Hereford Hospital CQC Report 14.10.14 ~ 'Inadequate'

[Roger]

 

Care Quality Commission Report 14.10.14

[megilleland]

I have been to the hospital several times since July and found nothing untoward regarding my treatment. The main problem I see is that the hospital is under pressure from too many people requiring attention on the day. The staff have always been helpful and I don't see them hanging around. On the contrary they all seem to be tearing around. No wonder they are stressed out. 

 

Extracts from Summary:

 

Many staff talked about the sustained pressure, and in some areas this had become a normal part of working practices. Increased pressure had reduced the time for staff appraisals and staff training. As a result the development of staff was not prioritised. Staff were proud to work for the trust, but many were weary with the continued pressure and could see no end to this.

 

We saw a poor culture of incident reporting resulting from a lack of feedback of actions arising from previous incidents. We saw poor leadership and little engagement of staff in decision making. Many staff talked about the sustained pressure and described their role as ‘firefighting’.

 

Plans to make changes to the service had not engaged staff. They believed the plans would result in less space and greater problems. The worries remained unresolved. Staff felt unable to influence decision making. Staff felt health record systems did not allow them to see all the records they required to deliver effective care.

 

We saw a poor culture of incident reporting resulting from a lack of feedback of actions arising from previous incidents. Staff felt that reporting was pointless; and lack of reporting of (mainly) non-harm incidents was endemic. As a result of this the trust was unable to learn and improve services and protect patients in the future.

 

Many staff talked about the sustained pressure; and in some areas, this had become a normal part of working practices. Over 50% of staff in a recent staff survey believed they worked in crisis mode too often.

 

Lack of financial resources from this government, ongoing PFI payments and more NHS tranformation/change schemes is no doubt going to cause further damage. Better get in the privateers or should that be the pirateers. The trouble with management in this country is that they come in change and transform everything according to the government's agenda and when they realise they've bucked it up move onto to other areas and services to bolster their CV portfolio. Its about time somebody exposed this - any whistleblowers out there?

 

 

[megilleland]

Just done a word count on the quality report. The word staff features 1201 times and senior managers only 8 times. Tells you a lot about where they want to put the blame.

[dippyhippy]

Listening to the Midlands Today report on this, A and E seem to be particularly hard pressed. Is it any wonder??

 

There have always been too few beds. The pressure on staff to perform the miraculous task of conjuring up a bed, whilst simultaneously treating patients within the allotted time, is unbelievable. It's not just now and again, (when there is an outbreak of Norovirus, or some other winter pressure) it is year round. A relentless struggle.

 

I spent time in hospital last year, and I can say hand on heart that the treatment I received was excellent, and equally as important, the care I received was superb.

 

I am sure being shackled to the PFI contract has a large bearing on finances. If this could be tackled that would be a start.

 

Then managers need to start listening to their staff. They are the ones who see the problems, they are the ones who are best placed to ask.

 

We have a wonderful resource in The County Hospital. Let's support them in their efforts to improve.

[Cambo]

I was talking with someone who works there one of the problems is that they are always changing the top boss & every time a new one comes in they implement new strategies but by the time staff get used to it that boss leaves a new one comes in & changes everything so there back to square one??!! Basically there's no stability @ the top??!!

[dippyhippy]

I think most people have lost count at just how many Top Dogs there have been in the last couple of years.

 

The most recent , announcing his departure, just prior to this report being published.

 

The chief exec is now Richard Beeken - he took over from Derek Smith in August of this year. I'm not sure how long Mr Smith was in post for, but I don't think it was more than two years or so.

[Roger]

Wye Valley NHS Trust Response in full

 

He added that it will be very much “business as normal†for many patients with many services 

performing well and others already improving - the Trust’s action plan in response to the CQC is 

already being put into action. This includes:

 

 The Trust Board agreeing to a £1 million investment in A&E

ï‚· Seven new nurses and third consultant already recruited to A&E

ï‚· New refreshment facilities introduced at A&E for patients waiting for treatment

 WVT working with partners to deliver £1.3 million investment for new stroke services

ï‚· New systems in place for managing controlled drugs

ï‚· Introduced improved systems for recording and reporting of staff training to ensure staff 

have the appropriate skills

ï‚· Real-time patient tracking system introduced

ï‚· Plans being drawn up for expansion of outpatient areas/planned reconstruction work in 

A&E will ensure patients’ privacy and dignity are respected

ï‚· New process to look after patients in their last days of life introduced in July supported by 

training and major awareness campaign

 £1/2 million investment in new midwifery led unit

 

 

Plus a tie in with University Hospitals Birmingham NHS Foundation Trust which does not appear in the press release ... 

