Monday, 24 December 2012

Liverpool Care Pathway – "So This Is Christmas..."

"Merry Christmas everybody..."

This is The Telegraph -

Hospital apologises to 38 families for appalling care that saw a patient starve to death

An NHS hospital has apologised to 38 families after a patient starved to death and it left other dying people screaming in pain.
From left: Patricia Bridle, Laurence Hodges, Lois Smith
and Chris Grande

9:00PM GMT 22 Dec 2012

Alexandra Hospital in Redditch is writing to 38 families after a massive legal action that exposed years of bad practice, ranging from nurses taunting patients to leaving an elderly woman unwashed for 11 weeks.
In one of the worst cases, a man had starvation recorded as the cause of his death after being treated at the hospital for two months.
Jeremy Hunt, the Health Secretary, said last night that he was “disgusted and appalled” by what the families had been through, and that the Government was acting to ensure that failings in care were detected more quickly.
Bereaved relatives had told how vulnerable patients were left to starve when trays were placed out of their reach, while others were left in soaking bedsheets.
Many of the families are to receive compensation for cases that their lawyer described as “appalling”.
The hospital is to admit its failings in each case in the letters.
The move will serve to intensify debate on why some nurses and doctors are treating patients without compassion, and will add weight to the warning by Mr Hunt that patients can experience “coldness, resentment, indifference” and “even contempt” in NHS hospitals.
He warned that in the worst institutions, a “normalisation of cruelty” had been fostered.
Concern over the issue is mounting, and on Friday the Prince of Wales made a direct plea to doctors and nurses to listen to their patients and to show them “human kindness”.
Writing in the Journal of the Royal Society of Medicine, the prince said there was an urgent need to restore “a climate of care and compassion” in the health service.
The catalogue of failings uncovered by the mass legal action is one of the worst ever exposed at an NHS hospital.
It included:
• A former nurse whose son told how she died after being left unwashed for 11 weeks, and was put on medication so powerful that she could not speak;
• A 35-year-old father-of-four whose family told how he wasted away because staff did not know how to fit a feeding tube;
• A pensioner who was left screaming in pain when his ribs were broken during a botched attempt to hoist him;
• A man who could not feed himself whose daughter described how he was taunted by nurses who took away his food uneaten;
• A great-grandmother left permanently unable to walk after doctors failed to detect a hip fracture.
In total the hospital has paid out £410,000 in 38 separate cases, five to people who survived, the rest to those whose relatives died.
The largest settlement is £22,500, and most are of about £10,000 for each family for the appalling conditions endured by patients from 2002 to November 2011.
The hospital did not admit liability — but crucially, and unusually, agreed to apologise fully to the families.
Lawyers said the NHS trust had left patients facing “shocking” indignities and the most basic failings in care, and that the poor care had continued for years, despite repeated assurances by trust managers that the problems were being tackled.
Emma Jones, a lawyer from Leigh Day & Co, who represented victims and families, said: “The failings we uncovered were appalling — vulnerable patients were left starving and thirsty, with drinks left out of reach, buzzers ignored and people left to sit in their own waste by the very people meant to be caring for them.”
Some of the families who have received compensation have been fighting for a decade for an explanation over failings in care by Alexandra Hospital, which is run by Worcestershire Acute Hospitals NHS Trust.
Others joined the group action, the second biggest the NHS has ever faced, after a report in October 2010 by the Care Quality Commission (CQC), the regulator, showed that care of the elderly at the hospital had broken the law.
One of the worst cases involved an 84-year-old man from Redditch who starved to death at the hospital in 2009.
The official cause on his death certificate was “inanition” — the clinical term for starvation, as a result of being left without food or drink.
The pensioner was admitted to the hospital in June 2009 after suffering a fall. While in its care, he was prescribed a special diet as he could only manage certain foods. However, he was not fed properly and died two months later.
His relatives did not wish for him to be identified.
Later the same year, regulators warned that so many patients were left at risk of dehydration at the hospital that doctors were forced to prescribe water for patients.
The warning was contained in a report that condemned the quality of care of the elderly across the NHS after spot checks at 100 hospitals. It found “major concerns” at Alexandra Hospital and at Sandwell General Hospital in West Bromwich.
Official statistics show that death rates at Worcestershire Acute Hospitals Trust were 10 per cent higher than the national average in 2010-11, when the CQC report was published, meaning there were 239 deaths more than would be expected.
Since then, mortality has improved but the trust still has 6 per cent more deaths than would be expected.
Mr Hunt said there was “no excuse” for the way in which patients had been treated.
He said the Department of Health would be closely monitoring care at the hospital, and would take further action if needed.
“I am disgusted and appalled to read these accounts of what patients and their relatives went through,” he said. “I know that most NHS staff — including many at the Alexandra Hospital — will be shocked to hear these stories.
"I want to support them in making sure these awful experiences are not repeated.”
He said the department would be bringing in ways to measure patients’ experiences so that the public could judge the quality of hospitals.
In a statement, the trust said: “Prior to the CQC inspection and as a consequence of rigorous clinical governance within the trust, the need to improve certain aspects of patient care had been identified and active steps had been taken to rectify shortcomings.
"The trust accepted the findings of the CQC report immediately and continued to implement improvements on relevant wards to ensure that standards were raised quickly.
"The subsequent CQC inspection in September last year confirmed that the trust met every CQC standard, and the focus now is to ensure that those high standards are maintained and built upon. The trust is committed to delivering the very best care to its patients.
“The trust has accepted that certain aspects of the care afforded to some patients fell below the standard that they were entitled to expect and which this trust now provides.
"We do not consider it appropriate to comment further on the care afforded to individual patients, some of whom were treated as long ago as 2002. Claims were pursued on behalf of a group of patients as a consequence of the CQC report.
"These were dealt with swiftly, amicably and without recourse to litigation, and the trust will shortly be writing to all concerned with full and unreserved apologies.”
Colin White 73, was another pensioner who was often left without food and water, after nurses placed his tray out of reach. He was one of several people on his ward with a red tray, which indicated that he had to be helped to eat.
His daughter, Kim, said the nurse on duty would say 'not hungry today then?’, before taking the food away, without waiting for an answer, despite the fact that he was often too confused to answer.
Mr White was prescribed a high-energy drink but it too was left out of reach. Miss White said that if it was still there when nurses did their rounds, they would throw it in the bin before marking on his chart that he had taken it.
After witnessing the treatment, his family made sure Mr White was never left alone at the hospital.
He spent his final few days in extreme pain as he was not given any morphine, she said.
“One of the last things he said was, 'Get me out of this hellhole’,” Miss White said. “For those to be the last words of someone you love was devastating.”

