CQC Enforcement Notice: A crisis in local healthcare

In Shropshire, Telford and Wrekin Defend Our NHS, we welcome today’s intervention of the Care Quality Commission (CQC), and the issuing of an enforcement notice. The observations of hospital inspectors – leaked and widely publicised last week – were genuinely shocking.

It is wholly unacceptable that patients in our hospitals have been ‘boarded’ in inappropriate areas, because of a lack of beds – on corridors, in areas without access to call bells or oxygen, or on wards so crowded with extra beds that a resuscitation trolley could not be pushed through.

It is disgusting that hospital inspectors had to go to the aid of patients multiple times because of staff shortages. It is close to unbelievable that those patients included a diabetic patient left without food or fluid for 15 hours; close to unbelievable, too, that a high dependency area was left completely unstaffed for 15 minutes.

We applaud the courage of staff who approached hospital inspectors, and told them of the problems. It was staff who blew the whistle here. A letter from the CQC to hospital trust SaTH reported: “Staff across all areas and grades raised concerns with us about this practice (‘boarding’) and told us they felt it was unsafe, demeaning, undignified, and disgusting. Two staff members told us they felt patients who were boarded were treated like ‘animals’ and ‘cattle’.”

Something has gone very badly wrong at our local hospitals. Julia Evans is Secretary of Shropshire, Telford and Wrekin Defend Our NHS, and is a former A&E Nurse at the Royal Shrewsbury Hospital. She says, “NHS cuts lead to shockingly bad care – and that is the fundamental lesson that must now be learned from the crisis at Princess Royal and the Royal Shrewsbury Hospitals”.

The key questions are around what happens next. We call for the following:

No closures

The solution to unsafe services cannot be to close them down, leaving patients without care. Initial reports are that the CQC’s initial focus is on the safety of the A&E service at Telford’s Princess Royal Hospital, and also on sepsis care.

We need more information – but we would be very concerned if the outcome is that patients are diverted to Stoke, Wolverhampton, or other out-of-county A&Es. Overnight closure is already SaTH’s intention. We need both our A&Es. At the Board meeting of 30th August, Chief Executive Simon Wright acknowledged that neighbouring A&Es might not have the capacity to take patients diverted from Telford, and the ambulance service might be unable to get them there. SaTH leaders were clear at the same meeting that Shrewsbury’s A&E does not have the capacity to take patients diverted from Princess Royal’s A&E. And only days ago[i], the A&E at Royal Shrewsbury was closed to ambulance admissions because it was full.

Partial closure of the A&E at Princess Royal poses a risk not just to residents of Telford and Wrekin. This is the specialist hospital for all stroke patients, head and neck emergencies, and very unwell children in Shropshire and mid-Wales, as well as the Telford area. Journey times from South Shropshire or Powys to Wolverhampton or Stoke are too long to be consistent with safety.

Any closure of the A&E at Princess Royal Hospital is unsafe. The CQC should instruct SaTH to call a halt to this. We need a solution to unsafe care, not a process that swaps one set of risks for another.

Pull the plug on Future Fit

The horrific problems identified by the hospital inspectors have arisen overwhelmingly from a lack of beds and a shortage of staff. Future Fit will reduce the bed base by 110 beds, and will slash the number of nurses by an estimated 330 posts[ii]. The Future Fit plans are also to replace some registered nursing posts with ‘nursing associates’ roles[iii] – although national nurse leaders are clear that this substitution should not be taking place. Future Fit is a cuts project.

Future Fit will turn the existing crisis into a catastrophe. Our Clinical Commissioning Groups and NHS England must stop the Future Fit process now.

Review NHS funding in Shropshire, Telford and Wrekin

SaTH now has an annual recurrent deficit of over £20 million. It is absurd to think that local people had £20 million ‘too much’ hospital care last year[iv]. And Shropshire CCG now plans £99 million cuts over the next 5 years[v] – which will have a devastating impact on healthcare for local people.

Behind the crisis in care lies a crisis in staff and beds – and that is due to the grotesque underfunding of the NHS in our area. We ask local MPs and Councillors to support the call for an urgent funding review.

Maternity: The tragedies must end

We welcome the extension of the Ockenden Review into the tragedies of avoidable death or harm to babies or mothers as a result of failings in SaTH’s maternity care. It is time for absolute transparency about what has gone wrong, and for an insistence by regulators that maternity care is made safe, with enough midwives to support Obstetric Unit care and accessible Midwife-Led care.

It’s time for a leadership change at SaTH

We know that experienced nurses are leaving SaTH in droves now because of overwork, a lack of support, and a complete lack of information and honesty from the Senior Management Team. It is not just patients who have been let down by hospital leaders.

Chief Executive Simon Wright has presided over a failing hospital trust. Medical Director Edwin Borman has clinical responsibility for services that are unsafe. Did they not know about the shortage of beds and staff, and the dreadful care provided as a direct result? Were they unaware of the shocking levels of baby deaths in the maternity service? If they did not know, they are not competent. If they did know, and chose to put cost cutting and secrecy ahead of patient safety, they are not fit to hold their jobs.

Either way, they should resign or be removed from their posts.

Conclusions

The NHS is one of the most precious collective assets that we have in our society. All of us will need it; none of us can afford to see it being destroyed. The solutions for Shropshire, Telford and Wrekin do not lie in further spin and cover-up. We need honesty and accountability. We need support for staff, and a fundamental change to a culture of bullying and a culture where staff are afraid to speak out over clinical risk. And we need decent funding instead of year-on-year cuts: for staff and beds at our hospitals, and for community NHS and mental health services too.

[i] Reported on Twitter by the BBC’s Joanne Gallacher. 3rd September 2018

[ii] Future Fit Pre-Consultation Business Case; SaTH Annual Report. May 2018

[iii] Future Fit website. FAQs page

[iv] SaTH. Annual Governance Statement. May 2018

[v] Shropshire CCG. Financial Recovery Plan. August 2018

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