Stafford Hospital: what the Royal College of Nursing saw.

The thing that you keep finding with the Stafford Hospital story is that there are so many things that don’t quite fit.

The press have their simple story of a uniquely bad hospital where hundreds of people are dying of poor care, and then right in the middle of the healthcare commission investigation you get this letter from the CEO of the Royal College of nursing talking in glowing terms about his visit to the hospital, and the great work that is happening there. This was a letter that in the words of the inquiry caused the pressure group to "take umbrage." It is perhaps characteristic of an inward looking group, which has been successful in commanding the attention of the press, that they assumed that Peter Carter must know all about them and was deliberately contradicting their story. The fact was that he is a busy man, he knew nothing about them at this stage and he was merely reporting the very positive visit he had to the hospital.

The Royal College of nursing is of great importance to the Stafford Hospital story, because this is the body that represents the nurses. Poor nursing care is central to the stories that the media has to tell on Stafford Hospital, and to other hospitals highlighted by the recent ombudsman’s report.  The Evidence of Peter Carter, CEO of the RCN gives us a lot of highly useful information Full transcript.

There is a useful snippet if personal information about Peter Carter. He says of himself:

"I've built my reputation on calling it as I see it. And I certainly wouldn't have been used as an instrument to do someone else's bidding". He also tells us of the highly relevant subject of his thesis completed 1998 “was on why nurses abuse patients”

The royal college has a dual role. It is the body which advises on the professional standards of the nursing profession and it is also a union for nursing staff.

Peter Carter has a responsibility for the entire RCN. Funded by membership subscriptions there is a staff of 300 staff at head office; they take care of its 416,000 nursing staff in hospitals, and care homes. As someone with such a huge organisation it is clear that he has to rely on the information that is filtered up to him.

It was clear that in the case of Stafford he was heard nothing. This is not unusual. He would only hear about concerns in a particular hospital in exceptional circumstances.

Sue Adams is one of the RCN’s Stewards at Stafford, Her personal experience is of staff who were under pressure, but were coping, and that she received no information of any serious concerns about patient care. She also says that because she had to fit her union duties in on a voluntary basis around her own heavy workload, that she was in no position to go hunting for problems. It is clear that her superior in the union was also coping with a heavy workload, and was seen by some of the staff as too close to management to be an obvious channel for complaints about workload.

If we look beyond Stafford, the RCN carried out research that correlates staff mix – the ratio of Qualified to unqualified staff, to quality of care.  It is clear that if this falls below a certain level then there is a strong likelihood that patient care may suffer.

Sue Adams own evidence also shows in a pretty clear way what happens when the ratio of patient to staff levels is badly balanced

 I was absolutely aware of the staff shortages and the lack of qualified staff on duty in some areas that had been reported to me. But I can honestly say that none of the staff were saying that the nursing care was not being given.

You've already described how nurses would come and speak to you about concerns they had, and indeed you say in your statement that, at times, your members had burning issues that they wanted to discuss with you, but not about failings in nursing care.

They felt that they were trying to give the best care they could with the numbers that they had, but weren't able -- weren't able to deliver the care that they knew the patients wanted, needed and deserved. With the best will in the world, if there were three nurses on duty and five people buzz for a commode and each patient needs two nurses to get them out on to the commode, they can only help one patient at a time, and by the time they get to patient 5, that patient hasn't had the care that they need and may well have been incontinent

Sue said that there were real concerns about the staffing levels and staffing mix and that she actively encouraged staff to put in incident forms whenever they felt the staffing levels were wrong. This may possibly explain the persistent stories of someone having seen complaints forms in a bin. This was mentioned in Sue Adams evidence, but the details of this are not clear. Maybe we will eventually hear the full facts of this, but then again maybe we will not. There is nothing certain about it.

Robert Francis has clearly understood the crucial question of staffing levels and mix and asked good questions about who should be responsible for stipulating staff and staff mix levels. Peter Carter was very clear that this is something that it is completely inappropriate to leave to local discretion – it has to come from Government and it needs to be enforced by the Care Quality Commission. This is a message that needs to get through to this government as it directly contradicts the direction of the health bill proposals.

Well, first of all, Mr Francis, I actually think it should start at government level. I think it's wholly unacceptable that this is left to local employers. So, first of all, from the top there should be a compulsion on people to do impact assessments and to be clear about what their staffing is. But I would also put this into the remit of the Care Quality Commission. And I think that with their inspections and visits, they should have a real focus on staffing levels and they should be tasked to take employers to task on this.

Peter Carter was asked in some detail about his visit to Stafford and the letter that he wrote to the press which gave such offence to the pressure group. he had been shown a series of presentations on different wards which included work they were doing on infection control, and monitoring pressure sores  He also did what he habitually does on such visits and had a private discussion with several groups of patients.

Here are some of the exchanges about that visit.

When I go on visits I always obviously talk directly to nurses and other staff, but one of the things I always ask to do, and it's never denied to me, is I ask to  speak to patients, and I think that's really important. And how I do this, I've got a kind of tried and tested way of doing it, is I put it to the -- the people that are escorting me around "Well, look, I want to ask patients at first-hand what they feel about their care, but it's going to be pretty intimidating if there's a small entourage with me". You know, you can hardly say to a patient "How do you feel about the nursing care?" if there are four or five nurses around. So what I do is I tend to go into, say, a four-bedded dormitory by myself and I simply say "Look, I'm Peter Carter from the Royal College of Nursing, I'm fishing here today, do you mind if I ask you about your care?" I do it in the a very low-level way. I've never been refused and people -- people talk.And at my visit to Mid Staffs, all of the people  that I spoke with, could not have been more fulsome in their praise. I mean, look, I had -- I didn't know any of the people at Mid Staffs. There's no pre-existing allegiances. I mean, had people been saying to me "I'm  glad someone's asking me, you know, I've got some real concerns about what's going on", I would have raised it with Helen Moss, I would have said -- but it was -- it was entirely the opposite. Really, really glowing  tributes about what people were saying on the wards that I visited.

