Secret inquiry into NHS hospital shows the real effect of socialised care *
By Fay Schlesinger, Andy Dolan and Tim Shipman
Up to 1,200 needless deaths, patients abused, staff bullied to meet targets… yet a secret inquiry into failing hospital says no one’s to blame
Up to 1,200 patients died unnecessarily because of appalling care
Labour’s obsession with targets and box ticking blamed for scandal
Patients were ‘routinely neglected‘ at hospital
Report calls for FOURTH investigation into scandal
Not a single official has been disciplined over the worst-ever NHS hospital scandal, it emerged last night.
Up to 1,200 people lost their lives needlessly because Mid-Staffordshire NHS Trust put government targets and cost-cutting ahead of patient care.
But none of the doctors, nurses and managers who failed them has suffered any formal sanction.
Indeed, some have either retired on lucrative pensions or have swiftly found new jobs.
Former chief executive Martin Yeates, who has since left with a £1million pension pot, six months’ salary and a reported £400,000 payoff, did not even give evidence to the inquiry which detailed the scale of the scandal yesterday.
He was said to be medically unfit to do so, though he sent some information to chairman Robert Francis through his solicitor.
The devastating-report into the Stafford Hospital-shambles’ laid waste to Labour’s decade-long obsession with box-ticking and league tables.
The independent inquiry headed by Robert Francis QC found the safety of sick and dying patients was ‘routinely neglected’. Others were subjected to ‘ inhumane treatment’, ‘bullying’, ‘abuse’ and ‘rudeness’.
The shocking estimated death toll, three times the previous figure of 400, has prompted calls for a full public inquiry.
Bosses at the Trust - officially an ‘elite’ NHS institution - were condemned for their fixation with cutting waiting times to hit Labour targets and leaving neglected patients to die.
But after a probe that was controversially held in secret, not a single individual has been publicly blamed.
The inquiry found that:
Patients were left unwashed in their own filth for up to a month as nurses ignored their requests to use the toilet or change their sheets;
Four members of one family. including a new-born baby girl. died within 18 months after blunders at the hospital;
Medics discharged patients hastily out of fear they risked being sacked for delaying;
Wards were left filthy with blood, discarded needles and used dressings while bullying managers made whistleblowers too frightened to come forward.
Last night the General Medical Council announced it was investigating several doctors. The Nursing and Midwifery Council is investigating at least one nurse and is considering other cases.
Ministers suggested the report highlighted a dreadful ‘local’ scandal, but its overall conclusions are a blistering condemnation of Labour’s approach to the NHS.
It found that hospital were so preoccupied with saving money and pursuit of elite foundation trust status that they ‘lost sight of its fundamental responsibility to provide safe care’.
Health Secretary Andy Burnham accepted 18 recommendations from Mr Francis and immediately announced plans for a new inquiry, to be held in public, into how Department of Health and NHS regulators failed to spot the disaster.
But Julie Bailey, head of the campaign group Cure the NHS, condemned his response as ‘outrageous’ and backed Tory and Liberal Democrat demands for a full public inquiry into what went wrong.
The Francis probe was launched following a Healthcare Commission report on Stafford Hospital in March last year. It found that deaths at the hospital were 27 to 45 per cent higher than normal, meaning some 400 to 1,200 people died unnecessarily between 2005 and 2008.
Two weeks before the report’s publication, the Trust’s chief executive Martin Yeates was suspended. He eventually resigned in May after being offered £400,000 and a £1million pension pot.
The Francis report said staff numbers were allowed to fall ‘dangerously low’, causing nurses to neglect the most basic care. It said: ‘Requests for assistance to use a bedpan or to get to and from the toilet were not responded to.
‘Some families were left to take soiled sheets home to wash or to change beds when this should have been undertaken by the hospital and its staff.’ Food and drink were left out of reach, forcing patients to drink water from flower vases.
While many staff did their best, Mr Francis said, others showed a disturbing lack of compassion to patients.
He added: ‘I heard so many stories of shocking care. These patients were not simply numbers. They were husbands, wives, sons, daughters, fathers, mothers, grandparents. They were people who entered Stafford Hospital and rightly expected to be well cared for and treated.’
Family who lost four loved ones
Kelsey Lintern was at the centre of one of the worst tragedies in the hospital’s appalling catalogue of failure.
She lost four members of her family within 18 months, her grandmother, uncle, sister and six-day-old baby.
Mrs Lintern, 36, almost became the fifth victim when a nurse tried to give her pethidine while she was in labour, despite her medical notes and a wristband clearly stating she was allergic to the drug.