A contagion of cruelty that taints the health service

The shocking revelations from Alexandra Hospital in Redditch call for a 'back to basics’ approach to nursing

Nursing should recruit people with a spirit of compassion, but it
must also be reinforced by training
 Photo: ALAMY

 By Telegraph View 7:00AM GMT 23 Dec 2012

A different kind of Dickensian scene confronts us this Christmas, not associated with good cheer but reminiscent of the Victorian workhouse, as the appalling conditions that formerly prevailed at Alexandra Hospital in Redditch are exposed after a huge legal action by bereaved families of patients. Starvation, dehydration, cruelty and incompetence all feature in these shocking revelations. They are a far cry from the idealised image of traditional British nursing that was projected at the opening ceremony of the Olympics. At the same time, while deploring this lethal lapse in standards, we should bear in mind that it is far from representative. In hospitals across Britain, dedicated doctors and nurses are caring for patients with a combination of professionalism and compassion that is inspirational.
That said, what happened to 38 patients at Redditch was an affront to the conscience of a civilised country. It is tragic that one of the victims was a former nurse, left unwashed for 11 weeks, according to her son, and put on medication so strong it deprived her of the power of speech. The cause of one 84-year-old man’s death was so incontestable that on his death certificate it was given as starvation (“inanition”). A 35-year-old father of four died after reaching a weakened state because, his widow says, staff did not know how to insert a feeding tube. According to his widow, when the nurse found he was dead she laughed. The callousness of nursing staff is one of the most chilling aspects of this scandal. Trays of food were left out of patients’ reach, then taken away untouched. Such conduct, in what should be the most caring of all professions, is deeply disturbing.
These revelations lend credibility to the claims by Jeremy Hunt, the Health Secretary, that patients in NHS hospitals are exposed to “coldness, resentment, indifference” and “even contempt”. In the current issue of the Journal of the Royal Society of Medicine, the Prince of Wales writes that “those age-old qualities of human kindness and compassion” are “palpably lacking” in health services today. While few institutions will be practising the level of abuse recorded at the Alexandra Hospital, any loss of basic human sensitivity in the nursing profession must be addressed. Compassion should be an essential part of the culture of a hospital. Redditch shamefully illustrates Mr Hunt’s alarming contention that, in the worst instances, there is a “normalisation of cruelty”. That contagion must be expunged from the NHS.
What is needed is a return to traditional standards of caring. Values that were intrinsic to the nursing profession from the days of Florence Nightingale need to be reasserted. Ideally, recruits to that profession should already be characterised by a spirit of compassion, but it must also be reinforced by training. This is an instance where “back to basics” is the only correct approach. It must be enforced by strong management, with clear responsibilities. The highest standards of decency and respect must be reinstated as the prevailing ethos in every hospital, without exception.
In a sense, medicine is the victim of its own success, with demographic consequences – an ageing population – that make maintaining standards ever more challenging. But that is no excuse for callousness. Doctors at Redditch were driven to prescribe water for their patients to counter dehydration caused by dereliction of duty by nursing staff. Did clinicians not feel an obligation to act as whistle-blowers? Where was the clear-cut chain of command, where the communal acceptance of the primacy of patient care? And why did it take so long for the inspection system to uncover such grotesque neglect of vulnerable people?


  1. Another week, another appalling scandal in the NHS.

    "reminiscent of the Victorian workhouse"

    Without defending workhouses, I've read that in those institutions there was always someone to sit with, help and comfort those who were sick or dying. Another inmate or member of staff would be on hand to ensure each patient in the workhouse hospital was fed, watered and, where needed, had assistance with their toilet rquirements.

    Leaving patients in the disgusting conditions found in too many NHS hospitals these days is a scandal that seems to be unique to the present, allegedly modern, age.

  2. Here's what the Morning Star has to say about the appalling treatment of sick people in the two Worcestershire hospitals concerned.

    "A nightmare NHS Trust in charge of a hospital where a man starved to death is buckling under the strain of PFI debt, campaigners said yesterday."

    "...Layers Leigh Day and Co sued the Trust 15 months ago on behalf of badly treated patients after the scandal was exposed by the Care Quality Commission."

    Health Emergency Information officer John Lister said: "The Trust is laden with PFI debt." "Such financial problems would have an enormous impact on staff numbers and the quality of care it delivers," he said.

    "There's no excuse for individual failings in care but what must not happen is the wake of this is the scapegoat of a handful of nurses while the systematic failings of management are ignored."

    "...Last September the morning Star reported that the trust was one of 22 that could have its finances wrecked by PFI debt and government cuts. "

    My question is: how can the use of LCP, in hospitals governed by trusts in this sort of state, possibly result in anything but more appalling treatment of sick and disabled patients - and even more scandals?