He explains this apparent contradiction in a simple way – A hospital is made up of a series of microclimates. Individuals matter. A gifted sister can make a great difference. Some wards will run well, others not so well. This does give us a clear picture that at the time when the HCC investigation was in full swing there were certainly some areas of the hospital (it could of course be argued that he was only shown the good bits) where things were not merely adequate, but very good.

I'm astonished that -- I mean, I consider myself experienced. I'm astonished that you could go and visit a few wards and get such a really good feel-good factor, to then subsequently know that in part -- and we've -- we've got to be clear, it's parts of the hospital. The Healthcare Commission's inquiry was not into Mid Staffs per se. It was into the A&E, the medical wards and some other aspects of care. And it's not uncommon, and I've used it my statement, that hospitals are a series of microclimates. You can go to one ward with an excellent ward sister that's well managed and it's everything that you could wish. You can go to another ward and the care can be very poor. And that, I think, is what confuses people. All I'm saying is I called it straight and what I saw it felt really good.

He later returned to the hospital before the issue of the HCC report and held an open forum attended by 92 staff. Staff at this forum told him of their appreciation of his letter

Look, we feel the whole hospital has been traduced here and yet many of us provide excellent nursing care". And in fact some of them were appreciative of my letters because they felt that reflected the truth.

But also the staff were also more open about the problems they were experiencing in other areas. I mentioned the open forum that I had, the word "Beirut"(which has become a part of the mythology of the Stafford hospital Story) in relation to EAU was mentioned then.

When the Healthcare commission report and the press frenzy that accompanied it came out this came as a great shock to Mr Carter, as it did not accord with his experience, and he had certainly not had any indication of the level of problems raised by the report through the RCN channels.

There was an exploration of the reasons why he had not heard anything. This is the central question that the Inquiry is trying to ask, and it always does come down to a complex mix of reasons. It is from the evidence of an increasing number of the witnesses pretty clear that if there were problems they were not at all obvious even to those who were working in the hospital. There is still no sense at all that anyone one understands the scale. Are we looking at a handful of individuals in a few wards, or were the problems more widespread?
The inquiry explores this further – which is right – because if the indications are not coming from the nurses who are there giving the day to day care, then where are they going to come from.

“ I think you're critical, I think, of Monitor and the PCT and other agencies for  not spotting what was going on. But, of course, if your  members aren't coming forward to you, if there's a general culture of people not being open about what's  going on, it's very difficult for anybody to find out, isn't it?

I genuinely believe the vast majority of the nurses at  Mid Staffs were nothing other than decent people, it is fair to say that, for a whole collection of reasons, which I'm happy to explore with you, people were not more open about the deficiencies in care. Now, I've already given one explanation is that people felt, well, if you're cutting 150 jobs, there was a heads down mentality, and there's also evidence that a lot of good nurses decided to leave

Robert Francis askes about Whistle blowing. Does it work?

Yes, Mr Francis. Look, I think there's a huge problem with this. I mean, first of all, I'm sure you and your colleagues will be aware of this that sometimes ministers think that in Whitehall you have a piece of legislation and it solves the problem. And in my experience that's rarely the case.

A particular issue that Peter Carter raised which I feel has a crucial bearing on the future of the quality of care is the matter of Nursing care assistants. I think it is clear that he believes we are looking at care being delivered by under regulated, untrained and un-unionised workers. He finds that a matter of concern, and so do I.

 

For the record, I think it's important to clarify, the RCN has 416,000 members, only 8,000 are healthcare assistants. So healthcare assistants are a tiny part of the membership. I just thought that was right for the record. The problem is the vast majority of healthcare assistants are not in any organisation at all. They'd be very welcome to join the RCN. In addition to that, the RCN is currently lobbying that we think healthcare assistants should be properly regulated and they should be trained. If I may go on  just to add, you have -- have a phenomena at the moment -- and by the way, through -- across all sectors, both care homes, residential homes and hospitals, there are nearly half a million healthcare assistants. So it's a huge component of the workforce. And the problem at the moment is in the absence of any mandatory training, it's left to local employers. Now, there are some trusts that do it really well. They employ people, they induct them, they train them and teach them all of the skills that are needed. Sadly, at the at the other end of the spectrum, we've come across instances where people have no training at all. They're literally given a tunic, it looks like a nurse's uniform. They're put on wards and they pick it up as they go along. Now, we say that's wholly unacceptable.

Mr Carter was asked about some aspects of the HCC report.

He makes it clear that he has no knowledge of the mortality statistics which he sees as the responsibility of the trust, the PCT and the SHA.

Perhaps because of this gap in his specific knowledge he accepts what he has heard about the HCC report without question.
But there are issues raised in the HCC report that did really upset him, as they did anyone who was concerned about the provision of good health care.

Receptionists were triaging patients in A&E, patients being left in excrement, nurses in the cardiac unit had not had the cardiac sciences training and so were turning off the cardiac monitors, intravenous infusions were not running properly.

All these are real and serious concerns. All have been dealt with. What neither the HCC report or any of the subsequent reports have really told us is the extent of the problem.

What I feel from reading Peter Carter’s evidence is that he has got to the heart of the matter. The hospital is not a single entity, it is a series of microclimates which are all behaving in their own unique way. There is nothing contradictory in saying that there was very good practice side by side with very poor practice.

I believe there is also a fundamental message here. Care in the end is delivered by individuals. If we want good care we have to look after the people who are delivering it in the right way. Competition and driving down costs is very unlikely to deliver the quality of care that we would like to see, and we have to encourage staff to find their voice and know that they can and should speak out strongly when things are not as they should be.

There is also a message with regard to the role of the press. The press have been too concerned to deliver a simple coherent story. They would be serving us better by showing the facts in their full complexity. Good and bad co-exist. If the wellbeing of the staff is central to the quality of care that is delivered then what has been perceived as a prolonged and unbalanced press campaign to vilify the staff is counterproductive.

Richard Peppiatt's Resignation from the Daily Star

Late yesterday afternoon, the Guardian reported a remarkable resignation here. A journalist working at the Star newspaper wrote an angry and scathing letter, here , to Richard Desmond, owner of the Daily Star, giving the reasons for his leaving what must have appeared secure employment with the paper.

The journalist, Richard Peppiatt,admitted in his letter that he had been guilty of submitting stories about celebrities which were untrue and concocting others which had no basis in fact whatsoever. 

