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Tameside General Hospital

Volume 454: debated on Tuesday 5 December 2006

I am grateful to have been granted this Adjournment debate and I am pleased to see my hon. Friend the Minister in his place, particularly given his special responsibility for dignity in care, which is the main theme of the debate. He will know from the exchange of correspondence with the Department, and from my informal conversations with him, of my concerns about standards of care at my local hospital. Those standards of care recently led our local coroner, Mr. John Pollard, to describe the treatment of some patients there as “despicable” and “chaotic”.

I am grateful that the Minister has already agreed to meet me privately to discuss the issue in more detail than the time available today will allow. However, today’s debate provides an opportunity for me to place some of my concerns on the public record. I genuinely regret that that has become necessary, but the issues that I shall speak about are extremely serious and have had a devastating impact on the lives of too many of my constituents. Those issues have also damaged public confidence in our local hospital. My main purpose today is to start to rebuild that confidence, and I believe that that will be possible only if there is an external and independent inquiry into what has gone wrong.

Tameside and Glossop general is situated in Ashton-under-Lyne and also serves as the local hospital for the constituents of my hon. Friend the Minister for Pensions Reform, who represents Stalybridge and Hyde, and my hon. Friends the Members for Denton and Reddish (Andrew Gwynne) and for High Peak (Tom Levitt). It is one of the smallest acute trusts. In many ways, it is a competently led and managed hospital. Financial management has been good; this is not a hospital in financial crisis. The hospital managers have frequently assured me that their staffing levels are adequate and appropriate. Just a couple of years ago, the hospital secured three-star status, and under the new assessment regime it is classed overall as “good”. What is more, Tameside hospital has met the criteria for, and been given approval to go forward with, foundation status. Most significantly, it has recently been given the go-ahead for a much-needed £100 million new hospital construction project, which will see the largely Victorian workhouse buildings swept away to be replaced by 21st-century facilities.

All that is tremendously good news for my constituents, but sadly there is another side to the coin, and too often the bad news has outweighed the good. A number of factors have contributed to that. First, the hospital’s standardised mortality rate is far too high. It is under investigation by the local authority health scrutiny committee. Next is the persistent and apparently insoluble infection problem, which has placed Tameside in the national top 10 worst hospitals for the incidence of MRSA. Then there are the long-running anecdotal stories in the local community about lack of care and dignity in treatment, particularly of elderly patients.

More recently, those fears have been given a new legitimacy—initially last year by one of the hospital’s own consultants, who made harsh criticisms of care standards, which he blamed on inadequate staffing levels. This September, the local coroner, Mr. Pollard, made his comments in court about “despicable” and “chaotic” treatment, which, not surprisingly, were picked up by the press and subsequently widely reported in the local and national media.

In the few weeks since the coroner spoke out in court, we have seen the emergence of the Tameside hospital action group, with more than 100 members, all of whom recounted stories of poor standards of care at Tameside hospital similar to those highlighted by the coroner and many of which could equally well be described as despicable or chaotic. Again, many of those stories have been picked up and widely reported in the press.

I would like to expand a little on some of those events. Last year, the hospital became the subject of media attention when one consultant went public with a whistleblowing claim that care standards were being adversely affected by inadequate staffing levels. The hospital management’s response was to invoke their disciplinary procedures against the consultant. Local press reports claimed that the consultant had been “gagged” and that the staff had been warned not to speak to the press. However, the hospital management did not deny the existence of problems. At that time, 18 months ago, the hospital’s medical director said:

“An action plan has been developed and approved by the Board to address a whole range of issues”,

which he said were “being fully addressed”. I would like to return to that later.

Also last year, the hospital was ranked seventh worst in the country for its standardised mortality rate. That was according to the respected Dr. Foster organisation. The number of deaths at the hospital was far greater than would be expected from a similar-sized hospital serving a comparable population. The local authority health scrutiny committee is investigating the mortality rate, particularly among elderly patients. As might be expected, that issue, too, has been widely reported in the media, to the apparent discomfort of the hospital management, who complained about the presence of the media at a recent scrutiny committee meeting. Such meetings are, by law, held in public. Among the reasons proffered by the hospital for the high standardised mortality rate is the supposed Shipman effect, whereby general practitioners and nursing home managers are reluctant to take responsibility for patients as they approach the closing days of their lives, and instead refer them for admission to the hospital.