[Denise Lloyd]

I was talking to a nurse over the weekend and asked her if she had received special training for ebola and no was the answer.  Quite frightening really when you take into account there is no assurance of who is coming into this country.

 

I too have had many trips to the hospital and have never had a problem with the care and kindness offered to me by the doctors and nurses.  The dedication of these professionals is to be applauded and they must be devastated that despite never ending hard work it still doesn't come out right.  Another case of the suits messing up when will they will realise they are the ones at fault and throw in the towel.

[dippyhippy]

Hi Roger, I have read about being partnered with Birmingham....that information is on HT I'm sure.

 

More sobering news.....apparently Herefordshire is the worst in the country for diagnosing dementia. Let's hope that this improves as well. Our elderly population is on the rise.....

 

(I was surprised that following the report on "transforming" Adult Services, it was online over at HT, and not a single comment has been made).  

[twowheelsgood]

I was talking to a nurse over the weekend and asked her if she had received special training for ebola and no was the answer.  Quite frightening really when you take into account there is no assurance of who is coming into this country.

 

I was horrified to hear on Newsnight last night, the minister/MP in charge of managing Ebola in the UK confirm that we had all of 26 beds ready … and she was confident that would be adequate (for now). In fact she was only expecting 3 cases in the next 3 months. And how many more will arrive through 'unofficial' channels?

[Ubique]

My experience at this hospital was two years ago when I was putting an axe back into its sheath , I missed the sheath and cut my hand ,in doing so cut the ligaments . I went to A and E , supurb service , after initial treatment was told that I would be called back the next day to have the ligaments repaired . Told not to eat or drink from 10pm The hospital would phone me in the morning to tell me what time to report . Next day phone went at 7.15am instructing me to be there at 8am . I was told to get changed into the "gown" and relax on the bed. By 4pm still with nil by mouth I was in a state of collopse , they had to connect me to a drip to re hydrate me. I finally went to the operating theatre at 5.15 pm and allowed home at 10pm . So to sum up I was very pleased with most of the Service I received and not so pleased with the rest .

[George Armstrong]

I was pleased to hear of the Street Pastor initiative to open a shelter to deal with drunks - called a Pando - which will be opening soon. That should take some demand off the A & E Dept on weekend nights, and can therefore only be welcomed. The Pastors are medically trained so this has got to be a good thing.

[Roger]

Jesse Norman

 

Like many colleagues, I first understood the impact of the private finance initiative through my local hospital. Starting in 1999, Hereford hospital was one of the earliest PFI projects. It was built and is currently owned 

23 Jun 2011 : Column 144WH

and managed under a 30-year contract through a special purpose company, which is three-quarters owned by Semperian, a large PFI firm based in the City of London, and one-quarter owned by the French industrial services giant, Sodexo. Non-clinical services are contracted out to Sodexo, WS Atkins and to others.

Car parking charges at the hospital have been the source of huge local anger because they penalise patients at a very vulnerable time in their lives. They particularly hit frequent users such as those visiting in-patients and those suffering from cancer. They are socially regressive, falling relatively harder on the poor than on the rich. As I investigated further, I found that that was only the tip of the iceberg. The reason why the charges were so high was down to the PFI itself, because car parking was contracted out not once but twice—first to Sodexo and then to CP Plus, and each had its own mark-up.

Joseph Johnson (Orpington) (Con): Is my hon. Friend aware that fewer than a quarter of England’s 168 NHS hospital trusts have significant PFI hospitals within them, but that those trusts account for almost two-thirds of A and E closures or proposed closures? I know from my own observation of the South London Healthcare NHS Trust how extreme the operational constraints are that face managers who have PFI hospitals within their trusts and how those hospitals force them to take decisions on operational grounds that might not be in the best interests of patients.

Jesse Norman: It seems to be true that many decisions were made from a desire to fit the financial cloth to the pocket rather than from the actual clinical needs of the patients. It is certainly true that the squeeze that these inflation-adjusted costs exert on hospitals is heavily responsible for the closure of A and E units.

Let me return now to the situation at Hereford hospital. Later PFI contracts have contained financial safeguards for the NHS, including automatic efficiency savings of 3% a year and the right for a hospital to put services out to public tender periodically. However, the Hereford contract contains neither of those safeguards. There are no automatic efficiency savings, and the contract cannot be retendered until 2029. The hospital trust is doing a valiant job, but it has little influence, legal scope or access to underlying costs which might help it to negotiate changes to the contract. Worse still, no mechanism exists by which the hospital can group together with other PFI hospitals to exercise collective influence over the PFI contractors. By contrast, Semperian has 106 PFI contracts. The imbalance in power is obvious, yet the NHS seems to have done nothing to remedy that.

