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| Colchester General hospital in Essex, where patients have been urged only to attend if they have a life-threatening condition. Photograph: Nick Ansell/PA |
The scale of the problems at Colchester hospital have been laid bare
after the hospital’s chiefs admitted there had been 563 serious
incidents over a two-year period.
The incidents, disclosed to the Guardian by the hospital, are defined as those causing or threatening serious harm to patients, staff, the public or the trust itself over the past two years. They may include unexpected or avoidable deaths, serious harm requiring lifesaving intervention, serious hospital-acquired infection outbreaks, maternal mortality and allegations of abuse. The hospital refused to divulge precisely what the 563 cases involved.
All hospitals keep such records but they are rarely made public. None of the incidents are part of the normal running of the hospital, such as deaths due to serious illness or expected surgical complications, but arise instead from errors being made. The figures exclude cancer cases, which are currently under separate investigation after the hospital was accused of tampering with data last November.
Patients have been urged only to attend the hospital in Essex if they have a life-threatening condition. The call was made last week after the hospital failed a surprise inspection by the Care Quality Commission, which found high levels of demand and raised a series of concerns relating to inappropriate restraint, resuscitation and sedation of elderly people, some with dementia. The hospital said it was facing “unprecedented demand”.
A CQC spokesman has since confirmed that it is looking at an allegation that waiting time figures were tampered with to meet targets. They also confirmed that a dead body was taken through the A&E department within the sight of patients and inspectors.
The hospital was placed in special measures last November after a CQC report found cancer data had been tampered with.
A spokesman for Colchester Hospital University NHS Foundation Trust said: “Serious incidents are reported to our local clinical commissioning group (CCG) which then considers them. It is up to the CCG to determine when a serious incident has been satisfactorily resolved.
“The trust has a meeting every day involving members of the executive team and senior managers to discuss any serious incident concerns. In the past the trust has been criticised for not being ready to declare serious incidents often enough. The fact that we now have a higher number is regarded as positive, because it shows that we are encouraging our staff to raise concerns and that we have a no-blame culture. Serious incidents provide the trust with learning opportunities and help it to reduce risk and improve quality.”
Peter Walsh, the chief executive of the charity Action against Medical Accidents, said Colchester seemed to have a large number of serious incidents, especially considering it was not a large hospital.
“This is a gut feeling, but from my experience that sounds on the high side. It sounds like an unusually high number of incidents,” he said.
However, he added: “These things are under-reported, so it’s not possible to say if a large number of incidents is a sign of a good reporting process or that a lot of things go wrong. It could be either. So the figures should be treated with caution.”
The Guardian understands that there is a backlog in dealing with some of the serious incidents and some delays in producing reports about the incidents, which has meant that the issues cannot be resolved.
A trust spokesman said the root cause of all serious incidents had to be formally investigated and the final report ultimately approved by a medical or nursing director. Any serious incidents that remained outstanding may need extra information or “action points” to be addressed on the action plan that is drawn up after the investigation, and the CCG’s policy was that incidents were only closed when these things had been done.
“There is therefore a foolproof method of ensuring that the trust is held to account in respect of all outstanding actions and that learning from incidents can take place to prevent recurrence,” he said. “Some actions may take longer to complete, such as the need to provide a particular type of training to an entire team of staff or department.”
When the major internal incident was declared, Colchester hospital closed its doors to all but life-threatening emergencies and began discharging all patients who were clinically fit to leave. Extra social workers from Essex county council were drafted into the hospital over the weekend to try to find places in care homes to accommodate some of those being discharged.
A council spokesperson said: “Specialist advisers are providing extra support to hospital-based social care staff and we have brought in additional resources to help with the assessment of patients. Care home placements which were made over this weekend were all to local homes and choice was offered. We have not had any requests to find more placements this week.”
Tim Roberts, regional coordinator for Unison, said: “We have had three chief executives in the space of a year [at Colchester] and the director of nursing has gone. As far as staff go, morale is not good. There is a shortage of trained nurses in the region and many of those who are in this area aren’t minded to come and work at Colchester hospital. “I think the declaration of the major internal incident has been really unhelpful. As far as staff are concerned the situation in the hospital is the same this week and last week as it was the week before. There is no quick fix. It is going to take time to sort out the problems at Colchester hospital.”
One patient, who asked not to be named, said her experience there had been mixed. “I am receiving treatment for a gynaecological condition and my treatment has been wonderful,” she said.
“However, my daughter, who died at the hospital, received appalling treatment. She often went to A&E in excruciating pain and was told by some of the nurses that she was making the whole thing up. When I was an in-patient at the hospital following a fracture I witnessed two of the elderly patients being treated appallingly.” Basildon hospital, also in Essex, has been experiencing similar pressures to Colchester but has dealt with the issue differently. It was placed in special measures by CQC but those were lifted earlier this year after a positive CQC inspection report.
A spokeswoman said: “Black alert is a hospital’s most severe internal status level and means we have far more demand coming through A&E than beds available. We are currently on red status [one step down from black] but were on black alert throughout [Monday] and, separately, for three days last week.
