Addenbrooke’s on Fire

The ‘special measures’ meted out to Cambridge’s prestigious Addenbrooke’s hospital by the CQC is a symptom of an NHS struggling to cope nationally and locally. Fifteen NHS trusts are now is such measures, whilst two thirds are in debt and 33 are without a permanent chief executive. Many services are deemed inadequate and unsafe because they don’t have sufficient clinical staff, particularly nurses and midwives, which makes NHS England’s decision to halt and refuse to publish NICE’s work on safe staffing levels all the more inexcusable.

Even if more money was available, failings in workforce planning mean many hospitals and GP practices struggle to recruit staff, and the working conditions and static pay make them hard to retain. A new contract is to be imposed on junior doctors which could mean some specialties – particularly GP trainees – face large salary cuts which is hardly likely to help recruit the additional 5000 GPs needed to keep the NHS afloat. Large cuts in benefits, social care and local authority budgets are pushing up demand in the NHS, as is an ageing population. Clinical Commissioning Groups are also in debt and struggling to cope with their responsibilities. And despite the myriad inspections, there are still huge variations in the quality and standards of NHS care.

The recent publication of the third NHS Atlas of Variation got much less coverage than the hospital failures in Cambridge and East Sussex because it doesn’t name institutions or individuals, so it’s far harder to blame anyone. But the statistics were still alarming. There is a 2.1 fold variation in the number people under the age of 75 losing their lives to cancer, and patients who received an early-stage diagnosis – a critical factor in treatment outcome – ranged from 22.7% to 60.8%. Some is down to patient education and behaviour, some is down to bad luck and some is down to a failing NHS.

With strokes, 40% of patients are still not admitted quickly to a specialist unit, despite longstanding NICE guidance (Eyes passim). Some diabetic patients are receiving less than half their recommended check-ups and are more at risk of complications. Elderly patients in some parts of the country are nine times more likely than in others to be admitted to hospital as emergency cases. Lack of resources is only one cause of poor quality care, but it’s the most important. And yet the NHS is sinking deeper into debt with a likely £2billion deficit this year.

Alas, the CQC does not have a ‘requires investment’ category. Along with the government and NHS England, it is in denial about the scale of NHS debt and believes the problems or poor quality care, and lack of access to care, can be solved by further efficiency savings, collaborations, mergers, hospital chains and federated GP practices. With most struggling hospitals, the earliest signs are a poor staff survey and unhappy whistle blowers. The NHS Staff Survey 2014 for Addenbrooke’s saw the trust performing worse than average for 62% (18/29) of the key findings. 52% of key findings fared worse in the 2014 survey than it did in 2013. Measures of ‘staff engagement’ were worse than in 2013 and staff reported worse rates of harassment, bullying, or abuse from other staff.

The CQC heard staff voice concerns about unsafe staffing levels and the chaotic introduction of a new IT system but did not comment on its treatment of whistleblowers. Dr Narinder Kapur was sacked as head of neuropsychology at Addenbrooke’s in 2010 after raising concerns about staff shortages and unqualified staff working without proper supervision. An employment tribunal ruled in 2012 that Kapur had been unfairly dismissed, ruled that accusations of fraud against Kapur were unfounded and that he was a man “of the highest integrity”. Dr Kapur has since campaigned for an inquiry into the sacking of three Indian consultants who raised concerns by Addenbrooke’s. One was a highly regarded Obsetrics and Gynaecology consultant. The department was rated ‘inadequate’ by the CQC.

Some of the trust’s failings were doubtless due to problems with the introduction of an ‘eHospital programme’ and an ‘Epic’ electronic patient record system which “affected the trust’s ability to report, highlight and take action on data collected on the system.” But the surest sign of a trust in trouble is poor staff morale caused by overwork, understaffing, bullying and not having concerns listened to. If there is no money to invest in better services across the NHS, then the CQC will find far more of them inadequate and unsafe in the next five years. Already, the CQC is failing its own inspection targets because it can’t recruit inspectors. How long Jeremy Hunt can tough this out remains to be seen. Meanwhile Addenbrooke’s needs a new chief executive. Any takers?

MD’s book, Staying Alive – How to Get the Best from the NHS – is available here