Kelly Brook, often the subject of articles in the Daily Star, once asked where the stories came from. Peppiatt in his missive to Desmond says:

"Maybe I should answer that one. I made it up. Not that it was my choice; I was told to. At 6pm and staring at a blank page I simply plucked it from my arse. Not that it was all bad. I pocketed a £150 bonus. You may have read some of my other earth-shattering exclusives."

To many of us , this admission is remarkable. 

We may have suspected the dearth of veracity in some of the articles we read in such papers, but to have our suspicions confirmed in such a powerful way in Peppiatt's letter leaves us sighing 'At Last! One of them has held up his hands and told the truth!'

What seems to have been the straw which broke Peppiatt's journalistic back was his being 'forced' to write articles denigrating Muslims and aimed at a faction of the public only too willing to believe the worst of this group in our society. He writes in his letter to Desmond:

"The decision came inside my local newsstand, whilst picking up the morning papers. As I chatted with Mohammed, the Muslim owner, his blinking eyes settled on my pile of print, and then, slowly, rose to meet my face.

"English Defence League to become a political party" growled out from the countertop.

Squirming, I abandoned the change in my pocket and flung a note in his direction, the clatter of the till a welcome relief from the silence that had engulfed us. I slunk off toward the tube.

If he was hurt that my 25p had funded such hate-mongering, he'd be rightly appalled that I'd sat in the war cabinet itself as this incendiary tale was twisted and bent to fit an agenda seemingly decided before the EDL's leader Tommy Robinson had even been interviewed.

Asked if his group were to become a political party I was told the ex-BNP goon had replied: "Not for now."

But further up the newsprint chain it appears a story, too good to allow the mere spectre of reality to restrain, was spotted. It almost never came to this. I nearly walked out last summer when the Daily Star got all flushed about taxpayer-funded Muslim-only loos.

A newsworthy tale were said toilets Muslim-only. Or taxpayer-funded. Undeterred by the nuisance of truth, we omitted a few facts, plucked a couple of quotes, and suddenly anyone would think a Rochdale shopping centre had hired Osama Bin Laden to stand by the taps, handing out paper towels.

I was personally tasked with writing a gloating follow-up declaring our postmodern victory in "blocking" the non-existent Islamic cisterns of evil."

Many of us interested in daily news outlets had been aware for some time that the mood and direction of the Daily Star had (not so subtly) changed and that the Editor or Desmond himself had decided to throw their support behind the EDL and redouble efforts to stir up public antipathy against Muslims. 
As Peppiatt himself states:

"Our caustic "us and them" narrative needs nailing home every day or two, and when asked to wield the hammer I was too scared for my career, and my bank account, to refuse."

Is this not what many of us had suspected all along? 

To be so overtly supportive of such a movement is unusual for a British daily, and it will be interesting to see whether the stance of the paper changes now with Peppiatt's revelations.

The Guardian also prints a reply from the Daily Star:

"Richard Peppiatt worked purely as a casual reporter at the Daily Star for almost two years. Recently he became unhappy after he was passed over for several staff positions. He refers to a Kelly Brook story: in fact, he approached and offered the newspaper that story, vouched for its accuracy, and then asked for and received an extra freelance fee for doing so. Since he wrote his email we have discovered that he was privately warned very recently by senior reporters on the paper after suggesting he would make up quotes. Regarding the allegations over the paper's coverage of Islam, he was only ever involved in a very minor way with such articles, and never voiced either privately or officially any disquiet over the tone of the coverage. For the record, the Daily Star editorial policy does not hold any negativity towards Islam and the paper has never, and does not endorse, the EDL."

Is this a suggestion that the revelations in Peppiatt's letter of resignation are simply bitter vitriolic outpourings from what is a 'rogue reporter'?

Where have we heard that before, News of the World?

In an ideal world, Peppiatt would be the first of many journalists grafting for these papers to come to their senses and rediscover the ethos and principles they must have had when rookies. They owe it to the rest of us.


Healthy democratic choice in any country is completely dependent on the truth. Facts must be presented honestly to the public for an informed choice to be made. 

Update March 9th:

As well as new links to this story under the 'Journalists' tab on this blog, I have come across this recent podcast which adds more detail in an interview with Sean Ellis.

"Ex Daily Star journo Rich Peppiatt" speaks to the Pod Delusion: here 

 A podcast in which he offers further, more detailed reasons for the tone of his resignation letter. 

A fascinating insight, perhaps, into the way papers like the Daily Star operate.... 

Rosie Robertson

So, Cameron has been told to rein in his special advisers or 'spads' as they are known...

The cabinet secretary, Sir Gus O'Donnell, has written to Cameron asking him to rein in government spin doctors, saying that some have behaved "unacceptably" - read the article from The Guardian http://is.gd/L2a7Go. 

It turns out that one of Pickles' Special Advisers has been criticising Jenny Watson, who is Chair of the Electoral Commission and sits on the board of the Audit Commission.  Unacceptable remarks were made about her, which I shall not replicate, during a briefing.   The remarks, which are in the Guardian article linked to above, came to the notice of Sir Christopher Kelly who condemned the language.  The remarks first came to light in The Times last September.

It has become clear that there was mounting concern about the behaviour and language of some Govt special advisers. Gus O'Donnell raised the matter with Cameron asking him to rein in the spads. It was expected that Cameron would have words with those concerned, but it appears that no such action was taken.  Basically, whoever made defamatory, arrogant remarks about Jenny Watson got away with it.

PR Week, under the Freedom of Information Act, requested letters, emails or faxes sent by Gus O'Donnell to Cameron or Edward Llewellyn last autumn regarding the status, role or conduct of special advisers. The Govt response was to deny information, including any of the correspondence in question stating, I gather, that this would be considered to be personal data and would contravene a data protection principle. However, the official from the Cabinet Office replied  ‘I can confirm the Cabinet Office holds some information relating to your request on the role, status or conduct of government special advisers.’. The official ignored and/or refused repeated requests to provide a redacted version of the correspondence. This week the official said "We are still considering your request".

In response to a separate Freedom of Information request,No 10 said it had no records of any meetings between Cameron's and Pickles’special advisers to discuss the issue of the said behaviour.  But Ministers recently admitted that no-one has been disciplined in this matter.

