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Motion made, and Question put,

Hon. Members: Object.

24 May 1999 : Column 134

Nursing Care (Eastbourne Hospital)

Motion made, and Question proposed, That this House do now adjourn.--[Mr. Clelland.]

10.51 pm

Mr. Nigel Waterson (Eastbourne): I am delighted to have this opportunity to highlight the concerns of many of my constituents. Let me begin by paying a warm tribute to the nurses, doctors and other staff who work at Eastbourne district general hospital. Their commitment to patient care, their expertise and their sheer hard work are commented upon by almost everyone who visits the hospital, whether as a patient or in any other capacity.

Although I am raising some genuine concerns this evening, they should in no way be allowed to overshadow the excellent work of the DGH, to undermine staff morale or to cause apprehension among those who may be undergoing or awaiting treatment there.

I want to touch on two specific cases, both tragic. Mrs. Marjorie Dyer was admitted to the DGH in October 1998 after collapsing at home. On 18 October, another patient alerted nursing staff to the fact that Mrs. Dyer was in difficulties--she was choking on a sandwich. First aid was given. A nurse obtained medical records--but, tragically, those relating to another patient. The records said that she was not for resuscitation. The cardiac arrest procedure was not implemented. Other attempts to revive her proved unsuccessful, and she sadly died.

Another incident, which occurred in March 1998, attracted even more local publicity following the recent inquest. It concerned Mrs. Pauline Freeman, who went into the DGH for a hysterectomy. This is a major, but routine, operation. In the normal way, it should certainly not be life threatening--especially for a healthy woman like Mrs. Freeman.

While she was recovering from her operation, a ligature used to tie a main artery slipped. As a result, she haemorrhaged badly, and later suffered a fatal heart attack. It emerged at the post mortem that there were 4,000 ml of blood in her peritoneal cavity. Expert evidence stated that that could have taken up to four hours to accumulate.

At the time of her death, Mrs. Freeman was in a ward of 35 patients who were being looked after by just one registered nurse, with two nursing auxiliaries and a health care assistant. Her consultant gynaecologist--acting as an expert witness at the inquest--stated that, in his opinion, the ward was understaffed, and that more frequent observations of Mrs. Freeman could have identified the problem earlier.

There seems to have been no proper care plan in place for Mrs. Freeman, post her operation. Instead of being observed every half-hour--as was thought appropriate by the expert evidence--she was observed only, at most, every two hours, and the decision was made to reduce the frequency to every four hours. An expert nursing consultant told the inquest that, in her view, staffing levels were too low. The obvious conclusion is that more nurses would have meant more frequent observations, but that is not accepted by the hospital.

Mr. Charles Wardle (Bexhill and Battle): I am grateful to my hon. Friend, and I know how hard he works in the interest of his constituents. He referred to the

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terrible tragedy of Mrs. Pauline Freeman, a constituent of mine who died last year in the DGH after a hysterectomy. The House will appreciate how devastated her husband, Roy Freeman, and her family have been by the suddenness and the appalling circumstances of her death.

After meeting Mr. Freeman and listening to his account of his painful experience and of his family's sense of total shock and loss, I was able to speak to the chairman of the NHS executive south-east and to the Secretary of State for Health and to communicate with the chairman of the local health authority, all of whom, I am sure, appreciate Mr. Freeman's feelings. I believe that they are trying to help.

I know that my hon. Friend is working closely with the hospital trust. It may be helpful if I tell the House briefly what Mr. Freeman wants as an enduring tribute to his wife. He--

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. I feel for the hon. Gentleman--it is a very tragic situation--but the rules of the House do not allow an intervention to go on for so long, and I will have to stop him.

Mr. Waterson: I know that my hon. Friend has been in contact with Mr. Freeman and has passed on his views to the authorities, and in particular to the Secretary of State for Health, and I am sure that he will continue to do what he can to look after his constituent in this time of great need.

The trust has maintained that the decision to reduce the frequency of observation was a proper one in the circumstances. It also contends that, had there been more staff on duty at the time, it would have made no difference to the management of Mrs. Freeman's care.

In a letter to me, the health authority's chief executive said:

He also said:

    "at no time has the Trust advised the Health Authority of an inability to provide a safe service, although it would be fair to say that the Trust had requested funding to improve the quality of nursing cover above the current level."

I view those claims with considerable scepticism. Can it really be the case that extra staff would have made no difference at all? Why was the decision taken to reduce observations of Mrs. Freeman to only once every four hours? If the trust is confident that it is providing a safe service, why is it requesting funding to improve the quality of nursing cover?

I do not want to dwell too much on individual cases, but the cases have revived concerns that have been around for some time, about the total number of nursing staff on duty at any one time and the heavy use of agency and bank staff. The local community health council, to which I pay tribute for its concerned but balanced role, has raised concerns over a two-year period; I have expressed concern about the level of nursing staff in the past; and

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many local people have spoken out, often through the columns of my local newspapers, the Herald and the Argus.

Perhaps most worrying was the district audit report produced by the Audit Commission last September. I have retained a copy. The main conclusions are summarised as follows:

The report goes on to talk of

    "staffing more than 10 per cent. lower than is the norm elsewhere . . . Eastbourne has 65 fewer nurses in post on these wards than the average elsewhere."

In fairness, I should say that, at each of the inquests, the coroner recorded a verdict of accidental death, but we know that there are limits on the extent to which a coroner can apportion blame or indeed engage in detailed investigations. It may be that those were in truth tragic accidents that would have occurred in any case, whatever amount of nursing care was available, but I continue to be troubled by the expert evidence that has been adduced as well as by the fact that the concerns are not new.

What action is being taken in the light of those findings and events? The trust and the health authority have challenged the findings of the audit report. Investigations were carried out after the two fatalities. The hospital's patient services director is reviewing her original investigation into the death of Mrs. Freeman in the light of the independent expert evidence at the inquest. The health authority has engaged the services of a former regional director of nursing to advise it.

I welcome the fact that the south-east region of the NHS executive is carrying out an investigation. There is to be a report to the primary care group meeting on 21 June and to the health authority on 24 June.

Mr. Norman Baker (Lewes): My constituents, half of whom are also served by the DGH, view the situation seriously. While they endorse the good work done by the nurses, they are very concerned by the incidents that the hon. Gentleman has mentioned. They are concerned about why those incidents happened and why they were not picked up earlier. Does he agree that serious questions need to be asked about the shortage of nurses at Eastbourne DGH and about the competence of the management? I assure the hon. Gentleman that, although we belong to different parties, I am willing to stand shoulder to shoulder with him on this issue of great importance to my constituents.

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