Bosses urged to resign at scandal-hit Essex hospital

Managers at a scandal-hit hospital should resign after a report found a catalogue of failings and an unusually high death rate, the head of a patient group said tonight.

Katherine Murphy, director of the Patients Association, called for board members of Basildon and Thurrock University Hospitals NHS Foundation Trust to step down after the damning report found poor hygiene and standards of care.

Inspectors from the Care Quality Commission (CQC) found blood-splattered equipment, blood stains on floors and curtains and badly soiled mattresses in the A&E department with stains soaked through.

Equipment was being used repeatedly that should only be used once and resuscitation room equipment was past its use-by date.

Other items found at the trust included blood pressure cuffs stained with blood, suction machines contaminated with fluid inside and out and evidence of mould.

Yet in the same month as the CQC issued the trust with a warning over poor standards, it also gave it a glowing review.

Basildon and Thurrock was rated as "good" on quality of service in the CQC's 2008/09 assessment and marked "excellent" for its financial management.

The CQC gave the trust 13 out of 14 for cleanliness, seven out of eight for standards of care and five out of five for keeping the public healthy.

Ms Murphy said the hygiene problems and failure to provide basic care echoes other similar reports on other hospitals.

"How many times do the public need to keep hearing about this before the Government is embarrassed enough to do something about it?," she said.

"Will someone be held to account this time?

"Yet again the regulators' assessment of a hospital has proven to be farcical.

"It is nothing but a tick-box exercise that didn't reveal any of these problems."

She called on managers at the trust to resign.

"The board should most certainly resign - I would say the entire board.

"If there was one member of the board who had any concern, they should have been raising that over the past couple of years.

"There have been opportunities but nobody whistle blew on any of the issues that have been highlighted."

The CQC's inspector report, published earlier this month, detailed a series of concerns.

It said: "In the accident and emergency department we found dust on high and low surfaces, including curtain rails, vents and floors.

"Six out of 12 privacy curtains we checked were soiled, some with blood spatter.

"There was no clear system for replacing curtains; some were dated beyond the date of replacement and others had no date."

The report went on to describe other poor conditions: "Six procedure trays used by staff to carry equipment when they take blood samples or give injections had blood spatter on them, a commode was soiled under the seat, and several blood pressure cuffs were stained.

"In the accident and emergency department we saw a trolley mattress with a hole in the cover; we asked the nurses to check the mattress and it was found to be badly soiled and to have a foul odour.

"In all, 12 mattresses were checked by trust staff and 11 were stained through to the foam.

"We saw tubing that is for single-use only that was still attached to a ventilator after use.

"We saw other single-use items that were out of date in the accident and emergency store, including two endotracheal tubes with a use-by date of June 2005.

"In the clean stores we found a blood spattered procedure tray.

"Three blood pressure cuffs were stained, including a children's blood pressure cuff that was very heavily stained with blood."

The CQC has noted the trust's death rate in 2008 for all emergency admissions was 6.1%, above the national average of 4.4%.

The trust's own analysis also showed that between 18 and 20 patients per 1,000 had evidence of pressure sores, compared with a national average of 11 per 1,000 people.

The trust - which runs Basildon University Hospital and Orsett hospital - has foundation trust status, which is a supposed marker of excellence.

It has held the title since 2004 and has greater freedom to manage its finances.

A statement from Monitor tonight said it had used its formal powers of intervention to require the trust to take immediate action to deliver improvement.

Dr William Moyes, Monitor's executive chairman, said: "Monitor is intervening to ensure strong clinical leadership and the delivery of rapid improvement of services at the trust.

"This formal use of our powers is needed to quickly and effectively deliver the improvements in patient care which have been too slow to date.

"Our concerns about board effectiveness, together with the concerns that the CQC has raised about quality of care, mean that we are placing a requirement on the trust to take action with immediate effect to resolve these issues.

"While some progress has been made, the pace needs to accelerate in order to ensure the trust is in a position to provide the best possible care to patients.

"We will be reviewing the trust's performance regularly and in detail - if we don't see measurable results quickly, we'll take further action."

CQC chief executive Cynthia Bower said: "The trust has taken our concerns seriously but improvements are simply not happening fast enough.