The horrific story began in January 2007 when her baby daughter Nyah had to be delivered by her own grandmother because a distracted midwife was not looking.
The baby was not breathing but she was resuscitated, then discharged by a junior paediatrician just two days later, despite the family’s fears she was seriously ill.
She was not feeding properly and still appeared blue. She died four days later. A post-mortem examination revealed four holes in her heart. Mrs Lintern accepts that Nyah may have died in any case, but said the hospital should at least have ‘realised there was a problem’.
It was when she was in labour with Nyah that a nurse arrived with a syringe of potentially-fatal pethidine, oblivious to the fact Mrs Lintern was allergic to it.
In April 2007, Mrs Lintern’s sister, Laurie Gethin, 37, died of lung, bone and lymph cancer, which had taken 18 months to be diagnosed, even though she was displaying tell-tale symptoms.
Her body, with her eyes still open, was left on her blood-splattered bed in full view of other patients. Tests revealed that Mrs Gethin had ‘markers’ in her blood which can indicated cancer.
But it was only when she was sent for a scan at another hospital that tumours were discovered. Mrs Lintern’s uncle, Tom Warriner, 48, died in January 2008 after his intestine was accidentally pierced in an operation for bowel cancer.
A coroner ruled the death was accidental. That summer, her grandmother Lilian Wood Latta, 80, died hungry and dehydrated after suffering a stroke. She was left in her own excrement during her final days and the family said the dehydration was caused by staff failing to give her adequate fluids.
Mrs Wood Latta had been referred to the hospital by her GP after suffering a series of mini-strokes at home. She was moved between wards three times, and it was left to relatives to change her incontinence pads.
Her dying wish had been to see Mrs Lintern’s new baby Khalen, so, after checking with staff, Mrs Lintern took her daughter in. But as the frail pensioner held her great-grandchild, a nurse appeared and said: ‘What on earth is a baby doing here? You do know we’ve got MRSA and C-Diff on this ward?’
Mrs Lintern, who lives in Cannock, Staffordshire, with husband David and their two daughters, said: ‘It is called the caring profession. But where is the care?’
James Reay died in agony after a junior doctor at Stafford Hospital failed to check his medical history and gave him the wrong drug.
The 67-year-old former miner was admitted to A&E in May 2006 with a swollen leg. Medics administered the anticoagulant Heparin – but failed to take into account Mr Reay’s history of stomach ulcers, which are known to react badly to the drug.
Two days later he was rushed to another hospital where he died from internal bleeding after three weeks of intense pain. Yesterday his widow Olwen won a five-figure pay-off in an out-of-court settlement after Mid Staffordshire NHS Trust admitted liability.
Mrs Reay, 69, said: ‘I have won my case but to me it is blood money and I cannot enjoy it. I would rather have my husband.’
‘Failed boss with £1million pension pot’
With a background in the hotel and catering industry, Martin Yeates was brought in to help Mid Staffordshire achieve the holy grail of foundation trust status as a supposed beacon of quality in the NHS.
A profile on the Trust’s website, since removed, boasted that he had developed ‘a more businesslike approach for the organisation’ after his appointment in September 2005.
The Trust finally achieved foundation status two years later. Mr Yeates’s career in the NHS began when he switched from the hotel trade to manage the catering department at Walsgrave Hospital in Coventry in 1977.
It has now ended with a £1million pension pot, six months salary and a possible £400,000 pay-off for the father of two – despite the Trust’s catastrophic failings.
In his report, Mr Francis said Mr Yeates had failed to resolve ‘governance and staffing issues’ at the Trust and that he and colleagues had ‘focused on systems’ instead.
Of the other Trust bosses, former chairman Toni Brisby resigned in March last year after the NHS watchdog Monitor said it intended to remove her. She told the Francis report she received no termination payment of any kind. Jan Harry, the trust’s director of nursing from 1998 to 2006, oversaw disastrous changes to the organisation of wards.
But she told the inquiry she could not recall a decision to axe 52 nursing posts and was ‘not aware’ of plans to drastically alter the ratio of trained to untrained staff. She also said it was not her job to monitor ward standards – a claim later described as ‘absurd’ by Dr Peter Carter, general secretary of the Royal College of Nursing.
Helen Morrey, former director of operations at the trust, admitted that risk assessments about the impact of job cuts were inadequate and accepted responsibility for a failure to thoroughly investigate complaints by patients. She was put on paid leave last July, before leaving the trust in November.