Belfast Telegraph

Friday 19 December 2014

Five baby deaths probed in new Northern Ireland health service shock

Fears ongoing failings mean it’s just tip of iceberg

The Causeway Hospital in Coleraine
The Causeway Hospital in Coleraine

A probe into the deaths of five babies in the Northern Health Trust has led to concerns over how many more questionable deaths across Northern Ireland will emerge.

In another crisis to hit the troubled health service it emerged the deaths of the five babies were among 11 cases currently being probed.

Health Minister Edwin Poots told the Assembly healthcare failures linked to 11 deaths within the trust area were not properly acted on.

Mr Poots said he had been made aware of 20 cases in which the trust's response was said to be “below standard”.

There was evidence to show that there were delays in eight of the cases being reported as “serious adverse incidents”.

Mr Poots said it was not clear whether the deaths between 2008 and 2013 were avoidable, but he said the trust's response should have been better.

He said this was especially true where cases were not identified as “serious adverse incidents”.

A serious adverse incident is any event or circumstance that led or could have led to serious unintended or unexpected harm, loss or damage.

This includes whether a patient has died in unusual circumstances.

It is understood the five babies were either born prematurely or were less than a month old.

And it is further understood that at least one of the 11 deaths was linked to a delay in diagnosis in an emergency department.

The minister said the cases had been identified in radiology, obstetrics and gynaecology, and accident and emergency.

The trust has publicly apologised to the families affected. In a statement it said it had “failed to learn from incidents”.

In the statement, the trust said: “To those people affected, we apologise.

“We have identified 20 separate incidents over a five-year period where the response by the trust was below standard.

“We have advised the department and welcome the minister's statement and his continued support.”

The statement added: “The trust, over the past year, has doubled the number of serious adverse incidents reported. While this does not represent a deterioration in care offered, it does represent a change in the culture of the organisation and a desire to learn from our mistakes.”

The SDLP’s health spokesman Fearghal McKinney said legitimate questions now must be asked about how many more deaths were failed to be reported as serious adverse incidents.

”The fundamental issue is that learning mechanisms within our hospitals are not being adhered to. If the problems are not being reported then they are not being learned from,” he said.

“If they are not being adhered to in the Northern Trust, then we must ask if the same is happening elsewhere?”

The trust is also completing a review of about 35,000 X-rays taken at the Causeway Hospital, Coleraine, Co Derry, between 2011 and 2012. Nine patients have been recalled.

That review is now being extended across the entire health trust, involving 48,000 |X-rays.

Mr Poots said the cases were discovered by a “turnaround team” he sent to the trust.

“I wasn't happy with the Northern Trust, I wasn't happy with the way things were being done there, and that's why I put a turnaround team in,” he said.

The performance of the trust has been under intense scrutiny in recent years and in 2012 Mr Poots ordered the ‘turnaround team’ from England to start working alongside management to raise standards.

Concerns over serious adverse incidents have not been confined to the Northern Trust, and last month bosses in the Belfast Trust were heavily criticised after it emerged that waiting times and staff shortages were contributory factors in the deaths of five patients in the Royal Victoria Hospital's A&E last year.

In February the Health Minister said his department would review serious adverse incidents in Northern Ireland's hospitals from the years before 2013.

It follows news that the five patients at the Royal Victoria Hospital's A&E may have died in 2013 partly because they were not treated quickly enough.

What is a serious adverse incident?

A serious adverse incident is any event or circumstance that led or could have led to serious unintended or unexpected harm, loss or damage.

This includes whether a patient has died under unusual |circumstances.

This may be because:

  • It involves a large number of patients.
  • There is a question of poor clinical or management judgment.
  • A service or piece of equipment has failed.
  • A patient has died under unusual circumstances; or there is a possibility or perception that any of these may have occurred.
  • It is serious enough to warrant regional action to improve safety or care within the broader HSC.
  • It is of public concern.
  • It requires an independent review.

A legal 'duty of candour' essential to improve transparency, says Allister

The launch of a probe into the deaths of five babies at the Northern Health Trust has led to calls for a 'duty of candour' to be introduced in Northern Ireland to improve transparency within the health service.

Patients' groups have also called for the trust to disclose to the families and patients affected all the information it has about the cases "as soon as possible".

TUV leader Jim Allister said a statutory duty of candour would improve openness in Northern Ireland's health service.

Westminster Health Minister Jeremy Hunt announced this week that a legal duty of candour will be adopted by the NHS in England and Wales.

Healthcare organisations will have to be open and honest with patients and families when significant harm has been caused.

Mr Allister said: "While I appreciate the detail provided, I was disappointed that the trust was not prepared to reveal in how many of the cases there had been late reporting to the coroner and affected families.

"I'm not looking for a witch-hunt of staff, but I do feel the public are entitled to basic information."

Mr Allister added: "Only a statutory duty of candour will provide for an enforceable system of timely reporting of serious adverse incidents.

"Without it we will continue to encounter statements and belated revelations."

Assembly health committee chairwoman, Sinn Fein's Maeve McLaughlin, said the news of the cases was "quite alarming".

"I think there are very serious questions (to answer)," she said.

Maeve Hully, chief executive, Patient and Client Council, said the investigation will lead to worry for thousands of people.