“All non-urgent meetings are cancelled and an incident room with a gold, silver and bronze management structure is put in place. We are well versed in responding to ‘black alert’ or peaks in demand and our dedicated staff rise to the challenge, sometimes working extra hours, sometimes taking on different roles.”
The incidents, disclosed to the Guardian by the hospital, are defined as those causing or threatening serious harm to patients, staff, the public or the trust itself over the past two years. They may include unexpected or avoidable deaths, serious harm requiring lifesaving intervention, serious hospital-acquired infection outbreaks, maternal mortality and allegations of abuse. The hospital refused to divulge precisely what the 563 cases involved.
All hospitals keep such records but they are rarely made public. None of the incidents are part of the normal running of the hospital, such as deaths due to serious illness or expected surgical complications, but arise instead from errors being made. The figures exclude cancer cases, which are currently under separate investigation after the hospital was accused of tampering with data last November.
Patients have been urged only to attend the hospital in Essex if they have a life-threatening condition. The call was made last week after the hospital failed a surprise inspection by the Care Quality Commission, which found high levels of demand and raised a series of concerns relating to inappropriate restraint, resuscitation and sedation of elderly people, some with dementia. The hospital said it was facing “unprecedented demand”.
A CQC spokesman has since confirmed that it is looking at an allegation that waiting time figures were tampered with to meet targets. They also confirmed that a dead body was taken through the A&E department within the sight of patients and inspectors.
The hospital was placed in special measures last November after a CQC report found cancer data had been tampered with.
A spokesman for Colchester Hospital University NHS Foundation Trust said: “Serious incidents are reported to our local clinical commissioning group (CCG) which then considers them. It is up to the CCG to determine when a serious incident has been satisfactorily resolved.
“The trust has a meeting every day involving members of the executive team and senior managers to discuss any serious incident concerns. In the past the trust has been criticised for not being ready to declare serious incidents often enough. The fact that we now have a higher number is regarded as positive, because it shows that we are encouraging our staff to raise concerns and that we have a no-blame culture. Serious incidents provide the trust with learning opportunities and help it to reduce risk and improve quality.”
Peter Walsh, the chief executive of the charity Action against Medical Accidents, said Colchester seemed to have a large number of serious incidents, especially considering it was not a large hospital.
“This is a gut feeling, but from my experience that sounds on the high side. It sounds like an unusually high number of incidents,” he said.
However, he added: “These things are under-reported, so it’s not possible to say if a large number of incidents is a sign of a good reporting process or that a lot of things go wrong. It could be either. So the figures should be treated with caution.”
The Guardian understands that there is a backlog in dealing with some of the serious incidents and some delays in producing reports about the incidents, which has meant that the issues cannot be resolved.
A trust spokesman said the root cause of all serious incidents had to be formally investigated and the final report ultimately approved by a medical or nursing director. Any serious incidents that remained outstanding may need extra information or “action points” to be addressed on the action plan that is drawn up after the investigation, and the CCG’s policy was that incidents were only closed when these things had been done.
“There is therefore a foolproof method of ensuring that the trust is held to account in respect of all outstanding actions and that learning from incidents can take place to prevent recurrence,” he said. “Some actions may take longer to complete, such as the need to provide a particular type of training to an entire team of staff or department.”
When the major internal incident was declared, Colchester hospital closed its doors to all but life-threatening emergencies and began discharging all patients who were clinically fit to leave. Extra social workers from Essex county council were drafted into the hospital over the weekend to try to find places in care homes to accommodate some of those being discharged.
A council spokesperson said: “Specialist advisers are providing extra support to hospital-based social care staff and we have brought in additional resources to help with the assessment of patients. Care home placements which were made over this weekend were all to local homes and choice was offered. We have not had any requests to find more placements this week.”
Tim Roberts, regional coordinator for Unison, said: “We have had three chief executives in the space of a year [at Colchester] and the director of nursing has gone. As far as staff go, morale is not good. There is a shortage of trained nurses in the region and many of those who are in this area aren’t minded to come and work at Colchester hospital. “I think the declaration of the major internal incident has been really unhelpful. As far as staff are concerned the situation in the hospital is the same this week and last week as it was the week before. There is no quick fix. It is going to take time to sort out the problems at Colchester hospital.”
One patient, who asked not to be named, said her experience there had been mixed. “I am receiving treatment for a gynaecological condition and my treatment has been wonderful,” she said.
“However, my daughter, who died at the hospital, received appalling treatment. She often went to A&E in excruciating pain and was told by some of the nurses that she was making the whole thing up. When I was an in-patient at the hospital following a fracture I witnessed two of the elderly patients being treated appallingly.” Basildon hospital, also in Essex, has been experiencing similar pressures to Colchester but has dealt with the issue differently. It was placed in special measures by CQC but those were lifted earlier this year after a positive CQC inspection report.
A spokeswoman said: “Black alert is a hospital’s most severe internal status level and means we have far more demand coming through A&E than beds available. We are currently on red status [one step down from black] but were on black alert throughout [Monday] and, separately, for three days last week.
“All non-urgent meetings are cancelled and an incident room with a gold, silver and bronze management structure is put in place. We are well versed in responding to ‘black alert’ or peaks in demand and our dedicated staff rise to the challenge, sometimes working extra hours, sometimes taking on different roles.”
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