“Appalling” emergency care at the Staffordshire NHS Foundation Trust could have led to hundreds of unnecessary patient deaths, a report by the Healthcare Commission has found.

Deficiencies at “virtually every stage” in the care of people admitted as emergencies were revealed by the report, which slammed the hospital for “low staffing levels, inadequate nursing, lack of equipment, lack of leadership, poor training and ineffective systems for identifying when things went wrong”.

The Commission launched its investigation in March last year following growing concerns from patients over the standard of care at the hospital and a particularly high death rate in emergency cases, with 400 more patients deaths at the hospital than what is considered ‘normal’ during the timeframe.

Its review has uncovered a shocking series of problems that put patients “at serious risk” and “undoubtedly resulted in poor outcomes”, the NHS watchdog said. “This is a story of appalling standards of care and chaotic systems for looking after patients,” commented Sir Ian Kennedy, the Commission's Chairman. “There were inadequacies at almost every stage in the care of emergency patients [and] there is no doubt that patients will have suffered and some of them will have died as a result”.

Problems seemed to start as soon as patients walked through the A&E doors, as the priority of cases was assessed by receptionists who had no medical training. This led to a patient with an open fracture of the elbow having to wait covered in blood for more than four hours with no pain relief, the report said, citing an example of poor care.

It also found that staffing levels were too low to be able to provide the necessary calibre of patient care expected in the National Health Service, with too few consultants on call, a lack of supervision of junior doctors, and not enough nurses to provide adequate care.

Drinking from vases
One relative of a previous patient told the BBC News that the lack of basic nursing care drove patients to drink out of vases and eat with their fingers, and the report cites other relatives as claiming patients were left for hours in wet or soiled sheets, which put them at greater risk of infection. In fact, rates of the potentially serious diarrohea bug Clostridium difficile doubled in the early months of 2006, highlighting stark failings by the hospital in infection prevention and control.

Worryingly, some nurses had not been trained to read cardiac monitors and these were sometimes turned off, the Commission found, while some patients were given the wrong medication and others were not given correct amounts of intravenous fluid as nurses did not know how to use IV pumps properly.

And adding to the catalogue of errors, essential equipment was not always available or working properly, there was often no experienced surgeon in the hospital at night, and delays in operations were “commonplace”.

Furthermore, the report criticised the trust for not having an effective system in place for monitoring patient outcomes and failing to identify the cause of the higher death rates in patients needing emergency care.

The Commission’s analysis of the trust's board meetings between April 2005 and 2008 found that discussions “were dominated by finance, targets and achieving foundation trust status”, and it seems that poor standards of care were not addressed during this time.

It was also revealed that, in 2006/07, the trust set a tough target of saving £10 million - or 8% of turnover - in its drive to attain coveted Foundation Trust status, but as a result shed 150 posts when levels staff were already on the thin side.

Sacrificing patient care
The trust, which achieved FT status last year before the investigation was formally launched, has now come under increasing fire for sacrificing patient care while trying to hit government goals. “Government targets have directly impaired safe clinical practice and money and greed for FT benefits has taken priority over patient’s lives,” said Director of the Patients Association Katherine Murphy.

But, while “sincerely” apologising for the past mistakes, chief executive Eric Morton insists that the trust has made significant progress in a relatively short time, with new management in place as well as “effective governance structures and made operational system changes” to address key issues such as accountability, staffing levels and staff training.

More than £750,000 has been sunk into A&E services so patients in Stafford “now have access to triage for more hours of the day and access to more senior specialist consultants than in most other hospitals,” he said, and added that proper systems have now been put in place for recording admissions, diagnoses, treatments and outcomes for patients.

“This has clarified areas of concern investigated by the Healthcare Commission and shows that currently our mortality rate is 11% lower than the standardised mortality rate of NHS hospitals”, Morton stressed. But despite the recent improvements the regulator has promised to keep “a close watch” on the trust over the coming months to ensure that this progress is continued.

On the back of the investigation’s findings, Health Secretary Alan Johnson has launched an inquiry into the hospital’s operation during the five years between 2002-07, but was quick to blame “poor, abysmal management” instead of government targets as the reason for the shocking failure, reports BBC News Online.

However, Dr Jonathan Fielden, Chairman of the British Medical Association’s Consultants’ Committee, said it is “essential that top-down targets do not get in the way of good clinical leadership”. Doctors and senior healthcare workers should be allowed to improve the whole patient journey “not just the apparent bottlenecks”, he said, adding: “Targets need to be flexible and must not interfere with clinical priorities”.

And Shadow Health Secretary Andrew Lansley also criticised the prioritisation of targets over patient care. “It is unacceptable that the pursuit of targets – not the safety of patients – was repeatedly prioritised, alongside endless managerial change and a ‘closed’ culture, which failed to admit and deal with things going wrong,” he said.

He called on the government to use data on heath outcomes to “actively investigate where results are poor, and to provide health staff with the training and equipment they need”.