Caroline Flint, Shadow LG & Communities Minister, wrote to the Minister, Eric Pickles, asking him to confirm whether he'd taken legal advice on this matter and if so how much that advice had cost the taxpayer. She also asked if he knew the identity of the adviser who made the comments. (It is alleged that the comments were made by one of Mr Pickles two special advisers, Sheridan Westlake or Giles Kenningham, who receive an annual salary of  between £52,000  and £69,000. They are on the civil service paylist I gather.)  Eric Pickles replied that it was a “long-standing” position of the department not to disclose the nature of legal advice and in some circumstances even to acknowledge “whether or not we have sought and received such advice”.
“I am unable to say whether or not such advice has been sought or given in this case,” he said.

Well, that's very interesting.  If that is the case, what's all this fuss about the tory-led govt being transparent about public spending ?  This is what Eric Pickles said about government transparency “The sunlight of openness may be uncomfortable for some, but it will expose how taxpayers’ money is being wasted,”  Feeling the discomfort Eric ?

So that's the background.  What now for Jenny Watson...  Won't these remarks be damaging to this woman's career not to mention her emotional state...  The following rule was ignored "Special advisers should conduct themselves with integrity and honesty."  Arrogance,  rudness and intimidation replaced integrity in this case. I wonder if she's taking them to the cleaners...

And after all the criticism from the tories, one question I'd like to ask is "How many government special advisers are there now...?"  More, or less than before May 2010 ?

Murdoch may have offered to let SkyNews go... so that's all right then... ?

As I suggested yesterday morning, it appears that Jeremy Hunt, Minister for Media etc., is going to announce on Thursday that Murdoch is to take full ownership of BSkyB.  Doubtless the announcement will be couched in the usual reverential, authoritative tones that might lead one to suspect that there couldn't possibly be something amiss... I gather that Murdoch will be casting Sky News aside...  so that's all right then ?  However, I've scribed often enough about Coulson, Murdoch and their cronies.  I think we knew the inevitable would happen despite many many serious attempts to stop Murdoch going one step further in gaining a stronger hold on the media in this country.  Many people and organisations have tried to fight him off including Tom Watson MP and Chris Bryant MP who have certainly asked for clarification and raised issues.  John Grogan, former MP, was I believe the first to raise the issue about Murdoch's influence.

The tory-led govt appeared to have decided that Ofcom's opinions were not worthy so it was hardly going to listen to Ofcom's opinion on Murdoch's desire to acquire BSkyB.  As well as Ofcom, other organisations are about to fold up eg The UK Film Council that funded The King's Speech - winner of several Oscars !  It appears that organisations that are able to provide a fair independent judgement or can enable great things to happen are about to cease...  unfair and mistaken ?

One article by Stephen Glover in The Independent recently gave me much food for thought http://is.gd/yf7QbK It starts by explaining the happenings surrounding Vince Cable's interview by two journalists posing as constituents.  The Telegraph printed the story.  But further revelations transpired when the earnest and individualistic Robert Peston wrote on his BBC blog that Cable had also said to them that 'he had "declared war" on Rupert Murdoch by referring his offer to buy out BSkyB to Ofcom'.

Yes, The Telegraph was embarrassed for several possible reasons referred to in the article. And what happened later appears to have been almost as big as what Cable had said about Murdoch's desired acquisition..  An investigative firm was brought into the newspaper to get to the bottom of who leaked the information to Robert Peston.  But Stephen Glover wrote something in that article that really stood out
''One can only conclude that very senior members of the newspaper's management were deeply embarrassed by Mr Peston's scoop. The culprit must be made to pay. My advice, not that they will take it, would be to cool it. This is only journalism, after all. The security of the State is not at stake. And there is no point in expecting journalists to behave with the sense of honour and discipline of the old Prussian officer class".  This is only journalism after all !

Those six words made me feel very uncomfortable. In effect they mean 'It's only a story...'   Stories have wrecked lives whether there is truth in them or not !  We see and hear time and time again, people being asked if there is any truth in what an article may have said about them, a close friend or member of their family.  And how often do we hear actors, singers, politicians say that they've given up reading what the newspapers say about them as it's invariably lies and that they don't even recognise themselves as the person named in the article?  How much truth is there in our newspapers ?   Graphic and very sad examples of how newspapers can influence people's lives by inaccuracy or exaggeration can be found in some of Diana Smith's articles on this blog. And how the information contained therein can be taken as gospel... and exalted!


Are we comfortable in how information is gathered for stories that appear in some of our newspapers ? We have learned that journalists pose as others to gain information... isn't that deception? We have certainly learned that journalists hack people's phones to gather information... isn't that illegal ?  We know too that information is sometimes leaked...  for what purpose... justice or payment ?   What else does it take to fill a column and sell a newspaper ?

Without doubt there is much serious journalism and we would be sorry to lose that aspect.  Pity then that more and more people are saying 'You can't believe what you read in the papers...'  Maybe less bias, solatiousness, exaggeration and inaccuracy might bring more rewards... and respect !

MagsW

Stafford Hospital - Some reflections on the coroners tale

The first time that I saw something approaching a crowd of both public and press at the Stafford Hospital Inquiry was for the coroner’s evidence. It was clear that this would be a significant day.

It was the first time that I had seen Andrew Haigh, and I quickly warmed to this quiet, dignified, careful, skilled, and kind man. No one would ever wish to need the services of the coroner, but if I ever did, he would be the kind of person I would wish to see.  

I have looked up a little information about the coroner’s service, and find it has been in existence since 1194, so it is one of our most ancient institutions; something that has stood the test of time.

His evidence took us through the kind of cases that he should see, the way in which they are brought to his attention, the way in which he can investigate, and the methods he has to insure that any “lessons” that can be learned from a death can be flagged up to any interested parties.

Though details of the thousands of deaths that occur in his jurisdiction pass through his office in some form, his role is to focus on those deaths where there is a need for an inquiry process, where there are questions to be asked. The coroner will only normally become involved if there is a question of an “unnatural” element in the death. He explained that this can be interpreted widely and it could properly take into account cases where lack of care had contributed to or accelerated a death, as well as more obvious accidents.

It was clear that the numbers of cases that he saw from Stafford Hospital were not in unusually large numbers.

For many of the people who had turned up to see this evidence this was clearly frustrating. What people were looking for was some hard evidence to back their belief, fostered by years of press coverage, that hundreds of “unnecessary deaths” had occurred in Stafford Hospital. They did not get this. What they did hear, was the clear statement that the kind of issues being raised at Stafford were very comparable to the other similar hospital in his jurisdiction and in the other areas where he has worked as coroner since the 1980s.  

The frustration I heard from the public room centred on how it was possible for hundreds of deaths to occur “unnecessarily”, without becoming a matter of concern to the coroner.

It is worth taking a look at where this belief of large numbers of deaths comes from. The belief is founded almost entirely on the “Dr Foster figures” These are something that came to prominence in 2007 at a time when hospitals were beginning to be “paid by results” and when “patient choice” was opening up the possibility of competition between hospitals.

It is very important to measure the quality of the health service. It is also, as the whole of the Inquiry has shown us, very difficult indeed to do it effectively. The Dr Foster system was an attempt to measure the quality of the service by measuring the difference between expected and actual deaths. This is not a simple measure. It is a construct of many different factors, and it relies on accurate information to produce meaningful results. Though the Hospital Standardised Mortality Rate has been around for a while, and had been used by many hospitals as one of many management tools, the changes of 2007 brought these figures into much greater prominence. Because it rolls up the hugely complex matter of “Quality” into a single figure that makes a striking headline it is easy to see how attractive these figures would become to the press and the media, even if no one actually understood them.

It is completely understandable that a recently bereaved person might see the high mortality rate figures in the press, without any of the detail that needs to accompany them, and make the assumption that their own difficult bereavement was in some way the tip of the iceberg It is also completely understandable that someone in this position can become fired with a sense of their “mission”.

In most cases where hospitals had a high HSMR figure at this time the Health care commission dismissed this as a statistical anomaly. In Stafford, because of the emergence of the pressure group, the perfectly legitimate concerns they were raising, and the way in which all of this was attracting a growing amount of attention in the press, the HCC decided it was the best thing to mount a full year long investigation, an investigation which did throw up the many real problems that the Inquiry is still seeking to understand.  

The origin of the claim of “400-1200 excess deaths” which came to dominate the press coverage, is still shrouded in too much mystery. It is something that I personally believe the Inquiry will need to explore further. Most of the general public believe that the claim of excess deaths came from the Health care commission report, but this is not the case. The report neither states nor implies these figures. The claim first appeared in print on the day before the publication of the Healthcare Commission report. It is a leak from an unattributed source, in an article also contains quotes from Bill Cash and from the founder of the pressure group.

The Inquiry has already thrown a little further light on this. The figures are a leak based on an appendix that was deleted from the HCC report. Most people including myself have never seen this appendix and the accounts that I have heard of its exact contents vary. Most people who have seen it tell me that it is just the Dr Foster figures, from which someone then must have extrapolated the excess death figures, one of the members of the press tells me that the speculative figures are quoted. The reasons that people give for the deletion of this material vary. Was it deleted ,as the pressure group believes, as an attempt to hide the truth; or was it deleted as the SHA and Healthcare Commission say because the information, was misleading and likely to be misunderstood? Understanding this question is central to understanding the Stafford Hospital story.   

The Stafford Hospital story has focused a lot of attention on to the Dr Foster system. One of the recommendations of the Robert Francis Independent Inquiry was that an expert working party was needed to overhaul the mortality rate system. This group has done its job. It has now fully recognised the inherent problems within the HSMR system, and the way in which it was misused. The system will cease to be used in the same way and a new system, of which little is yet known, is being put in its place.

So to return to the Coroner. What we saw in the Inquiry room, and what upset some of the members of the pressure group was a clash. We saw an ancient system which has been tested by centuries of use. This system depends on the trust that people will raise concerns when they should, and that careful wise inquiry can find the answers to difficult questions. In Stafford this system came up against a passionately help belief, founded on the misuse of data from a complex and flawed statistical system which came to prominence in 2007 and will come to an end in 2011.

So is that an end to the matter? Probably not. Robert Francis indicated at the start of this Inquiry that it is unlikely that we will ever have an answer to the question “so how many people did die unnecessarily”. Having now heard the coroner’s evidence I can see what he means. The basics of the coroners system is sound, and should not be tampered with, but there may be a need for something additional, to take advantage of modern data handling tecniques.

We know that the commonly quoted excess death figures are ill founded, and were actively promoted by prominent figures like Bill Cash on the basis of no understanding of how they were constructed or why they were problematic. We now know a great deal about why the figures are so misleading, (this is inherent within the inquiry evidence - I will blog about it in more detail later) and we know that the route by which they came to dominate the press and media are unsatisfactory and may require reform of the rules of the press.  

But to my mind, as well as to the minds of the pressure group there is something missing. What I think we do not have in place, and perhaps need, is a better means of monitoring trends in mortality. Though we begin with looking at trends in one individual hospital it makes no sense to look at this in isolation. We need to understand trends in our communities and in the country as a whole. It is becoming increasingly clear as we go through the Inquiry process is the real difficulty that most people (in which I include most experts) have had in understanding the systems for measuring mortality rates, and for judging from it if the health system and public health system are performing as they should.

As the government puts more emphasis on patient choice, and the “market” in health provision, quality is not merely an end in itself, it is an economic imperative. Because of this, monitoring systems are likely to get more rather than less complex. In Stafford it is inexpert interpretation that has led us to where we are now. We may need to employ specialists who can understand the systems well enough to pick up clusters and changes in patterns of deaths under a series of different variables.

What we have now is the ill founded interpretation of some flawed statistical data which suggests large numbers of deaths occurring.  We also have a whole series of different monitoring systems and individual expert impressions which suggest that this is not in fact the case. What I am looking for is some means looking at a discrepancy of this nature and determining if these figures that were supposed to act as an early warning system did tally with what was happening in reality. If something of this nature had been in place in 2008 this would have saved Stafford three years of torment, and saved the taxpayer many millions.

This is not a simple task that could be tagged onto the coroners job, or could easily sit within the very specific task that a coroner does, but it would make sense for this monitoring to cover an entire geographical area, and therefore it may require a new role attached to the coroner’s office. This would need to be aggregated to a national level in order to be able to provide meaningful comparisons.

I would expect that such a system would highlight issues that go way beyond what may or may not have happened in one hospital, and will show the huge discrepancies in health and mortality that exists between different sections of the population.

Given the trend towards localism that is central the Health Bill, a national monitoring service may be a necessary protection against the growth of health inequality. If I were conducting the Inquiry this is a recommendation I would make.

I would make another recommendation too. There has been a lot of focus on what went wrong, who is to blame, and how to give patients greater power. In part this is about building a responsive complaints system, and having independent bodies to give patients support if they need it, but perhaps one of the most positive things we could do is put in place more professional support for people who are about to lose or have lost a relative.

There are bereavement officers, and there are chaplains. These are very demanding roles. Doing them well makes a huge difference to the people who receive this service. It is essential for there to be enough staff working in this capacity to support people at difficult times. Their role should be sufficiently flexible to include picking up any concerns that people want to express.

More support at this level may have meant that some of those people would get the skilful help they needed to make sense of their experience. It might also have meant that some people who had just experienced a difficult death might have been directed to the coroner and might have had the satisfaction of knowing that their concerns were noted and carefully explored.

Journalists, Public Unite Against Murdoch Threat.

There is today a renewed campaign to influence Government and the public against the move by Rupert Murdoch to gain overall control of BSkyB. 

On Twitter (: An Avaaz.org e-petition currently with over 90 000 signatures ), in the House of Lords: (Lord Prescott speaks against the transfer of shares to Murdoch prior to conclusion of the phone-hacking cases ) and in the wider media world: (Evening Standard ), voices are raised against this proposal. 

One new but strong voice is that of the NUJ which joins with the Campaign for Press and Broadcasting Freedom  and plan a demonstration for the day of the announcement by Jeremy Hunt, Minister for Culture, Media and Sport and have called for supporters to join them The announcement is expected this week.


Pressure was being brought to bear on Jeremy Hunt to refer the proposed take-over to the Competition Commission for a final decision, but as reported here, behind the scenes negotiations to hive off Sky News, or place it under the auspices of an 'independent' Trust, have been taking place to negate the need for the Commission to make a judgement.

Should Rupert Murdoch not succeed in his aim for full ownership of BSkyB, it will not be because of lack of guile, nor support in high places...

Rosie Robertson

News From Nowhere - How the Papers got Their Stories - BBC Radio 4, Thurs. 24th Feb

This saga, long running, some believe, because of poor investigative rigour and lack of will, for whatever reason, on the part of the Met. police force to pursue many strong leads and a welter of evidence, rumbles on.

Recently, thanks to dogged work to keep the story alive by the Guardian, Independent, Channel 4 Dispatches, concerned Bloggers and 'victims' from all walks of life, it appears that the feeble flame is at last showing signs of bursting into the roaring fire it should have been at least six years ago.

On our Blog, #PRESSREFORM, here, are links to many articles and comments made about the whole affair over the past years. An example of these would be this :

Secret Phone-hacking Documents - Guardian

We seem now to be moving ever deeper into the murky world of (questionable at best and corrupt at the very worst) news story information gathering.

Today's Radio 4 programme, News from Nowhere - How the Papers got Their Stories, with presenter Jon Manel, sought to show that the methods of collecting details and information on personalities in the public eye were not merely confined to phone-hacking. Listen here.

It illuminated the way newspaper journalists used private detectives to gain access to medical records, addresses from phone numbers, details about and information from friends and relatives of targets, vehicle registration numbers, ex-directory numbers and so on. The PIs were skilled in the art of 'Blagging' and could elicit very personal details of a target's life from receptionists, office clerks etc. 

The programme suggested that the illegal practices employed by journalists and sanctioned by their editors were not confined to the News of the World, nor did they cease when the Private Investigator Glen Mulcaire was sentenced to prison. There is evidence that the practices still go on today....which goes some way to explain why most of the media have failed to publicise this whole affair properly.

Have editors, journalists and newspaper proprietors bitten their tongues, squeezed their eyes tight shut and held their breath in the hope that they could delay the inevitable, put off the reckoning which edges ever closer? 

Rosie Robertson

A glimpse into the future - where the Stafford story is leading us.

Yesterday 23rd Feb 2011 I had a glimpse of the future.

We are in a time of rapid change in the NHS. Few people yet understand the details and fewer can predict the outcomes.

As a result of the public perception of what happened at Stafford, and the way in which it resonated with the press and media,  Andrew Lansley has justified his decision to cut two whole tiers of the management of the NHS. The Primary Care trust, and the Strategic health authority are both going.

It is interesting that the health bill was initially supposed to take on board the recommendations of the Stafford Public inquiry, but the time scales may make this impossible. The Inquiry in its slow and painstaking examination of the evidence of many individuals is painting a much more complex and balanced picture of what happened at Stafford, than we have so far seen through the press. It is by no means certain that the recommendations that the Inquiry will make will be what the secretary of State wishes to hear.

But without waiting to see what the Inquiry tells us about the state of the NHS and the management needs, the structures are changing now.

Yesterday I went along to take a look at the first meeting of the joint Health scrutiny committee, which brings together the Borough and County scrutiny committees. The Chief executive and Chair of Stafford hospital were there to give a presentation and to answer questions from the assembled councillors and from the public gallery.

This new committee is set to take on the role of overseeing the performance of the Hospital and the health service in this area. It will scrutinise the performance of the brand new GP consortiums who will take on the role of commissioning the health services in this area. None of us have any idea of how well this may work.

What I saw, looking down from the public gallery was the normal assortment of middle aged, middle class, councillors, all who are in some way concerned for the good of the community, but few if any who have the requisite skills or experience to know if the health service is being run well or not. The questions from the floor were interesting. Many seemed to be based on anecdotes - things that the councillors had learned from a friend. Few seemed to ask the deep questions that are necessary at this time.

I suspect that most of the individual councillors in the committee would if asked indicate that they are not sure that they are well qualified for this job.

The Chief exec recognises their difficulty. The Councillors had raised question about being able to carry out on the spot inspections of the hospital. He was quite amenable to this, but also suggested the need to provide some basic training for councillors to give them some indication of what they might be looking for. Going in and looking round is very unlikely to give the kind of in depth insight into the workings of the hospital that we as citizens will now need these councillors to have.

The make up of the public gallery was interesting too. The pressure group were there in force. There was one gentleman who had been associated with the health councils that were disbanded some years back, one ex councillor, and myself. That was it.

I think it is worth pointing out that on the basis of a perception that may be ill founded, massive changes are being made now to the structure of the NHS. The job of scrutinising the NHS has been shifted from paid professionals who understood the task to amateurs who have got there through election to the councils and who may or may not have the necessary skills. The only members of the public who are interested enough to be there are people with a specific interest, which may or may not be representative.

At the moment this body is simply taking a look at what the Hospital and other aspects of the health service is doing. In the future it will be rubber stamping passing the responsibility for delivering service into the private sector.

Political opportunism? - I wouldn't go there Mr Lansley.

When I heard Andrew Lansley’s complaint that Labours stance on the NHS was political opportunism, I almost dropped my cornflakes.

His concern may be a sign that the reality of being in government is coming home. The press is a ready-made tool for demolition. It is much harder to use it effectively as a tool to explain your plans and persuade people to like them.
Andrew Lansley is struggling to get us to like his plans. Most people still have little idea of what is proposed, and many of those that do know are giving clear indications that they do not like what is on offer. For my own part, I would like to see the process slowed right down, give Mr Lansley the time to get his points across with much greater clarity, and give him a chance to listen effectively to well informed public response to these proposals.

For Mr Lansley to make the assumption that the resistance to his plans is coming chiefly from Labour would I think be a serious mistake. What I am seeing as a labour party activist are many people who are concerned that Labour is not being nearly strong enough in its opposition to the plans. If it is opportunism to represent people, in the confusion and anger that so many people feel about these plans, then yes this is political opportunism.

My shock at hearing the words "political opportunism" from Mr Lansley springs from the fact that I live in Stafford, where we have spent the last two years finding out just what it feels like to be one of Mr Lansley's political opportunities. Perhaps this needs a little explanation.

What the world in general “knows” about Stafford is that it is the town where hundreds of people died because of poor care at the hospital. My understanding from three years of close and well informed observation of what has actually happened here is rather different.

I see a hospital that certainly has had its share of problems. Problems which are now being microscopically examined by the fifth major investigation in three years. I see this within the context of an NHS which has real and growing challenges to meet, as expectations rise, and our life expectancy continues to increase at a very rapid rate.

I also saw in Stafford a completely unique set of circumstances:
• There was a statistical system that was vulnerable to bad data, and there was bad data to invalidate its findings.
• There was an impenetrable statistical row between different sets of statisticians. Something that the press, public and politicians all struggled to understand.
• There was a forceful lady fired with the energy and anger that can only come from a difficult bereavement.
• There was a political party with an election they were determined to win, and some questionable methods of going about this.
• There was a need for the Conservative party to prove that they cared about the NHS.
• There was Andrew Lansley with his mission to change the NHS and a burning need to demonstrate that it needed changing.
• There was the media fired up by finding themselves at the centre of a cracking good story.
• And there were lawyers, lots and lots of lawyers, with an opportunity to ply their trade.


The reason why the Stafford Hospital story became a global media scandal, and persisted beyond a few days was quite simple. It was because of the claim that 400-1200 people had died as a result of poor care.

This information was credited by press and media to the healthcare commission report. I find it is still a considerable shock to people when I say “this is not actually true”. The report does not either say or imply these numbers. It makes no attempt to quantify the number of people who may have died as a result of poor care.

I cannot give you the precise source of these numbers, because they are now being attributed to a document that most members of the general public, including myself, have never seen. We do know this unpublished material was left out of the Healthcare commission report, because it was considered that it was not well based and that the public would misunderstand it. We do also know that the writer of this deleted report has made it plain that his numbers cannot be used for the purpose to which the press have repeatedly used them.

All this is public knowledge, but despite a huge amount of effort on my part it still seems impossible to quash the use of these figures. Some papers have now stopped using the figures, some have even printed a low visibility paragraph showing that they got the attribution wrong, no one has yet published the very prominent correction that is needed.

In my dealings with the press they always come back with the question “well how many people did die of poor care then?” which is a question that does not and probably never will have an answer. There is however a steadily growing body of evidence, supported by pretty well all the testimony to the public Inquiry,that there was nothing particularly unusual about the level of mortality at Stafford.

The factual errors that have been made in the reporting by Press and Media are both complex and serious. These errors, and the disproportionate reporting that has resulted from them are now the subject of a complaint to the press complaints commission and the BBC. (see clips below for a snap shot of the reporting of this case.)

Is anyone to blame for all this? I really do not know. There is a magic mirror where people see what they most desire to see. For me the Stafford Hospital story has something of this quality. So many people are involved, each one sees something different. In the centre of all this the patient figure of Robert Francis, trying to find a view point which is true and will satisfy the key players in the story.

I do not hand out blame easily:
I do not blame the statistician whose system was devalued by poor data and misused by the media.
I do not blame the lady, whose anger and grief made her a powerful media performer, and who could never have anticipated the harm that her story could bring about.
I do not blame the individual journalists presented with the impossible task of trying to make sense instantly of information that had many experts seriously puzzled.
I do not blame the lawyers for plying their trade.

I did blame Bill Cash, because I believed that he had deliberately manipulated the media, and that he had understood the material he was dealing with. After his evidence to the Inquiry I now know that I was wrong. If he is to blame, it is for failing to ask questions that he should have asked, and for speaking with apparent authority on a subject where he understood so very little.

Do I blame Andrew Lansley? Yes. At this moment I think I do.
Andrew Lansley would say of himself that he is the man who understands the health service best. It is his responsibility to understand the systems that he is now in the process of destroying, and that means he should have had a firm grasp of the detail.
Lending his authority and leading the public into believing that a massive failure of the NHS had taken place in an individual hospital, would, unless there was the clearest possible evidence that this was the case, be seen by many as an irresponsible act.

