Mid Staffordshire Hospital Research Articles

The compassionate organisation

The Francis Inquiry into the Mid-Staffordshire Hospital Trust makes sobering reading.1 ‘Patients were routinely neglected’, says the press release, ‘by a Trust that was preoccupied with cost cutting, targets, and processes and which lost sight of its fundamental responsibility to provide safe care.’ Largely as a result of profound staff shortages, basic elements of care were neglected. Patients were left in soiled sheets or sitting on commodes for hours; food and drinks were placed out of reach, and so on. Like Robert Francis, I find these stories deeply shocking. But I am also shocked that having framed the problem squarely as one of lack of compassion, almost all his recommendations relate to documents or procedures. For example: …

Instilling a patient safety culture in the NHS

John Tingle, welcomes much of Professor Don Berwick's review in the aftermath of the Mid Staffordshire Hospital scandal as thoughtful and reflective, but says one key recommendation—to create criminal sanctions against health staff—will not make the NHS safer for patients.

Facing up to the Francis Report

I write this in mid-September knowing that, as you read it in October, the Independent Inquiry into Care Provided by Mid Staffordshire NHS Foundation Trust report by Sir Robert Francis QC should be on its way to the Secretary of State for Health for consideration before publication, unless further reasons for delay emerge. I know it’s coming and there is nothing I can do about it, but it fills me with apprehension. Some might say it has been a long time coming—the events at Mid Staffordshire Hospital took place between 2005 and 2008—and many relatives and, no doubt, staff have been eager to see what might be concluded and learnt from these events. I am sure it has been a hard and challenging task to review the evidence, listen to the stories of relatives and patients, hear witness accounts from staff, consider the context of the organisation as it sought approval as a foundation trust, and then draw some meaningful conclusions and recommendations from it all. I also have no doubt that the nursing profession will be in for a hard time and not just in Mid Staffs. The particular issues will be generalised to point at whole system failures; failures of caring and compassion, education and training, and regulation and governance across the hospital and the external bodies whose very existence is meant to prevent this kind of thing from occurring. I doubt there will be very many who can walk away hand on heart saying ‘none of this applies to me and my hospital’. This is by no means the first story of failure; disasters of this kind can be traced back over many years but what is harder to trace is the learning and change that followed them. It is this that makes me apprehensive. Yet another high profile report will shout out the failings of nursing and, no doubt, of wider aspects of the NHS. Stories of shameful neglect and lack of respect will abound and everyone will be judged as failing. Too often, we jump to the blame game instead of keeping patients and their families at the centre of our improvement plans, seeking to affect the real change which matters to them and involves them. We jump from specifics to generalisations, assuming that everywhere must be the same and that the reasons for the failure have easy answers like ‘bring back Matron’! As we face the Francis report, my hope is that the recommendations will be reasoned and well thought through in terms of nursing and the current context of health care. I hope the report will recognise that skilled care from registered nurses is an asset we must promote and protect within the NHS. I hope the recommendations will reassert that the fundamental purpose of nursing is the provision of essential Melanie Hornett Nurse Director NHS Lothian Health Board care to all of our patients, regardless of their age, and acknowledge that for any of our patients, this can be a complex task of assessment provision and evaluation of physical, psychological and social needs, which cannot always be disaggregated and delegated down the line. I hope the report recognises the benefit of an allgraduate nursing workforce and the positive aspects of undertaking multidisciplinary undergraduate training with an emphasis on simulation approaches to test out key communication, as well as clinical skills in ‘real-life’ scenarios.

Principles of practice

The public inquiry on the lack of care shown to patients at the Mid Staffordshire Hospital is currently being held. The ‘great and good’, such as David Nicholson, Chief Executive of the NHS, Christine Beasley, Chief Nursing Officer for England, and Peter Carter, Chief Executive of the Royal College of Nursing (RCN) are being called on to give evidence.

Poor quality care: the dangerous effect of silent collusion

It may seem that the NHS is struggling with one scandal after another with regards to how individual and systemic errors are compromising quality care. Last week saw the report into Anne Grigg-Booth, the night nurse who was accused of killing three patients at Airedale Foundation Trust Hospital by illegally administering opiates (Thirwell et al, 2010); and last year there was the scandal of unnecessary deaths at Mid Staffordshire Hospital.

Preoperative staging of rectal cancer: pelvic MRI plus abdomen and pelvic CT. Does extrahepatic abdomen imaging matter? A case for routine thoracic CT

To assess the quality of preoperative magnetic resonance imaging (MRI) staging of rectal cancer, and the clinical significance of abdomen and pelvic computed tomogram (CT) scans in preoperative staging of rectal cancer in a district general hospital. We postulated that the 'metastatic yield' of extrahepatic abdominal imaging is poor, and rarely altered management of rectal cancer. This is a retrospective study of preoperative MRI, CT scans and postoperative histology results of patients who had definitive surgery for rectal cancer at the Mid-Staffordshire General Hospitals NHS Trust over a 36-month period. Preoperative multiplanar pelvic MRI locoregional staging was compared with eventual histology. The incidence of and significance of abdomen and pelvic CT detected pathology (including metastasis) in the management of rectal cancers was also assessed. Preoperative pelvic MRI correctly predicted 'clear' Circumferential resection margins, in 28 of 29 patients who had primary surgery. This is comparable with many published studies. Significant CT detected pathology (including metastasis) on preoperative abdomen and pelvic CT scans was uncommon, and did not influence management of any rectal cancer patient in our study. Given that exclusive CT detected significant pathology caudal to the liver (extrahepatic abdomen) is rare, can full abdomen and pelvic CT scans be justified for preoperative staging of rectal cancers? - especially where chest X rays are employed for lung staging. Preoperative thoracic and upper abdomen CT scan may be a more productive use of resources. Full abdominal scans may be more appropriate for selection of rectal cancer patients with isolated liver metastasis for metastasectomy.

Evaluation in practice.

If the benefits of professional nursing are to be effectively articulated, the process of evaluation in practice must be fully exploited. Nurses in the Mid-Staffordshire General Hospitals have developed methods to help them evaluate their practice. In this article the principles underpinning these developments are described.