 

For almost a year now, I have been campaigning for a voluntary rebate for taxpayers on the PFI of £500 million to £1 billion. Those are large numbers, but that goal is not unrealistic.

 

 

 

House Of Commons 23.06.11

[dippyhippy]

I've just spent the last two hours reading this report in full. If you have the time, I would suggest you all do the same.

 

The issues around A and E alone, are extremely significant.

[Ubique]

Just read the A and E part of the report - not sure what to say except that some parts of it beggars belief . Of real concern was the apparent delays in seeing children. One child with head injuries was not seen until he was sick in the waiting room. It suggests that medicial staff were not really triage attendees face to face but relying on what the Receptionist put on the computer . Report included the fact that medicial instruments designed for one use only were being used more that once !

 

Noticed that a number of the Senior Management Team changed over very near to the time of the Inspection - wondered where the previous management are employed now.

 

Hopefully only good can come out of this damming report , will require a lot of hard work by the 2700 Management and Staff.

[Guest smartieno1]

I can not believe that no one ever makes the link between University Education and the state of our Public Services.......every single management failure will be at the hands of a degree wielding sycophant who could not be trusted to pump up a flat tyre..

I see the disgusting Neil Doverty...a man who was too frightened to meet my Sister and I..is apparently clever enough to get a promotion at another Trust...despite being a massive failure in Hereford....

Until we stop rewarding failure nothing will change



 

[Ubique]

Doh ! Reference my post 12 , it was my tendons that had to be rejoined not ligaments ( not being a medical person they could for all I know be the same ! )

 

Further to the report , similar to my experience a number of patients also suffered from dehydration .

[bobby47]

And in 2004, when they delivered me to the Hospital, they said, 'on the scale of one to ten what's the pain like'. I said, 'I'll tell you what its bloody like. I've been shot, stabbed, blown up and been the recipient of several good hidings and all of that combined doesnt get half way near the pain my back is in now. Give me the Morphine!'

And they did. This sweet angel of mercy shoved the thingy and its needle into my hand, they turned the tap on and for the first time in my life I experienced the joys of diamorphine. It was bloody heaven. It did nothing to stop the pain. It's just that I could no longer be bothered by it.

Once on the ward all the staff were more than happy to get out of their chairs, pop their magazine down, rush over and turn my tap on whenever I shouted, 'More morphine'. And shout I did. Regularly, and not once did these angels of mercy ever say, 'fatso you've become an addict overnight'.

In short, it was a joy to be in there. Every moment of the day I was out of my mind on Morphine. When Jonny Wilkinson kicked that rugby ball over the bar to win us the World Cup I cried like a wench howling, ' I love everyone in the whole world. More Morphine'.

Even tha ale that the lads had smuggled in to sustain me throughout this drug fueled feast did nothing to dampen my love for everyone who chose to listen to my mad gibberings as I laid there howling 'thank you Jesus. Thank you Lord'.

Not once did those saintly wenches ever refuse to turn my tap on. God bless them I say and a merry Christmas to one and all.

And it didn't end there, when they finally decided to throw me out because folk were tired of watching my eyes spin like lemons in a one armed bandit, they handed me a big bag containing Morphine Linctus, Diconal, Diazepam and some other stuff that I can't even spell and that was it.

When I filled in the questionnaire that described my feelings toward the staff and the treatment I received, I reported that I had fallen in love with everyone of them, particularly those who turned the tap on for me.

If you are in pain and in desperate need of drugs I can highly recommend you stay at this hospital.

[Ubique]

Bobby , I am sure that a Nurse continues to care for your every need - I hope so !

[Ubique]

Council Response

 

http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTQxMDE1LjM3MDM4NTkxJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDE0MTAxNS4zNzAzODU5MSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3MDkzMTQzJmVtYWlsaWQ9R3VubmVyNzQwQGhvdG1haWwuY28udWsmdXNlcmlkPUd1bm5lcjc0MEBob3RtYWlsLmNvLnVrJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&101&&&http://www.newsroom.herefordshire.gov.uk/2014/october/herefordshire-councils-response-to-the-wye-valley-nhs-trust-cqc-announcement.aspx

[bobby47]

http://www.herefordtimes.com/news/11536999.Wye_Valley_NHS_is_not_a_failing_organisation_says_chief_executive/

 

Whether they serve the Council or the NHS, all these public service suits are cut from the same cloth. They desperately try to manage the corporate message that all is well under their guidance. Don't get me wrong, I've no problem with the odd embellishment or even a downright cleverly constructed lie just as long as its reasonably convincing and I can see a great deal of effort has gone into it. This lot, the ones we've allowed to germinate, take root and flourish within the public sector ain't any good at it!