"Our confidence in the management's ability to deliver on commitments and to turn the situation around has been severely dented."

In March, the CQC's predecessor, the Healthcare Commission, found appalling standards of care at Mid Staffordshire NHS Foundation Trust, which meant between 400 and 1,200 more people died than would have been expected in a three-year period.

Shadow health secretary Andrew Lansley said: "I am extremely disturbed by this news and the effect that these shocking conditions may have had on patients.

"It is unforgivable if any lives have been needlessly lost."

Liberal Democrat health spokesman, Norman Lamb, said: "People have a right to know how on earth a hospital can be rated 'good' a few weeks before such serious failings come to light."

Health Minister Mike O'Brien said: "Patient safety must be a top priority for the NHS and all patients deserve the highest quality of care.

"We expect these issues to be dealt with quickly and effectively to ensure high-quality, safe care for patients."

Trust chairman Michael Large said tonight: "That Monitor has found us to be in breach of our terms of authorisation as a Foundation Trust is an extremely serious matter and we do not seek to under-estimate its gravity.

"I want to reassure our local community that the safety and well-being of our patients is our highest priority.

"We welcome the fact that the regulator has recognised the progress we have made in reducing the Dr Foster measure of mortality.

"Monitor also acknowledge that we have an effective programme in place to make further improvements.

"We welcome the opportunity to work with advisers to specifically focus on the areas where we need to make rapid changes.

"The trust has a clear strategy for improving patient safety and sets ambitious improvement targets, reporting performance measures monthly.

"We understand that Monitor needs to assure itself and the public that the concerns that have led them to this intervention are not indicative of wider problems. I am confident they are not.

"We have had expert independent clinical advice and nothing has pointed to a fundamental problem with clinical care.

"But we are not complacent and this further scrutiny of our leadership and governance processes is another opportunity for us to prove ourselves."

Chief executive Alan Whittle said he was still confident the hospital would meet its improvement deadline of Monday.

"We are deeply disappointed that we were found wanting in three of the 15 measures covered by this inspection," he said.

"I am confident the actions we, and our cleaning contractor, are taking will return us to compliance by November 30.

"I am also grateful to the CQC for pointing out in its report that our infection rates have fallen year on year and are lower than the majority of similar trusts."

A trust spokeswoman said that on October 8, when the inspection took place, an emergency order for 30 new trolley mattresses was placed which ensured all were changed the following day.

Trolley mattresses in other departments were checked on October 8 and regular checks have been added to the inspection programme which previously only included those on beds.

The spokeswoman said all clinical equipment has been checked and cleaned where necessary and more stringent monitoring has been introduced.

Where possible, the trust is changing to disposable items.

An action plan has been agreed with the cleaning contractor which includes more high-level supervision and monitoring, extra cleaning staff, a complete replacement of all curtains and a planned cycle of renewal.

Staff are being reminded about maintaining hygiene standards and the trust held an infection prevention conference last month and relaunched the hand hygiene guide.

More than 50 specialist staff carry out hand cleaning training and monitoring in all wards and departments.

The A&E department, the focus of much of the CQC's concern, is to undergo phase two of a £22 million expansion and refit and a temporary children's A&E area opened within the existing department on Friday, staffed by registered children's nurses.

A rolling ward refurbishment programme began a year ago and two wards have each undergone a £500,000 complete refit.

An additional temporary ward is currently being constructed so the programme can be accelerated by allowing each ward to be relocated for three months while a refit takes place.

The trust spokeswoman said it had worked closely with Dr Foster, which compiled the mortality figures, its partner organisations and external clinical experts to discover the reasons behind the high level and to reduce it.

An independent review of the care provided to older patients carried out by Dr Ian Sturgess, consultant geriatrician and associate of the NHS Institute of Innovation and Improvement, found nothing pointing to a fundamental problem with clinical care, she said.

The figure fell 20 points from summer last year to this summer and in July and August this year the monthly standardised mortality figures were below the national average (95.1 and 92.8 respectively).

She said the hospital had employed more senior doctors and added that consultants were working extended days to increase cover during evenings and weekends to provide early assessment when a patient was admitted.

The nursing budget has been increased by £2 million.