Avoidable deaths and superbug infections among hospital issues
9:31am Tuesday 9th October 2012 in News
A DAMNING performance report examining the failings at the Royal Bolton Hospital has been revealed to the public for the first time.
Individual directors have been held to account for the failings, which include increases in avoidable deaths, superbug infections, elderly patients falling and hospital acquired infections.
Other areas of concern include a shortage of midwives, cancelled operations, delayed transfers of care, increased staff sickness and a poor uptake of mandatory training.
Directors on Bolton NHS Foundation Trust’s board presented exception reports, which detailed why certain areas in the hospital were failing, to the first Trust board meeting to be held in public.
The Trust’s new interim chairman, David Wakefield, made the decision to start holding meetings in public to add more transparency to the Trust and asked the directors to create reports for the problem areas.
Mr Wakefield was appointed by the health watchdog Monitor in August, after the Trust was put into “red risk” for financial failings, It came five months after Monitor slammed the board’s governance in March, when it was first placed under “red risk” for meeting A&E and 18-week healthcare targets.
Since he was appointed, Mr Wakefield has made changes to the board. He appointed Wendy Hull as interim finance director to replace Gary Raphael, who left by mutual agreement, and has appointed Terry Watson as a turnaround director as part of a £1 million turnaround plan with Deloittes.
The Trust remains in “red risk” and the lowest rating of one out of five, and at the meeting, Trust secretary Esther Steele said Monitor would be confirming at its next meeting that the Trust would be unlikely to achieve a three rating for the next 12 months.
Chief nurse and director of patient safety and experience Dee Sissons told the meeting the hospital did not have enough midwives per birth to meet national requirements and the financial situation was the only thing stopping them from recruiting more midwives. She said: “They have a different way of staffing their wards but there is no evidence that the services are unsafe.”
But Mr Wakefield said he did not want to wait until a mother had a bad experience or there was a problem with the department and asked the board to review the matter.
A report, from Jez Tozer, chief operations officer, detailed how cancelled operations were causing the hospital to miss targets, which could lead to financial penalties and even the intervention of Monitor for failing 18-week targets.
Ten of the 25 operations cancelled in August were due to failed machinery, which had not been properly maintained and cost £400,000 to replace.
A separate report, brought by Ms Sissons, revealed out of 11 best care indicators, only one — hand hygiene — was marked as green, two were amber and the remaining eight — including dementia care, falls assessment, food and nutrition and record keeping — were failing to meet their targets and marked as red.
Report highlights problems
The Royal Bolton Hospital does not have enough midwives, half its staff have not completed mandatory training and hundreds of elderly patients have been injured falling on wards.
A performance report, revealed at the hospital’s first ever board meeting to be held in public, showed the areas where the hospital is failing to meet targets.
Out of 60 different indicators for targets including A&E performance, cancer treatment, maternity services and superbug infections, nine were revealed to be failing overall this year.
The report, which included statutory targets, those set by health watchdog Monitor and some chosen by the hospital, coloured them red, for those it has failed, amber, for those that have improved but are off plan, and green for those doing well.
So far this financial year, 27 of the targets are green, 11 amber and nine red. The others have not been classified.
In August, 23 were green, 13 amber and seven red.
Here is a breakdown of some of the indicators.
A&E - Green
Accident and Emergency was heavily criticised in March by health watchdog Monitor for failing to achieve four-hour waiting time targets.
The national A&E target states 95 per cent of people should be admitted, treated and discharged within four hours.
The department has met its target each month from April and won a £225,000 performance award from Bolton Clinical Commissioning Group in September for its performance.
Bolton CCG has invested £800,000 into the A&E department, which included funding for a Clinical Decisions Unit.
The department has recently won two staff awards.
Referral times - Green
Referral time within 18 weeks was criticised by Monitor in March for failing targets.
Figures revealed at the time, showed in the financial year 2011/12, more than 2,500 patients waited more than 18 weeks and one in 20 patients, almost 900, had to wait nearly six months for treatment.
The national target is for 90 per cent of patients to be treated within 18 weeks.
Since April, the target has been met overall each month, but the hospital is still failing to meet it in certain specialisms, including orthopaedic care, oral surgery, and cardothoracic surgery.
Maternity - Red
The hospital does not have enough midwives per birth.
The expected national midwife to baby standard is 1:28. In Bolton it is 1:31.
The hospital is delivering 6,500 babies each year but only has enough midwives to deliver 6,300.
They currently have a shortage and are recruiting for midwives to take them up to the level for 6,300.
Staff are currently moved around the unit to flex the fluctuating workload.
Delivery is prioritised and one-to-one, but this is sometimes to the detriment of other areas.
Staff sickness - Red
The Trust is failing to meet its staff sickness target by 1.05 per cent.
So far this year, it has lost 4.80 per cent of days lo due to sickness. This figure dropped to 4.29 per cent in August.
The areas with the worst sickness records include Acute Adult Care, Elective Care, Family and Corporate.
Hotspots in August included the children’s nursing team, staff working with complex healthcare cases staff on ward C4 and F4 and ultrasound.
In August, 22 per cent of nurse bank hours were used to cover staff sickness.
Falls - Red
The hospital is failing its targets for falls for patients over 75 years of age so far this year and could get fined £22,000.
There have been 261 falls since April against a target of 214. The figure is lower than the number of falls in 2011/12, but the hospital is failing to achieve its target of reducing the number of falls by 30 per cent.
Since February 2012, 20 falls have resulted in moderate or severe harm, which includes a fractured hip, shoulder and pelvis, lacerations and fractures to wrists and fingers.
Staff feel they are understaffed.
Cancelled operations - Red
In August, the Trust failed its target for cancelled operations.
There were 25 cancelled operations in August. Ten of these were due to the failure of the endoscopy washers, which cost £400,000 to replace.
Of those cancelled, two were because patients had been sent the wrong starving instructions, three were cancelled due to overbooking, three after admin errors and one after an x-ray machine failed.
The cancellations could affect 18-week referral to treatment performance, which could lead to financial penalties at the end of the year.
Mandatory training - Red
Almost half of staff have not completed mandatory training. The figure across the Trust for August is 53.8 per cent.
It is 45.98 per cent in the Acute Adult Care Division, 53.44 per cent in Family Division and 59.24 per cent in Nursing Patient Safety and Experience.
Between April and June, 66 per cent of 880 places were taken for core mandatory training sessions.
Staff are not accessing online training — the uptake is between 50 and 24 per cent.
If this target is failed there will be a financial penalty in March.
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