[megilleland]

 

Parliamentary Television

Tuesday 18th November 2014 - 9.45am

 

House of Commons Welsh Affairs Committee - Grimond Room

Cross-border health arrangements between England and Wales

 

Witnesses

Welsh NHS Confederation, Aneurin Bevan University Health Board, and Betsi Cadwaladr University Health Board; Jesse Norman MP and Action4OurCare.

 

Be interesting to hear what JN says at this committee. In Question Time (29:38 mins) last week Welsh First Minister, Carwyn Jones said that Hereford Hospital wouldn't function without the number of Welsh patients who use it. Cameron also quoted as saying that Offa's Dyke is the line between Life and Death.

 

[Ubique]

I think that Mr Jones is trying to deflect attention from the Welsh NHS . There is a recent very bad report criticising the Welsh NHS.

[megilleland]

18th November 2014

Hereford Times News by Bill Tanner

Jesse Norman clashes with Welsh First Minister over future for Hereford County Hospital

 

Accusation of "playing politics" over cross-border care offered by Hereford County Hospital

 

Jesse Norman, MP for Hereford & South Herefordshire, has accused the Welsh First Minister Carwyn Jones of “playing politics†over the future for Hereford County Hospital.

 

Mr Jones told TVs Question Time this week that the hospital “wouldn’t function†without the number of Welsh patients who use it.

 

Speaking after the broadcast, Mr Norman said Mr Jones  â€œmight want to stop playing politics and start fixing the problems in his own back yard.â€

 

"It's silly for Carwyn Jones to be taking political potshots at Hereford Hospital.  We will always need a good hospital in Herefordshire, and historically the hospital has also served Welsh patients from as far as Llandrindod Wells and even Rhayader,†said Mr Norman.

 

"But problems arise when the Welsh NHS does not pay the full cost of the healthcare provided, or pays it late.  And that's before you consider the 3.500 people in my constituency who have been forced to use the Welsh NHS in violation of their rights under the English NHS constitution,†he said.

 

In July, the Hereford Times revealed the Wye Valley NHS Trust has to find around £12 million a year to cover the cost of Welsh patients who can’t go home because care packages aren’t in place.

 

Last year, when the Hereford Times highlighted the “postcode lottery†that pushed NHS patients on the Herefordshire side of the border into NHS Wales for treatment, the row went all the way to parliament.

 

As a result, the Welsh Affairs Committee inquiry into cross-border health care is  coming to Hereford on Monday (November 24).

 

The committee is looking to take evidence from patients, medical professionals and social care practitioners.

 

The five years since the committee last examined the issue in 2009 have seen an  increasing divergence between the healthcare systems of England and Wales, which has implications for patients in border areas.

 

In April last year, NHS Wales and the NHS Commissioning Board (CB) England agreed a Protocol for Cross-border Healthcare Services  but it is not clear how well this has been functioning to date.

 

The Silk Commission has also made recommendations to improve cross-border health delivery, and the Government is preparing its response.

 

The Committee is inviting written evidence on some, or all, of the following issues:

 

* The impact of the increasing policy divergence in the health systems of England and Wales on cross-border healthcare services, and on medical practitioners and patients in border regions in England and Wales.

 

* The experience of patients in England and Wales who are reliant on the use of healthcare services on the other side of the border.

 

* The case for greater sharing of resources and facilities between the English and Welsh healthcare systems, for example in relation to procurement and use of high-tech equipment.

 

* The impact of the Protocol for Cross-border Healthcare Services agreed by NHS Wales and NHS CB England, implemented in April 2013, and whether it is meeting its objectives.

 

* The Silk Commission Part II recommendations on cross-border health, particularly the proposal to develop individual protocols between each border Local Health Board in Wales and neighbouring NHS Trust in England.

 

* Any lessons that can be learned from other cross-border health arrangements, such as between England and Scotland or Northern Ireland and the Republic of Ireland.

 

At any one time, Wye Valley NHS Trust can be caring for up to a dozen patients transferred out of NHS Wales and waiting for struggling health and social services across the border to put care packages in place before they can be discharged.

