Hundreds of patients suffered and died unnecessarily as a result of appalling emergency care at a flagship foundation trust, the government’s health watchdog said today in the most damning report ever on an NHS hospital in England.
• Patients arriving in A&E were assessed by unqualified receptionists to determine whether they needed urgent attention. One patient with an open fracture of the elbow had to wait for more than four hours, covered in blood and with no pain relief, because the receptionist failed to give the case priority
• There were too few consultants in A&E to provide on-call cover all day, every day and junior doctors were not adequately supervised
• There were not enough nurses to care for emergency patients. A review of staffing levels in 2007/08 found the trust was short 120 nurses, of which 17 were needed in A&E, 30 in the surgical division, and 77 on the medical wards
• Nurses in the emergency assessment unit were not trained to read cardiac monitors and sometimes turned them off. Patients did not always get the correct medication. Nurses on the wards were not always able to identify when patients were deteriorating after an operation, for example, by monitoring vital signs
• Call buttons were not always answered when patients were in pain or needed the toilet. Relatives claimed patients were left, sometimes for hours, in wet or soiled sheets, putting them at increased risk of infection. Patients at risk of developing pressure sores did not get appropriate care. In one ward, 55% of patients were found to have pressure sores when only 10% had sores on arrival
• Delays in operations were commonplace, especially for trauma patients at weekends. Sometimes a patient’s operation might be cancelled four days in a row, and they would receive “nil by mouth” for most of the day, four days running
The commission analysed the trust’s board meetings from April 2005 to 2008. It found discussions were “dominated by finance, targets and achieving foundation trust status”. When the infection rate of Clostridium difficile doubled in the early months of 2006, the information was not released to the board or the public.