In August this year, the hospital gained another unwelcome top-10 placing. We heard that the long-running persistent failure to eradicate hospital-acquired infection placed Tameside in the 10 worst hospitals in the UK for control of MRSA. Again, that was widely reported in the local media, and again the reason proffered by the hospital was that it was someone else’s fault. This time, we were told, the blame lay with the patients, some of whom were alleged to have brought the infection from home or from their nursing home into the hospital.

All that negative, but none the less accurate, media reporting has contributed to a loss of confidence in the hospital in a community that, as I readily acknowledge, has an understandable scepticism about the medical profession based on the still fresh memories of the depredations of Harold Shipman in Tameside.

The final ingredient in the brew came in September, when the south Manchester coroner, Mr. Pollard, held five inquests on the same day into the deaths of patients at Tameside hospital. In four of those cases, he found that standards of care had been unacceptable. He described the care of one elderly patient as “absolutely despicable” and the care of another as “chaotic”. He made his comments in court after being confronted with evidence of poor standards of care.

The hospital’s response was to issue a press release, which described the coroner’s comments as “unfair”. The press release also tried to shift responsibility for the distress of bereaved relatives, or for increased anxiety for patients, from the hospital on to the coroner.

Sadly, the reality is that what the coroner found in those four cases could hardly be regarded as isolated incidents. Too many such cases have been reported in the past, and subsequently the coroner has heard even more cases involving allegations of poor care standards at the hospital. The coroner has provided me with brief anonymised details of 20 such cases that have been come before his court in the past 10 months alone. I shall not read out details of all 20, as the Minister will be grateful to hear, but I will give one or two selected quotes from two-line summaries that the coroner has put together.

There was an inquest in April into the death of a man called Kenneth, whose son complained about his father lying in a wet bed in a disgusting state, with huge pressure sores, and said that the staff had been very rude to him. In May, the coroner heard from the son of a woman who had been told that she had “a bit of an infection”, which turned out to be MRSA and pneumonia. She had fallen out of bed on the ward, and that had not been recorded when the family asked about it.

In June, another man’s son said that his father had had two falls while in hospital. In September, there was an inquest into the death of an elderly lady who had had two hip replacements and then developed MRSA and septicaemia. She was left in her own excrement for three hours and ignored by staff. That was during the last days of her life. Concerns were voiced about cleanliness and hygiene. In another case, a son complained about the lack of care for his father and the lack of communication with staff. He, too, was lying in his own excrement, which had dried on his skin.

The last example that I shall give involves a woman whose case was heard in September this year. Her son complained that she had deteriorated rapidly in hospital. She had lost a lot of weight through not eating; no attempt had been made to feed her. She had been sitting in her own urine and faeces. She had pressure sores and was in a lot of pain. Those are just examples from 20 cases that have been before the coroner, in which allegations of that nature were made as part of the evidence to the court. It is therefore hardly surprising that the coroner chose to speak out about his concerns in September.

As a consequence of the storm of media interest that followed the coroner’s comments, the sheer scale of the problem started to become clear. The four cases that he mentioned appeared to be the tip of an iceberg. In the few short weeks since the Tameside hospital action group was formed, more than 100 people have joined. I have received dozens of letters and e-mails, and many other people have contacted my office by phone. Not all the complaints of which I have been made aware relate to elderly people, but most do. Many have similarities to the cases that the coroner commented on in court. The majority of cases involve a bereavement—typically the loss of a frail, elderly family member. Relatively few correspondents report dissatisfaction with the quality of medical or surgical treatment, but almost all report very poor aftercare, including a lack of dignity.

A number of the letters talk about disappointment with the outcome when cases have been raised through the hospital’s complaints procedures. Many others express regret that the writers did not initiate a formal complaint in the difficult time following the death of a loved one. I know that the coroner has also received a number of unsolicited letters detailing similar experiences. I think that it would be helpful if I read out today a few more selected quotes from the letters that I have seen.

