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Thursday 28 Aug 2014

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Panorama: Hospital Trusts providing incorrect information on performance

More than half of hospital trusts inspected last year provided the public with incorrect information on their performance and quality of care, a Panorama investigation will reveal tonight in Panorama: Trust Us – We're An NHS Hospital (BBC One, 8.30pm, Monday 8 March).

Documents obtained by the programme reveal that, of those hospital trusts inspected in 2008/09, 60% had provided inaccurate information to the Government regulator.

The Care Quality Commission (CQC) uses this information, on criteria such a patient safety, care environment and public health, to give the trusts a rating – which is used by patients as a guide to their local hospital.

However, the fact some hospital trusts have been wrongly assessing their own performance casts doubt on the accuracy of some of these ratings.

The news follows the high-profile failures of two hospital trusts in the past year – both of which were found to have misled the regulator.

Mid Staffordshire NHS Foundation Trust and Basildon and Thurrock University Hospitals Foundation Trust were both slated for poor patient care, dirty conditions, and high death rates.

Yet Basildon had been rated "good" by the regulator and Mid Staffordshire "fair" for much of the time it was failing between 2005 and 2008.

The Francis Inquiry into care at Mid Staffordshire, published last month, also highlighted excessive secrecy and evidence that records had been fabricated.

Health Services Minister Mike O'Brien admits to Panorama that hospital trusts needed to be more open, but insists that increased checks being brought in in April would help tackle the problem.

"If you say to me, 'Are we still too secret?' to an extent yes, we need to be more open," he says.

"Is the health service as secret as it was? It's a lot more open than it ever has been in the past. Is it open enough? No, it's not open enough – and we need to be much more open in the future than we have been in the past."

The current system of hospital regulation is based on self assessment. Hospital trusts assess themselves against a range of standards, relating to patient care, hygiene and clinical performance.

The CQC allocates the trust a rating of "excellent", "good", "fair" or "weak" based on these assessments.

The CQC does use a complex system of checks and to monitor these assessments – and carries out inspections at about 20% of hospital trusts each year. However, some experts question how accurate or honest trusts are being in their assessments of themselves.

Professor Brian Jarman, who developed a system of measuring hospital mortality rates used in the annual Dr Foster hospital guide to patient safety, believes the system is open to manipulation.

Jarman, a professor of epidemiology and public health at Imperial College, says: "My view is that patients do not realise that hospitals are self assessing. I could hardly believe it until I read it.

"And I really could hardly believe that they would say and publish that hospitals are 'good' when we're saying that they are very, very bad, and have been bad for 10 years. They (the trusts) are saying that they are 'good' based on their own self inspection."

The CQC's inspectors currently carry out a combination of targeted and random inspections. Of the 28 hospital trusts the CQC inspectors visited in 2008/09, they found 60% had assessed themselves wrongly when it checked four of the 44 core standards trusts assess themselves against.

Nine of the hospital trusts had wrongly assessed on one of the four core standards inspected. Six had wrongly assessed on two.

Peterborough and Stamford Hospitals NHS Foundation Trust and the Southport and Ormskirk Hospital NHS Trust were both found to have provided incorrect information on three of the four standards assessed.

Peterborough and Stamford Hospitals NHS Foundation Trust Chief Executive Nik Patten tells Panorama that the Trust has now tightened up its assessment system: "If we were trying to mislead people that would be really serious. The work we've done over the last two or three months since the declaration was qualified has proven that isn't the case", he says.

"What it has proven is that our collecting of that paper evidence of quality of services hasn't been as good as it should have been. We've been putting that right now."

Antony Sumara, Chief Executive of Mid Staffordshire NHS Foundation Trust, who took up the post after the regulator's damning report into the trust last year, admits that in previous years the trust board had provided the regulator with inaccurate information and that it should not have been rated "fair".

"Some of those stories were horrendous. I'm considered to be one of the hard men of the NHS, which is why they send me to places, but they were awful enough to make me actually think about crying," he tells Panorama.

"The issue wasn't the individual complaints, the poor care in A&E or the appalling care on a particular ward. It is what I describe as a sort of serial and repetitious nature of those complaints."

A new system of regulation will be brought in on 1 April, also based on self assessment, but with increased numbers of checks. The Care Quality Commission says that all hospital trusts will be subject to a review every two years, with some being inspected or receiving site visits.

The Panorama documentary also visits a hospital trust under fire from members of its local population concerned about its high mortality rate.

Last year, Tameside Hospital NHS Foundation Trust had a mortality rate 19% above the national average. The figures suggest that there were 181 more deaths than expected at the hospital.

The trust was not subject to a core standards inspection, but received a rating of "good" from the regulator. The trust insists that it has made accurate self assessment against core standards. It says its high mortality rate has been largely due to high numbers of people dying in hospital rather than in their homes or care facilities.

It adds that it has brought its mortality rate down to near the national average in the last three months.

However, a consultant surgeon at Tameside has blown the whistle on what he calls the sub-standard quality of care at the trust.

Milton Pena tells Panorama he believes the trust does not have enough staff or beds to provide the necessary level of care for vulnerable patients.

"I have examples recently in my orthopaedic ward where we had one qualified nurse left with 17 patients, many of them elderly and highly dependent," he says.

Mr Pena also has concerns about the trust's Medical Assessment and Admissions Unit.

"There is no dignity of care for many patients there who simply wait in chairs for many, many hours, waiting for a bed or waiting to be clerked or seen by a doctor. There are simply not enough doctors and not of the sufficient seniority," he says.

And he warns against excessive use of temporary wards, which deal with high numbers of patients, called escalation wards.

"If the patient is on an escalation ward, usually there is no allocated medical staff. Therefore, if there is any deterioration, the medical doctor on duty may not be there immediately. That's very dangerous."

Tameside said that it plans to permanently staff its current escalation ward. It says it has enough nurses and has increased the number of beds and consultants. It also says patients only wait in chairs if they're comfortable and, if they need a bed, they get one.

Notes to Editors

Any information used from this press release must credit the programme: Panorama: Trust Us – We're An NHS Hospital, BBC One, 8.30pm, Monday 8 March 2010.


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