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5 Dec 2006 : Column 46WH—continued
On a more serious note, it seems that there is a high level of loyalty, commitment and passion for the job that the staff of the service do. That is to be commended. As part of that success story, the Government acknowledge the valuable support that community first responders offer as they are trained in
life support and first aid, and are equipped with defibrillators. I gather there are 313 trained community first responders living in the boundaries of the Staffordshire service and a further 116 in training at present.
My hon. Friends mentioned individuals to whom they had spoken and I pass on my thanks and appreciation via them to their constituents for the work they do in supporting the NHS and, more generally, in helping people in the community who need support. At the same time, it is right for me to say as a health Minister that if we have people helping in our NHS it is vital that they operate within a proper framework of clinical governance and accountability. That, too, is an important consideration to bear in mind.
I have listened closely to the comments of the hon. Member for Lichfield and other hon. Members about the Staffordshire ambulance service. I also heard the plea for transparency that was made in a useful contribution by the hon. Member for Northavon (Steve Webb) and I agree entirely with him. Where changes are made, there should never be suspicion of an agenda that is anything other than patient safety. All of us as Members of Parliament should have that as priority number one, two and three regarding any changes that are considered in the national health service. Nothing should be done that knowingly compromises patient safety and I urge that clear statement to be the backdrop for what we are discussing.
The piece of equipment referred to as the ResQPOD, or impedance threshold device as it is also referred to, has been temporarily withdrawn from use by the Staffordshire Ambulance Service NHS trust. I understand that it was withdrawn because of concern regarding the theoretical risk of pulmonary oedema, which is fluid accumulating on the lungs, when ResQPOD was used together with another device—the LUCAS device—in the treatment of cardiac arrest. The trust felt that on the basis of the advice it received about the theoretical risk, it should suspend the use of the device and undertake a review, which it has been seeking external expert advice to assist with. I understand that the review has now been completed and that the recommendations are being considered so that a decision can be made by the trust as to whether or not to reintroduce the ResQPOD.
As my hon. Friend the Member for Staffordshire, Moorlands said, the advice came from the then medical director under the former chief executive that it was right and proper to withdraw based on evidence brought forward about the use of ResQPOD in connection with another piece of kit. In response to the hon. Member for Lichfield, I accept that there are international examples; I am not contradicting that. It is also important to say that no other ambulance trust in the UK is using the ResQPOD. External advice is being sought and the collective view of ambulance trusts is that a formal controlled trial of this piece of equipment is required before clear guidance can be given. I resent the comment made by the hon. Member for Eddisbury (Mr. O’Brien) to the effect that bureaucrats are bent on delivering a financial and political agenda. The suggestion that this is not to do
with patients or patient safety does not further the quality of this debate one iota and was a mistaken comment to have made.
Clinical practice and governance of any group of individuals who are administering patient care is a matter that must be managed very carefully. The restriction of the number of drugs that community first responders in Staffordshire can administer as well as the equipment they use, is a matter for Staffordshire Ambulance Service NHS Trust. Staffordshire ambulance service has an obligation to ensure that it is providing a high-quality service and that it is acting in accordance with the law. When concerns were raised locally that the range of drugs administered by community first responders might be in excess of those permitted by the law, it is entirely understandable that Staffordshire ambulance service felt the need to take precautionary action while a review of its practice was undertaken.
I will now turn to the legal requirements that apply to the administration and supply of medicines. Under medicines legislation, the administration of injectable medicines is restricted. Unless self-administered, they may only be administered by an appropriate practitioner or anyone acting in accordance with the directions of such as practitioner. There is an exemption from those restrictions that allows anyone to administer a specified list of such products for the purpose of saving life in an emergency. Adrenaline and glucagon are examples of items on the list, which, as hon. Members know, are administered by community first responders in Staffordshire.
Apart from controlled drugs, there are no legal restrictions on the administration of non-parenteral medicines including those classed as prescription only medicines. However, the ability to obtain supplies of drugs is restricted. Controlled drugs are subject to additional legislation, which is set out in the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001. There are different rules depending on the type of drug, but generally they cannot be administered by anyone other than an appropriate practitioner or a person acting on the directions of such a practitioner. Examples of controlled drugs are diazepam and midazolam. Drugs such as those may not be supplied to community first responders.
The list of some of the drugs that have been in use was given and the hon. Member for Lichfield will know, as he referred to them, that diazepam and midazolam are among the drugs being used by community first responders. I have a list of drugs used by community first responders in ambulance services around the country, which indicates that diazepam and midazolam are not being used. However, there is variation and in other places a more restricted list of drugs is in use and advice has been taken about what constitutes appropriate practice.
When the Medicines and Healthcare products Regulatory Agency was asked for its views on the administration of drugs by the community responders scheme that advice drew the distinction between drugs for oral administration and those intended for injection. The agency’s advice was that, under medicines legislation, drugs for oral administration could be administered by community first responders in their capacity as “agents” of the ambulance trust
and within the trust’s guidelines for the community first responder scheme. After the trust took the decision to withdraw the drugs, the agency drew the trust’s attention to the fact that two products were also subject to the additional requirements set out in the misuse of drugs legislation, as I have said. I hope that the hon. Gentleman will accept that this raises important questions of clinical governance and patient safety and it is right that time is taken to ensure that the legal basis on which any such products are used is clear so that everybody knows where they stand.
I would briefly like to pick up on some of the hon. Gentleman’s other points. He said that community first responders have to wait for 30 to 45 minutes for an ambulance in some parts of Staffordshire. I wish to make it clear that community first responders are not a substitute for an ambulance. For category A calls an ambulance should arrive within 19 minutes of the 999 call 95 per cent. of the time and in addition to the initial community first responder. He also said that patients will die because community first responders cannot do anything when they get there. Again, it is important to be clear that community first responders are not a substitute for an ambulance; they should be deployed to patients whom they have the training to deal with. Where they are deployed, an ambulance should also be dispatched to the scene and be there in 19 minutes or less. Those are important points of clarification.
Some of these issues have raised questions relating to the governance of the ambulance service. The Healthcare Commission has recently been in touch with the ambulance service and has highlighted a number of areas of concern that it has asked the ambulance service to address. For the purposes of this debate, it is important that there is urgent clarification. I accept that and the point made by my hon. Friend the Member for Stafford. We need urgent clarification and to give people working in the field—the community first responders—absolute certainty about the ground on which they are operating so that we can continue to use their good will. However, I would say that the Government, in allowing the time that they did for these issues to be resolved in terms of the discussions about the merger of the two services, have been proved right by this debate.
Tameside General Hospital
12.30 pm
David Heyes (Ashton-under-Lyne) (Lab): 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.”
“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.”
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