The correspondence has a consistent theme of neglect and a disregard for elderly patients’ need for dignity. Many letters refer to incontinent patients being left for long periods before being changed and made comfortable. A lady wrote about her 86-year-old dad, who went into Tameside hospital in July this year with breathing difficulties. There he contracted MRSA and E. coli. On one occasion when she went to see him his medication was still on his tray from that morning—a total of eight tablets. She says:

“My dad was originally in a side room…then was moved to a 4 bay…even though he had MRSA”.

A man wrote to say that his mother had been

“forced to endure the discomfort and indignity of waiting over an hour and half festering in her own faeces before staff could spare the time to clean and change her.”

He went on:

“I saw for myself open rubbish bins that were full to overflowing, spillages not mopped up, and, on one occasion, an attached catheter bag left trailing on the floor leaving an elderly patient open to urinary tract infection or even worse”.

Another lady wrote about her mum:

“In November 2005 my mother was admitted to Tameside hospital. After extensive tests and excellent care over 5 days in the medical assessment unit she was treated for a heart condition and transferred to the geriatric ward. Whilst there she contracted a severe stomach upset. Despite poor mobility due to rheumatoid arthritis she struggled to go to the bathroom unaided during the night. She leant on a locker, which moved, causing her to fall. The staff did not respond to her cries for help and another patient had to get help for her…It then took 13 hours for my Mum to receive orthopaedic assessment, during which time she was in abject pain. It was then confirmed that she had fractured her femur.”

She adds:

“The nursing care was inferior to say the least, especially as during this time she was still battling a severe stomach infection.”

She was told that her mother was suffering a massive infection that was causing her vital organs to cease working; her mother died within the hour. Her request for an inquest was refused.

Another member of the action group wrote:

“Our family have had a few really bad experiences at Tameside. The first was my father, who had a stroke. I was actually sat at the bedside when he asked the nurse to help him, as he needed to go to the toilet. The nurse replied, “Just do it in the bed. I am too busy. We’ll sort it out later.” I will never forget the look of humiliation on my father’s face.”

The same correspondent says:

“Whilst sitting with mum before she died we witnessed elderly people being given food at the end of the bed where they couldn’t reach and then 20 minutes later it would be taken away; we saw a nurse clean an old lady after the toilet, then give someone a drink without washing her hands.”

She mentions her brother who developed an infection after an artery graft and ended up having his leg amputated.

There are two more letters that I should like to quote, which I think are significant for the debate. A man told us about his father, who died three weeks after being admitted to hospital. He was admitted to the ward, but had a fall. It was suspected that he had broken his hip. However, it took five days for the hospital to confirm that, and during that time he was doubly incontinent, and in severe pain. On numerous occasions the family would arrive on the ward to find that his food and drink had been left out of his reach.

Finally, a lady wrote:

“My husband was admitted to hospital on 21st June 2006. He was never given a bed bath and I regularly had to wash him myself. He was deteriorating all the time he was in hospital. One day I asked for a commode and I was told by the nurse that he had used the toilet the day before so he could not have a commode…One day I went to visit him and during the night he had experienced a nosebleed. He had blood on his hands and face. It was obvious that nobody had tried to clean him up. His meals had been placed out of his reach and then removed when the staff cleared up after mealtimes. Nobody ever questioned why he had not eaten.

My husband passed away on the 9th July and it breaks my heart to think of the undignified and negligent way he was treated at Tameside hospital.”

It is true, of course, that some of those patients would have died anyway of the illness that led them to be in hospital in the first place. The concern that has been repeated to me over and over again is that, even if death was inevitable, basic standards of care, cleanliness and dignity should still have been provided, and in too many cases they were not. Ensuring that very basic standard of care is the responsibility of the hospital’s management. Quite a few of the people who have contacted me about this matter have urged me to press for resignations from the senior management and the chair of the trust. If senior management continues to resist the external inquiry that the public are demanding, I fear that there may be an increase in such requests in future.