"This is very worrying time for everyone who uses health and social care particularly, those patients and families who are involved.

"People have already told us that they are concerned about the quality of care being provided especially in emergency departments.

"While the service is making an effort to be more open and honest with patients about the care they receive there needs to be a recognition about how worrying this information will be," she said.

Ms Hully added: "The Northern Trust needs to disclose to the families and patients all the information they have about this very troubling situation as soon as possible and appropriate support should be offered to them."

Alliance's Kieran McCarthy MLA, who also sits on the Stormont health committee, said the news of the probe was "shocking".

Years of A&E crises come to a head

Antrim Area

2010: Casualty departments at Mid Ulster and Whiteabbey hospitals close, putting the A&E at Antrim Area under strain. The hospital, built to cater for 30,000 admissions a year, was reportedly treating upwards of 72,000 patients.

2011: A damning indictment from Dr Brian Patterson, the former chairman of the British Medical Association in Northern Ireland, was made after it emerged 2,426 patients sustained 12-hour waits in the A&E in a 12-month period.

May 2012: Further concerns of staff being unable to cope emerged during an outbreak of gastroenteritis at Antrim Area.

May 2012: Two reports criticised practices at Antrim Area.

July 2012: The Northern Health Trust admitted it failed a cancer patient after an X-ray showing a lesion on his lung was left for nine months.

December 2012: Northern Health Trust chairman Jim Stewart was sacked by minister Edwin Poots. A ‘turnaround and support team’ is appointed to help address problems.

February 2013: Figures showed the A&E department was still failing to hit waiting time targets for emergency treatment.

April 2013: An investigation launched into a child’s death.

May 2013: Northern Trust chief executive Sean Donaghy axed as chief executive after months of speculation.

June 2013: A new £9.2m A&E department opened at Antrim Area Hospital.

Stop the gobbledegook, Mr Poots, we've had enough

Analysis By Liam Clarke

Ever since the entirely preventable outbreak of water-borne pseudomonas infection in our neonatal units in December 2011 there has been one scandal in the health service after another.

On that occasion we didn't hear about the dead babies until much later, although the health service had been told about the risks of dirty taps for months.

Take yesterday's written statement from Edwin Poots, the Health Minister, on the Northern Trust. It takes him more than 1,000 words about the progress of the "turnaround" in the ailing Northern Trust's fortunes before we get to the main shocking point.

Eleven people have died, five of them babies, in instances where the "response of the trust was below standard" and there is going to be an investigation to see if the "below standard response" could be related to the deaths.

We then have masses of statistics about "interactions" between staff and patients, employee numbers and hospital appointments before we reach the minister's conclusion: "What we are seeing is the outworking of the turnaround in the Northern Trust and that the necessary transformation of values and behaviour is well under way."

The minister may be referring to the fact that the trust has coughed up the ugly truth to him in a spirit of transparency.

That would be a good thing, but using the term "outworking of a turnaround" in a situation which involved the suspicious death of children has an ugly Orwellian ring to it.

In George Orwell's novel 1984 he invents a language called "newspeak" used by government to massage information.

"Doublethink", for example, was the ability to hold two contrasting points of view at once, and many will feel terms like "outworking of turnaround" is a modern example of this.

When Mr Poots took over the ministry he articulated a new vision in Transforming Your Care (TYC) which was widely admired. It spoke of "shifting resource from hospitals to enable investment in community health and social care services".

The old and the disabled would be given high quality care in their own homes. Well Being Centres and local clinics, based on best practice in Cuba or Norway, would deal with most injuries, allowing A&Es to focus on acute conditions.

The shift of resources away from hospitals is clear enough.

Figures unearthed by Jim Allister of the TUV show that the number of hospital beds has fallen by 16% since 2007, a total cut of 1,199. The A&E departments in Lagan Valley and Downe hospitals have been closed at weekends and staff shortages are widespread.

The compensating changes haven't followed.

"Services will regard home as the hub and be enabled to ensure people can be cared for at home," TYC promised, but instead care teams are having their hours reduced.

The local clinics have not been created in sufficient numbers to take the slack from hospital emergency departments.

Trainee doctors seek better working conditions in Australia at a rate of 50 a year and minor surges in demand require emergency plans. It is not all Mr Poots' fault. He inherited problems when he took over from the UUP's Michael McGimpsey in 2011. Some of the recently disclosed Northern Trust deaths go back as far as 2008, though the latest was last year.

Yet, it must be remembered that Mr Poots ridiculed Mr McGimpsey's pleas for more funds and warnings of an impending resource crisis. Mr Poots also promised to turn the situation around, and instead devoted much of his energy to issues like the banning of gay blood donations and failed attempts to bring in more restrictive abortion regulations.

Peter Robinson, his party leader, had originally intended to replace Mr Poots with Jim Wells this year. Instead, he has extended Mr Poots' time in the ministry to allow him to complete the promised turnaround of services.

But Mr Poots needs more than time to bring our health service up to scratch, as he promised.

He needs increased resources, and perhaps he needs, like Mr McGimpsey before him, to spell out clearly what is required and what the consequences will be if he doesn't get it.

It is time to stop trying to put a brave face on crisis.

It is time to end the doublespeak.

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