, but were recorded as being treated within that time.
An audit covering just 17 months in that period has found 1,889 undeclared breaches of the target.
The report is critical of the trust’s procedures, including a lack of audit of the electronic information system in the emergency department; potential difficulties in establishing who recorded what information on computers because staff did not always log on and off; and in-adequate communication and training of staff in the rules for the four hour target.
However, it said that patient care had not been compromised by the inaccurate reporting and there was no evidence that problems with reporting affected other areas of the trust.
It revealed that staff had raised concerns about four hour reporting in 2005 but these had not been taken beyond the department.
The report - by Dearden Consulting - recommends a range of reviews, improvements and assurances (see box).
It comments on the trust’s aim of becoming “England’s best acute trust by 2016”, saying: “Vision is not sufficient by itself. Equal attention needs to be given to detailed implementation.”
Mr Homa said the trust has responded or is responding to all the recommendations.
In 2008-09, even with the altered discharges, it did not achieve the 98 per cent target.
But Mr Homa said: “The staff in the emergency department have achieved, on a consistent basis since January, previously unattained standards on four hours. The average is now above 99 per cent.”
Although he is keen that the trust “draws a line in the sand” under the misreporting, it may still affect its assessment by the Care Quality Commission for this year.
“It will be their judgement as to what impact this has on our assessment,” he said.
The report from Dearden consulting recommends:
- A review of management structures to ensure clear accountability; clarity over the responsibilities of the director of operations and deputy chief executive; and a review of the role of duty nurse manager in relation to targets
- The trust needs the right capacity and capability to deliver on national targets
- Better systems to ensure that issues raised by staff are dealt with
- Assurance that policies are correctly and consistently applied