I was disappointed when my request for an independent external inquiry into the problems was turned down. I felt, and still feel, that the hospital cannot be regarded as a learning organisation. There is a theme in the events that I have described. It seems that when things go wrong at Tameside hospital the reaction is to look elsewhere to attribute blame—MRSA is not hospital-acquired, but home-acquired; the high mortality rate is somehow the fault of Shipman; and the loss of public confidence in the hospital is the fault of the coroner. What is more, the team that has been set up by the hospital to look into the issues arising from the coroner’s comments is dominated by the very people who carried ultimate responsibility for the problems that were identified. That means that in effect they will be investigating themselves. I do not believe that, given the previous tendency to look for a scapegoat, we can expect an internal hospital inquiry to come up with recommendations to tackle the deep-rooted, systemic and cultural problems that mark out Tameside hospital, and which are the responsibility of the hospital management.

Significantly, the Tameside hospital action group shares that view, and is steadfast in its determination to press for the independent inquiry that is its core demand. From what I have been told, we can expect an imminent announcement from the hospital about its plans to address the issues arising from the coroner’s comments and from the many cases that have been brought to the fore by the action group. I hear that the hospital board has approved a 17, 19 or even 21-point plan, which, like the long forgotten plan of 18 months ago, will address a range of issues. I am sceptical. The action group will be sceptical. I agree with it that nothing other than an independent external inquiry will do, and nothing that the hospital management has thus far proposed persuades me to waver from that view. I hope that what I have said today will be sufficient to persuade my hon. Friend to think again and order an independent look at Tameside hospital. I look forward to my promised meeting with the Minister or one of his colleagues, and I hope that I shall be able to persuade him also to meet a small deputation from the Tameside hospital action group.

I congratulate my hon. Friend not only on securing the Adjournment debate but on bringing to our attention the horrendous experiences of some of his constituents. I recently launched, nationally, a dignity in care campaign, because we believe that too many older people are not treated with the dignity and respect to which they are entitled, in a variety of care settings—on hospital wards, in nursing and residential homes, and even in services provided through domiciliary and day care. We are not only launching that campaign but seeking to stimulate a debate in every community, neighbourhood and care setting about the care that older people should be entitled to expect in a civilised society. Indeed, we are not only stimulating a debate but seeking to stimulate action from those who are charged with fulfilling the relevant responsibilities, whether they are in management and leadership positions or professionals working on the front line.

I think that my hon. Friend would want me to say that many people in the hospital, in his constituency and elsewhere in the NHS do a fantastic job in difficult circumstances, and we would not want to question their sensitivity, compassion and skill in any circumstances. As my hon. Friend said, there is much that is good about the hospital and the trust, which have been objectively inspected and given a three-star rating. Beyond that, we know that much of what they do is good. However, that cannot be an excuse for the treatment to which the older people covered by the coroner’s comments were subjected.

We should test our reaction to this issue by asking ourselves how we would feel if our own family members were treated in this way. Would we regard that as acceptable and be prepared to tolerate it? The answer, I suspect, is that no Member of the House would expect somebody they loved to be treated in that way in any circumstances, but particularly when, as in the case of many of the older people we are discussing, they were coming to the end of their lives. In that respect, my hon. Friend makes an important point. There is no suggestion that lives could have been saved in many of these cases. There is, however, a serious suggestion that the very least that one can expect when families are under the most stress and experiencing the most insecurity and anxiety, and when the older person concerned is sometimes in a lot of pain, is the greatest sensitivity, compassion and care. The evidence before us suggests that that has sometimes not been the case.

I understand that the report that the trust has conducted is due to be published tomorrow, and my hon. Friend will receive a copy, as will the relatives of the older people referred to by the coroner and the local authority’s overview and scrutiny committee. The report will obviously identify the internal inquiry’s findings, as well, I hope, as a programme of action. The overview and scrutiny committee is undertaking a review of older people’s deaths at the hospital and will no doubt consider the inquiry’s outcome and the recommended course of action.