 

The trust can claim back the care cost - an annual average of £12 million - through a tariff system that pays per person.

 

But such claims don’t come back quickly and the trust faces a £15 million deficit of its own without financial support.

 

The trust acknowledges a number of beds are blocked at Hereford County Hospital as delays in repatriating Welsh patients continue.

 

Trust chief executive Richard Beeken has written to NHS Wales highlighting the plight of Welsh patients at the hospital.

 

Some of the Welsh patients have been transferred to community hospitals to improve patient flow through the hospital.

 

The “postcode lottery†was taken up by MP Jesse Norman and the Aneurin Bevan Health Board (ABHB), which covers much of mid and south Wales, announced policy changes that made it easier for border patients to use the hospital of their choice.

 

Some 3,500 Herefordshire patients are registered with Welsh GPs.

 

The ABHB adopted a policy in September 2012 which attempted to keep these patients in Welsh hospitals wherever possible, effectively denying them their choice to come to hospitals in England.

 

In June last year, public health minister Anna Soubry ordered a review of access to NHS services for patients on the English side of the border.

 

The ABHB subsequently resolved to allow English residents registered with a Welsh GP to access hospitals in England without prior approval and work with GPs and health commissioners along the border to improve access in the longer term.

 

 

[Glenda Powell]

When I attended A&E a few years ago with 2 broken wrists, there were children there and they were seen first. I know the street pastors do a really good job but you will never stop people who are drunk or use drugs going to A&E.

[stupidfrustration]

Oh dear Glenda - the last two posts Ive commented on have been directed towards you.

 

The street pastors are creating a place of refuge for the drunks and minor triage which they can only be congratulated on for their efforts to reduce the burden on A&E.

 

A&E should be a place for, well, accident and emergencies - not people who have over indulged on a night out. 

The street pastors will take out some of the "silly" people who need help, but not serious enough for A&E.

 

The drug users are a different matter and these people need more specialist help - which would be a longer term kind of help which I believe is also coming to our town.

[Glenda Powell]

I sit on the board of the hospital and know what I am talking about. It is very frightening for genuine people who are taken to A&E seeing people handcuffed to beds with the police with them, and these people can and have been violent to the staff there. As I said before the pastors do a very good job but you will never stop these people going to be taken to A&E.

[Roger]

I must say that I have never been a fan of the street pastor people who give out love and flip flops ... I will probably get a few down votes but I just don't agree with that approach ... And I never will ... I disagree with the concept ... Not the people who do it ... 

[stupidfrustration]

I sit on the board of the hospital and know what I am talking about. It is very frightening for genuine people who are taken to A&E seeing people handcuffed to beds with the police with them, and these people can and have been violent to the staff there. As I said before the pastors do a very good job but you will never stop these people going to be taken to A&E.

Glenda - just because you sit on the board of something does not necessarily mean you know what you are talking about.

You would be surprised what groups/committees I sit on - doesn't mean I am a font of all knowledge in all these areas.

 

People being frightened - understood and agree - however as a way to reduce fear perhaps if an obnoxious person is being watched by a police officer and handcuffed to a bed - it would imply that person is of no cause of concern really. After all bring handcuffed to a bed does restrict their movement.

Still - not nice for other patients - especially those who live in a different world to the harsh realities of life of the un educated/unwashed

 

The street pastors - Glenda a couple of questions here :

1) how much does it cost for an ambulance to transfer someone from town to a&e

2) how much does each attendance at a&e cost?

 

Let's say the street pastors care for a lone drunk female who has been found in town.

If the street pastors pick up this female and care for her as opposed to an ambulance being called and an a&e visit has been saved - let's add answer 1 and answer 2 together.

 

Now multiply by x .

 

Not only is that a decent saving to a&e but also leaves a&e clear for those who really need it.

 

A win all around I would suggest

[greenknight]

Anybody that tries to lighten the load in the Emergency Department is doing said department a good deed. Our lady across the border is being rather stupid in her statement because with/without Welsh patients our hospital and in particular the Emergency Department will remain. The next available facilities at Worcester and Gloucester are miles away and have their own problems. Don't laugh but the big plan for the Aneurin Bevan Health Board is to site a brand new hospital which will be further away and downgrade the current A & E at Neville Hall Hospital Abergavenny so it will be interesting to see where patients from Monmouthshire/Powys choose to go!!!! We have a growing population, poor road infrastructure etc so it would be stupid to remove anymore services from Hereford. As anyone noticed the increase use of Hereford Hospital by the air ambulance ( voluntary) service?? There are reasons why they are increasing in frequency.