Mid Staffs NHS 400 Deaths Update More Information From NALM

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By Art De Rivers UK .

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The situation at the Mid Staffs Foundation Trust  has been continuing to develop since it became public knowledge that 400 extra deaths (beyond the expected rate) had occured there (2005 - 2008)   . The CEO of Mid Staffs Foundation Hospital Trust  has now resigned : 

 The National Association Of LINks Members NALM founded April 1st 2008  (now with 700 members nationally) chaired a recent meeting with "Cure The NHS"  - the group that has been foremost in drawing more attention to the Mid Staffs patient and carer side of the story . Malcolm Alexander Chair of  NALM chaired the meeting and concerns emerged .

Local Involvement Networks (LINks) are the latest arrangement by the Govt which claims it is creating firm principles of patient and public involvement in the UK and public monitoring of the NHS .. 

Since the end of 2003 when Community Health Councils with a health monitoring function were made defunct the Labour Gov't replaced them first with PPI forums (2004 - 2008 March)  and LINks has now evolved from that period - or at least something has rather weakly evolved in the UK  called LINks,  which is supposed to be looking after the public interest  and monitoring the NHS .

That LINKs is weak and patchy  is borne out in Mid Staffs,  and NALM express that within their own briefing circular formed after the meeting with "Cure The NHS"  at Mid Staffs.

The circular  contains the following concerns  all of which are worth recording as they finally home in more pointedly on the Mid Staffs 400 "extra deaths" situation

FROM THE NALM BRIEFING CIRCULAR 

"Continuity : 

Patients and the public need assurances that the Dept of Health  and Councils and Local Govverment are committed to 10 fully funded years to develop, monitor, inspect and create powerful LINks. They must be independent local organisations of citizens able to perform and ‘blow the whistle’ when patients complain and systems in the NHS and social care are going wrong.

Attempt by government to control LINk

The DH has used part of the £28m LINks budget to fund civil servants to work with each Regional Government office to organise LINks. The policy of funding civil servants to organise LINks on behalf of DH, could fundamentally undermine their independence. The resource should be used to enable LINks to set up their own regional and national structures through NALM

Weaknesses at Stafford

There was a large group of Foundation Trust (FT) governors who appeared to be out of touch with what was happening at grass roots level in the hospital. Governors had no real power and were unable to prevent the disasters at Stafford. The FT  members appeared to have no influence on the FT board and were largely cosmetic. The LINk members, with a few notable exceptions, according to  "Cure the NHS", failed to raise critical issues about the developing crisis. LINks, which were set up precisely for the purpose of monitoring, had not yet set up effective systems to identify problems and advise on finding solutions.  "Cure the NHS" feels let down by their local LINk. " 

It also appears from the briefing that local people want more heads to roll in the shape of Directors and non execs being barred from office :

"Members of the FT Board who were members during the development of the crisis should be barred from future public office as hospital managers, directors or members of Trust Boards. " 

The basis of this thrust is a document which signed off the Mid Staffs Trust in 2006 - 7  as being compliant with most health care standards to the point where nothing appeared amiss .

See Healthcare Return 

Lets remind ourselves what the BBC reported  about the Mid Staffs tragedy .

What did the Mid Staffs Patient and Public Involvement Forum (PPI) have to say about the Hospital standards in 2006 - 7   that they monitored for the public interest ?  . The letter text exists in the same Health Care report .

"Mr Martin Yeates 16th
April 2007
Chief Executive
Mid Staffordshire General Hospitals NHS Trust
Weston Road
Stafford

Dear Martin,
We were pleased to once again have an opportunity to comment on your response to the Healthcare Commission's annual Core Standards declaration. This has been forwarded to your Director of Nursing and Governance. It is important to report that our relationship with your Team at the Mid Staffs General Hospitals Trust has further developed during the last twelve months and we have been very encouraged by Team members' willingness to note, discuss and make changes following our suggestions and comments, particularly following our inspections at
the two Hospitals.

Additionally, the progress made by your Marketing Department during the year has been commendable as has been their willingness to solicit our opinions on some external presentation issues. You may recall that early in the year, following the bad press which the NHS received nationally in respect of hospitals achieving both the target 50 % reduction in MRSA rates and lower incidences of the Clostridium Difficile infection, we changed our monthly inspection policy from giving 24 hour advance notice of our inspections to just one hour's notice.

This change was met with goodwill by your Team and enabled timely and appropriate actions to be taken as a consequence of our findings. We would like to think that perhaps, in a small way, this has helped the Trust beat the national averages in both cases with, in particular, a greater reduction than the 50% target being achieved for MRSA rates.

There have also been a number of particular achievements with which we can identify such as our trailblazing nationally of the use of mobile phones as an alternative, where technically allowable, to Patientline, the establishment of an inter hospital - Cannock to and from Stafford - bus service and the introduction of a specialist MS nurse funded externally.

We have also been pleased to have been invited to become members of some of your internal sub committees such as Infection Prevention and Control, Think Clean, Housekeeping Audit, Transfer of Care/Discharge Pathway, Cancer Care Pathway, Disability Awareness, MS Care Path, CHD-NSF, PALS and the Transport Workgroup where not only have we learnt more of the working practices of the Hospitals but also, hopefully, have been able to input information and advice from the patient's, carer's and relative's perspective.

Similarly, we were pleased to have been invited to attend your meetings relating to the Foundation Trust application and are grateful for the opportunity to provide input from the patient's viewpoint. Also, our attendance at your Open Board meetings has been useful in keeping us abreast of developments within the two Hospitals. As you know, the PPIF is being dissolved at the end of March next year so we shall look forward to one final year of supporting the Trust in its positive contribution to the health of our mid Staffordshire community.

Summing up, we perceive it to have been a good year for the Trust and, most particularly, its patients. Our congratulations are thus enthusiastically passed to you and your Team.

Yours sincerely

Rod Hammerton

Chair, PPIF Mid Staffordshire General Hospitals NHS Trust " 

Mr Hammerton became a Foundation Trust Governor later after the PPI ended in March 2008 

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Andrew Lansley MP  had the following to say regarding patient and public involvement (forums)  in the debate to get a public inquiry into the Mid Staffs 400 Deaths 

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Andrew Lansley (South Cambridgeshire, Conservative) | Hansard source

Yes. I look forward to hearing from my hon. Friend if he manages to catch your eye, Mr. Deputy Speaker.

I know that other colleagues across the House want to contribute, so I shall try to be quick. I want to illustrate further why I feel that the reviews thus far have not answered the questions that must be answered. In his report, Dr. Colin-Thomé says:

"I feel very strongly that a lack of good patient engagement is the key to why Mid Staffordshire hospital trust continued to provide poor care for a protracted period of time."

That may well be true, but is there any analysis that goes beyond that? Is there any analysis of how the Government, through the abolition of community health councils and the emasculation of patients' forums, led to a reduction of patient engagement in a way that was a tragic failure? Is there any examination of how foundation trusts are engaging or failing to engage with the public?

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