Why do some Hospital Trusts perform better than others?

As a clinical negligence solicitor, I firmly believe (as do many of the medical experts I instruct) that pursuing legal claims leads to improvements in standards of care by raising awareness of problems and ensuring accountability. For those who criticise claimants, it should be remembered that negligence is not the same as a mistake. Negligence is only proven when it has been established with expert medical evidence that no reasonable or responsible medical practitioner would have provided care in that way.

Very often the factors that lead to negligent care involve poor teamwork and significant breakdowns in communication. This is often compounded by understaffed wards and a reliance on agency or locum staff who are often not familiar with the patients, the team or the environment. The question is why do some Trusts perform so much better than others and what can they teach those Trusts who are under-performing?

Professor Sir Brian Jarman is co-director of the Dr Foster Unit at Imperial College London, which monitors NHS performance. Blackpool Teaching Hospital NHS Foundation Trust crops up again and again in the Dr Foster Unit reports on the list of Trusts with the highest death rates. This has been the case since the statistics were first published in 2011.

Lack of Staff

In the last five years at Blackpool Teaching Hospital NHS Foundation Trust, there have been 1,878 extra deaths, i.e. over the number that would be expected. Compare this with Imperial College Healthcare NHS Trust which experienced 2,777 fewer than expected deaths. This is the case even taking into account factors such as age, sex, and the diagnosis of the patients treated.

Dr Chris Moulton, vice-president of the Royal College of Emergency Medicine said:

The figures show that there is really a postcode lottery. If you live in some parts of England your chance of dying if you're admitted to hospital with the same condition are much higher than others.

Why is Blackpool Teaching Hospital NHS Foundation Trust so much worse? Could it be to do with the understaffed wards and a reliance of agency and locum staff leading to poor care? I certainly believe this is a significant factor. Inevitably the use of agency and locum staff adversely affects teamwork, morale and communication, which are the bedrock of good care.

Imperial College Healthcare NHS Trust has 138 doctors per 100 beds; more than double the ratio for Blackpool Teaching Hospital NHS Foundation Trust which only has 59 doctors per 100 beds.

Another hospital with higher than expected excess deaths is Tameside Hospital NHS Foundation Trust and they had only 56 doctors per 100 beds. [The 16 best performing Trusts had above average numbers of doctors per bed and experienced 22,565 fewer than expected deaths].

No wonder the staff are under pressure. The Blackpool Gazette recently reported that Blackpool hospital signs off an average of two members of staff every day for stress-related illness. In 2011, 134 employees were ordered to take time off due to stress compared with 732 staff members in 2016.

Early discharge from hospital

It is also important to bear in mind that the recent statistics provided by the Dr Foster Unit relate to deaths in hospitals and within 30 days of discharge. This immediately rings alarms bells in my mind. In the cases I deal with, the same issues crop up again and again:

• Seriously ill patients incorrectly diagnosed and discharged too soon
• Patients rushed out of A&E departments and hospital wards to satisfy government targets
• Underlying problems not diagnosed, particularly sepsis, resulting in deterioration and death
• Under-resourced social care following discharge

It was death rate information which ultimately led to the public inquiry led by Sir Robert Francis QC into the care at the Mid Staffordshire NHS Foundation Trust. Sir Robert Francis said another Mid Staffordshire Trust case is ‘inevitable’ if particular NHS Trusts are financially strained and agree to performance targets they cannot meet.

Hospital Trusts and Community Care providers need to be given the resources to enable them give good quality care and to reduce the personal and financial cost of injury and deaths.

Gill Edwards is a senior clinical negligence solicitor with PotterReesDolan. Should you have any queries about clinical negligence issues, particularly regarding potential negligence at Blackpool Teaching Hospital and wish to speak with Gill or any other member of the team please contact us on 0161 237 5888.