I am very conscious of the development of the Tameside hospital action group, of which my hon. Friend has been a great supporter and champion. Essentially, it is a group of relatives who have come together and who feel that they have common experiences of the hospital’s not treating their relatives with the respect and dignity due to them. The message that I would want to come very strongly from the debate is that the trust management and the hospital authorities have a duty and a responsibility to engage directly with the action group and with relatives who have had such experiences. I say that for two reasons. First, many of those relatives are, frankly, owed an unequivocal apology. Public services, and those who lead and manage them, should be prepared to say sorry when that is appropriate. Secondly, however, they should do more than just say sorry, because many of the relatives want assurances that other families and older people in my hon. Friend’s community will not experience what they have experienced.

I am pleased to hear my hon. Friend say that, and the strong message from the members of the action group is precisely what he says it is: they are looking not only for an apology but, beyond that, for an assurance that patients at the hospital will not be treated in the way in which they saw members of their families treated. For the vast majority, that would give full satisfaction.

As I understand it, the hospital has indicated a willingness to engage some of the relatives in staff training and in a dialogue with staff who work on the front line in the hospital, and that is desirable and important. Equally, however, it is important to engage with relatives and to recognise that much of what they have experienced is unacceptable, rather than to hedge one’s bets by using language that simply recognises and acknowledges that things should have been done differently. People have a right to expect higher standards of care. It is also important to persuade people in my hon. Friend’s constituency through action, not words, that older people will be guaranteed the highest levels of care. Frequently, as my hon. Friend said, people have serious concerns not about clinical practice or the quality of the medical intervention but about the aftercare.

My hon. Friend specifically mentioned an independent inquiry. It would be premature to give a decision on that one way or the other at this stage, because we have to analyse the content of, and the recommendations from, the trust’s investigation, which I understand will be in the public domain tomorrow. At that stage, my hon. Friend will meet the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), and I hope that he will have the opportunity to talk to her with representatives of the action group; indeed, I am sure that she will accede to a request from him to bring members of the action group with him. There will be an opportunity to discuss the content of the report, the experiences of relatives and the wish for a more independent inquiry, if that is still the wish after the report has been published. My hon. Friend and the action group will have an opportunity to make representations on those issues to my ministerial colleague.

It is important that I mention one or two things that the trust has been doing to improve the situation. In July 2005, it introduced matron’s rounds, which are used to assess the quality of nursing care in all wards and clinical areas. They place particular emphasis on basic and essential care, nutrition and hydration, and communication and documentation. With the exception of the emergency and critical care areas, the trust has eradicated mixed-gender wards. It has also implemented the red-tray initiative, which is a system commended by Age Concern. Under the initiative, nursing staff are discreetly alerted when a patient requires assistance with feeding, without making it evident to other patients or visitors. The initiative was introduced in conjunction with new nutritional screening guidelines and protected meal times for patients.

On MRSA, which is a significant issue at the hospital, an action plan has been developed and is being fully implemented. A team under the chairmanship of the trust’s chief executive meets every fortnight, and progress against the action plan has been reported to the Department of Health’s MRSA improvement team every week since its visit. In addition, the trust is working with the team to develop a bespoke antibiotic prescribing policy, which should have a dramatic impact on reducing infection rates.

It is therefore important to acknowledge that the trust has been taking practical steps directly to address the real concerns that people have articulated. Although good intentions, action plans, strategies and a renewed focus are important, the difficulty, as hon. Members will be aware, is that it is the everyday experiences of patients and their families in the wards at the hospital that will determine whether the local community is reassured that lessons have genuinely been learned from the poor practice that has undermined dignity and respect for older people on too many occasions. That is where the judgments will be made. As my hon. Friend said, the community has been scarred by the damage done by Harold Shipman, particularly in relation to the treatment of older people, and we must remember that in any debate on these issues.

However, the proof of the pudding will be when older people and their families see that things are improving at the hospital and that their dignity and respect for them have been put at the heart of the care that they are offered. We expect no less. I again commend my hon. Friend for bringing this issue to the attention of the House and for championing those who are often voiceless in such situations—vulnerable older people and their family members. I promise that we will work closely with my hon. Friend to address these issues.