Care at an NHS hospital in Greater Manchester is so chaotic that patients are being left in pain, having to wait up to four days to see a consultant and languish in a corridor for hours because the A&E unit is full, two previously unpublished reviews commissioned by the hospital reveal.
So serious are the problems at Tameside general hospital in Manchester that local GPs now want the long-serving chief executive, Christine Green, and the medical director, Tariq Mahmood, to quit – while junior doctors working at the hospital have also privately raised concerns about staffing levels.
Long delays before being assessed by a doctor are putting patients at risk, with some admitted on a Friday not being checked by a consultant until Tuesday, according to two reports from NHS experts, based on visits in March and April and seen by the Guardian.
However, Tameside – which provides care to 250,000 people in east Manchester and Derbyshire – has so far failed to acknowledge the groundswell of medical concern. A posting on the hospital website, dated 28 February, notes that the Care Quality Commission, the care regulator, had given it a “clean bill of health” after an unannounced visit earlier that month.
The two reviews highlight a string of problems. Patient admission into A&E is being delayed because the hospital’s beds are frequently full. Repeated references are also made to shortages of doctors and nurses in key areas, difficulties ensuring full rotas of staff, especially overnight, and a lack of consultants present on wards and conducting ward rounds.
In response, Tameside said it had drawn up an action plan to address the issues highlighted in the reports, which had been approved by Monitor, which regulates semi-independent foundation trust hospitals. “Some specific issues” raised by a representative of the junior doctors in February had been addressed, a spokesman added. Although the hospital said it took staff’s views and concerns very seriously, it cast doubt on some concerns raised by staff, which “were not able to be substantiated”, the spokesman added.
But Jeremy Hunt, the health secretary, has criticised the hospital over the problems highlighted by the NHS review teams and the CCG. “Substandard care in hospitals is completely unacceptable,” Hunt said. “Patients should not face excessive waits for treatment and junior doctors must have the support they need from consultants to provide patients with that treatment”.
The Interim Management and Support (IMAS) team based at the NHS’s headquarters in Leeds, who visited Tameside at its request on 13 March, concluded that “delays in assessment, treatment and admission” from A&E are adversely affecting “individual patient experience” and, critically, “patient outcomes” – NHS speak for how people respond to treatement.
That review group also found that a nurse was accepting the handover of ambulance-borne patients from crews in the A&E unit’s corridor. “Up to eight patients at a time had recently been managed in the corridor with delays of up to two hours. Nurses … noted that one patient had waited up to seven hours in the corridor,” the review found.The Interim Management and Support report made repeated references to consultants being present on wards less often than would be expected — their presence and leadership can be “weak” and “variable”, it found — and urged Tameside to ensure its most senior doctors spend more time in contact with inpatients. “Consultant ward rounds still appear to be undertaken twice or three times a week only with ad hoc visits to the ward on non-ward round days”, it said.
A separate report, by the North West Utilisation Management Unit (UM), which helps hospitals in Greater Manchester improve their performance, also exposes an array of problems at Tameside. It warned that some patients did not receive painkillers promptly, noting that “some staff” reported that “responsiveness to analgesia needs could be improved”.
In addition, patients referred to the medical assessment and admission unit, which handles serious but not life-threatening cases by their GPs “may wait several more hours before being seen by an admitting/assessment doctor. Staff report they may wait overnight on chairs” before being seen, said the UM team.
Separately, in February a group of junior doctors at Tameside privately raised a number of concerns with the postgraduate medical dean for Greater Manchester, Jackie Hayden. In response to questions from the Guardian, a spokesman for the he British Medical Association, which has been helping the doctors, said: “Junior doctors working at Tameside General have raised serious issues about staffing, particularly about the level of cover at night.
“Specific areas of concern were radiology, the medical admissions unit and cover for the medical wards at weekends. Safety and quality are obviously the key considerations here, and the concern is that some patients may not have been receiving the best possible care.”
Local GPs who form the Tameside and Glossop clinical commissioning group (CCG), are sufficiently concerned by the range of problems at Tameside, and the fact that the hospital has not acted on warnings to instigate major improvements, that they believe Green and Mahmood need to quit.
Minutes of a private meeting of the CCG’s board held on 1 May, seen by the Guardian, make clear its view that, because all Tameside’s “shortcomings” were “currently having an adverse impact on patient care [and] some were serious enough to require immediate attention”, the hospital’s bosses needed to be replaced.
The minutes add: “Although there had been some progress in a number of areas more recently, opportunities to address others had been missed over a number of years. Many of the key failures reflected on executive and medical leadership.
“Our governing body considered the evidence and felt strongly that it didn’t consider that current senior management arrangements are capable of progressing change at the required depth and pace, and that we need a managed transition from the current medical and chief executive leadership.”
GPs also found nurses reported that “should the registrar [middle-grade doctor] be very busy over the weekend, patients transferred to the ward on a Friday night might not receive a senior review [by a consultant] until the following Tuesday”, perhaps 84 hours later.
A spokesman for Tameside said he was “surprised” to learn of the local GPs’ hostility to Green and Mahmood, as it had an excellent working relationship with the CCG. The body of GPs had not outlined such views to them, he added.
Tameside is one of 14 hospitals in England which ministers in February – following Robert Francis QC’s damning report into the Mid Staffordshire NHS care scandal – asked Professor Sir Bruce Keogh, the NHS’s medical director, to investigate apparently high death rates. Keogh’s report, due in two weeks’ time, is understood to include very serious criticisms of care, management and leadership at Tameside.
Denton and Reddish MP Andrew Gwynne, one of Tameside’s three local MPs, said: “The problem with Tameside is that there’s some very good care in the hospital but there are also far too many examples of poor care and care that’s frankly way below standard, and it has never managed to tackle that.”
Source: guardian.co.uk