Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
I have the utmost respect for NHS staff working at all levels; it’s a tough job and I definitely couldn’t do it. But writing this week’s newsletter has left me wondering, why is it sometimes so difficult for NHS institutions to do the right thing?
I’d really like to know what you think of my briefings. Take the opportunity to tell me I’m wrong. Contact me in confidence here.
Shaun Lintern, patient safety correspondent
For the want of evidence-based nurse staffing levels
“It is common not to have the correct skill mix” – this is the worrying comment to Care Quality Commission inspectors by the nurse in charge at Leicester Royal Infirmary A&E department during an investigation in November last year. The CQC published an inspection report which described care in the department as inadequate and said patient safety had been compromised. One of the key findings was poor nursing staff skill mix in the department.
The report highlighted other very serious care problems. This included potential sepsis not being acted on, and an agency nurse administering insulin to a patient without the drug or the patient ID being double checked. These are examples of what can happen in the reality of understaffed wards: corners are cut and patients can suffer.
The real scandal here is that the best available evidence-based expert view on what safe nurse staffing and skill mix should be in an emergency department was completed last year by NICE.
NHS England and the Department of Health intervened to stop this guidance being published, but HSJ obtained it and published it in full earlier this year. While not official guidance, the Royal College of Emergency Medicine said trusts should use the document to assess A&E staffing.
Leicester Royal Infirmary and other A&E departments would do well to heed that call. The full safe staffing documents obtained by HSJcan be downloaded here.
Deputy ombudsman resigns… over to you Dame Julie
After a few weeks to consider his position, the deputy Parliamentary and Health Service Ombudsman Mick Martin has fallen on his sword.
Frankly, his fate was sealed the moment HSJ connected the dots and revealed him as being complicit in a cover-up about the sexual harassment of an NHS director. It was impossible to imagine him continuing in a role investigating NHS complaints while having been involved in such behaviour.
But the issue has once again put the spotlight on Dame Julie Mellor and the inadequacies in her leadership at the PHSO. She knew about Mr Martin’s behaviour but appears to have taken no action at the time and he continued to be involved in casework decisions until HSJ highlighted the issue. This is only the latest in a string of controversies at the PHSO, which were recounted last month by HSJ’s editor who called for Dame Julie to step down.
Following the revelations about Mr Martin, whistleblowers have exposed a poor internal culture and sleight of hand in relation to investigation performance under Dame Julie. A union has voted no confidence in the PHSO leadership and now Dame Julie is facing an investigation by Sir Alex Allan into her knowledge and actions with regards to Mr Martin. There is much more to come on the PHSO and questions are likely to start being asked in Parliament in coming weeks.
The PHSO has to have the confidence of the public and the NHS. Currently the office is at risk of having neither if this state of affairs continues for much longer.
It shouldn’t be this hard
The board of Shrewsbury and Telford Hospitals Trust spent five hours last week meeting with and discussing the tragic case of baby Kate Stanton-Davies, who died having been tragically failed by the trust when she was born at a midwifery led-unit in 2009.
Her parents have fought the system all the way to get answers about what happened to their daughter, whose death was entirely avoidable. They had to threaten legal action just to ensure a proper inquest was held. Their complaints to the trust were originally rejected, and Kate’s death was never flagged as a serious incident or properly investigated.
And yet an independent report has now completely vindicated them and lambasted the trust for its defensive response.
Meanwhile, on Friday the parents of Lizzie Dixon met with Peter Hutton, who will be leading an inquiry into her death. They have had a 15 year battle for answers, and been turned down by every major NHS organisation. Families at Morecambe Bay and Mid Staffs faced similar incredibly long fights to get answers. It just shouldn’t be this hard.
The unanswerable question
The government has told HSJ it intends to bring in new regulations to make discrimination against whistleblowers illegal– a key recommendation from last year’s review of NHS whistleblowing by Sir Robert Francis.
As one loophole appears close to be closed, another has emerged, with the worrying ruling by an employment tribunal that junior doctors are not protected from detriment by their training body Health Education England, which is outside the scope of employment law.
Add to this the recent resignations of Dame Eileen Sills and her deputy David Bell from the office of national whistleblowing guardian and it is clear things are still far from adequate.
What realistically can be done to ensure genuine whistleblowers are treated appropriately and adequately protected? No matter what legislation is in place or how many inquiries are held, this will always be a question of personal relationships and how people treat each other. Structural policy solutions will help create frameworks for disputes to be resolved but can we ever stop them in the first place?
- Board Talk/governance/assurance
- Care Quality Commission (CQC)
- Department of Health and Social Care (DHSC)
- East Midlands
- Health Education England
- NHS England (Commissioning Board)
- Parliamentary and Health Service Ombudsman
- Patient safety
- Quality and performance
- UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST