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Hospital scandal rocks Britain's National Health Service

Cameron will appoint chief inspector, may call on Berwick

Topics: Mortality, Quality, Performance Improvement, Outcomes, Patient Experience, Safety, Medication Administration, Infection Control

February 07, 2013

British Prime Minister David Cameron this week issued a formal apology for the National Health Service (NHS) after a report revealed "truly dreadful" patient care at an English hospital.

The report—which examined conditions at Stafford Hospital in Staffordshire from 2005 to 2009—was prompted by the Healthcare Commission, which oversees NHS care and became concerned with unusually high mortality rates at the hospital in 2007.

It cited myriad examples of atrocious patient care, including patients who were:

  • Left unbathed and lying in their own filth;
  • Denied medication;
  • Left without food or water;
  • Developed infections due to unsanitary conditions; and
  • Sent home to die after receiving an incorrect diagnosis.

"This is the story of the appalling and unnecessary suffering of hundreds of people," said Robert Francis, the lawyer tasked to lead the government inquiry. He added that it would be impossible to determine how many patients died because of the substandard care at the hospital.

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How things went so wrong
The report attributes the scandalous care in part to a focus on external objectives over patient care. For example, the hospital strove to meet health-service targets, such as providing medical care to patients within four hours of their arrival at the ED. The hospital also strove to balance its accounts and save $16 million in 2006 and 2007 to achieve foundation-trust status, which grants it some independence from government control.

"The inquiry found that a chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care," Francis said, adding, "Staff who spoke out felt ignored and there is strong evidence that many were deterred from doing so through fear and bullying."

Speaking before the House of Commons, Cameron apologized for the way NHS had permitted "horrific abuse to go unchecked and unchallenged." He added that, at this time, "we cannot say with confidence that failings of care are limited to one hospital."

Cameron will appoint a chief inspector of hospitals, who will begin inspecting hospitals in the fall. He also announced several immediate efforts to address underlying issues at NHS, The Guardian reports. For example, he has proposed that hospital boards be suspended for severe, ongoing care failures, not simply financial failures. Cameron also  said NHS will change its hiring criteria for nurses and base promotions on performance, not tenure.

In addition, Cameron said the government will consider the report's 290 recommendations and make a statement of further reforms in March. Cameron has also said he will seek help from former CMS Administration Don Berwick (Lyall, New York Times, 2/6; Jowit, The Guardian, 2/6; Fox, NBC News, 2/7).

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