So when I think of political opportunism and the NHS, the images that spring to my mind are mostly of Andrew Lansley and some of his colleagues.

The fading photographs in my pile of press cuttings show him at the entrance to the hospital, Inside the Café headquarters of the pressure group, in the commons, on the green at Westminster, Bringing David Cameron into the centre of the picture, specifically leading public opinion to reject the “independent Public Inquiry, before it had even begun to sit, because he did not want to draw a line under this case before the 2010 election, On the party conference stage with the pressure group as one of his star turns, and on the politics show this month using the public perception of MidStaffs to justify his decision to scrap the primary care trusts, and to shore up the NHS reforms against a gathering tide of widespread opposition.

Political opportunism is perhaps something that too many politicians are guilty of. What I have seen in the complex interaction between the press, the pressure group and the political party in the case of Stafford Hospital is a kind of cleverly managed emotive opportunism that has shocked me deeply.

It is something that in the short term may have put enough votes in the right box to help tip the balance on the election of 2010, but the end result is that it damages our trust in both the press and the politicians caught up in this story.

It is the reason why I am actively campaigning now for reform of the press. We need good journalists who make their reputations by searching for the truth, and we need effective ways of challenging the press when they get it wrong. We also need a press that will also permit politicians to get their points across in an transparent and straightforward way.

So Mr Lansley, if you are thinking of using the words “political opportunism” in the future, I really could not advise you to go there.




Here is a tiny selection of some of the reporting of the Stafford Hospital Story.

http://www.dh.gov.uk/en/MediaCentre/Speeches/DH_116653

http://www.guardian.co.uk/society/2010/nov/08/stafford-hospital-inquiry-nhs
400-1200

http://www.bbc.co.uk/news/10274537

http://news.bbc.co.uk/1/hi/england/staffordshire/7948293.stm

http://www.dailymail.co.uk/health/article-1162552/Brown-apologises-unacceptable-failings-Stafford-Third-World-hospital.html

http://news.bbc.co.uk/1/hi/uk_politics/8534531.stm

http://news.bbc.co.uk/1/hi/uk_politics/8534543.stm

http://news.bbc.co.uk/1/hi/uk_politics/8534388.stm

http://www.guardian.co.uk/society/2010/jun/09/stafford-hospital-inquiry-david-cameron

http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-12251992

http://conservativehome.blogs.com/torydiary/2009/03/andrew-lansley-issues-five-point-plan-to-avoid-another-mid-staffs.html

http://conservativehome.blogs.com/files/patient_safety_plan.pdf

Whatever Happened to Balanced Reporting?

Heading up a veritable pot-pourri of gossip and comment in his Diary piece in the Mail yesterday was this by Ephraim Hardcastle : http://tinyurl.com/63ffyjt

Hardcastle is writing about the sexual assault and beating of CBS reporter, Lara Logan, in Cairo on Friday 11th February :

'Nothing excuses the Cairo sexual assault on CBS TV reporter Lara Logan, 39, the former swimwear model but she does have ‘form’ for dressing provocatively in inappropriate locations.'

Most people, reading a more factual and honest account of what happened to this woman, would have felt sympathy with her plight. Mr. Hardcastle, on the other hand, seeks merely to denigrate and blame the victim. 

Update, 6th March :

I have just come across this piece from the New York Times putting forward good reasons why we need the presence of women in war-zones. The article, by Kim Barker, mentions the treatment Lara Logan received at the hand of both her attackers in Egypt and the many hyper-critical journalists in the press and on TV. Article to be found: here.

Rosie Robertson

The Stafford Inquiry - Did the Case note review help?

When the Healthcare commission brought out its report, and the press published its leaked figures and Stafford found itself at the center of a media hurricane, we all knew that very strong emotions had been unleashed. Bereaved families needed a process to help them through this. We found that many families who had previously accepted their loss read the press stories, made comparisons and became concerned about their own experience. Each family had its own questions, they needed answers.

The papers were full of demands for sackings and retribution. In this climate it was impossible to ask the Hospital to re-examine cases, trust between patients and the hospital was so badly damaged that there had to be an outsider, and Dr Laker was brought into to run an independent analysis of the case notes.

His evidence to the Inquiry has been a quiet, thoughtful day He has tried to give answers about complex questions on hospital governance, and to look at the experience he had in trying to assist the bereaved families. The complete transcript can be found here

Initially there were about 20 families who came forward, but the press were very interested in promoting this process and continued to print prominent editorial stories to support it. This was in addition to the advertisements placed by the trust. It was also around that time that googling "Stafford" would always bring up adverts for lawyers offering their services.

As the press coverage continued day in and day out the numbers of families who felt that there may have been problems in their case grew too. The pressure group and their influential supporters made it clear that Dr Lakers process was not what they wanted. They wanted a public Inquiry. They did however advocate that as many families as possible should put their names forward for casenote review, in order to build up the pressure for an Inquiry.

In the end around 200 families signed up for this process and were seen by Dr Laker and his team. This large number put the process under real pressure. Additional staff had to be appointed for the task, and there was eventually re-organisation to have the project managed by the Primary care trust, Dr Laker felt the PCT did a very professional job.

The Inquiry made the point that this 200 were a self selected group, of those who felt that they had experienced a problem. By the end of the review process 60% of this self selected group felt that they were still in some measure dissatisfied and wanted to take matters further. Many of these were involved in the group legal claim that was "settled" by the hospital in 2010.

Dr Laker was asked about the expectations of the group, and whether he felt the process had been able to meet them. One of the expectations that he found was that some families wanted him to tell them if they were “one of the 400”, referring to the problematic number used repeatedly by the press of those who “may” have died as a result of poor care. (It is the use of this number and the misleading claim that this is stated by the Healthcare Commission, which is central to the report which is now finally being investigated by the Press Complaints Commission).

Dr Laker says that answering this question from the families was by no means straightforward. There were a small number of cases – a handful – where it was possible to identify with complete clarity that some form of medical mishap had taken place, but this was unusual. There were also cases where the case note process was able to give people closure. They could see by working through the case notes with an expert, and asking the questions that they needed to ask that there had been nothing untoward. They could let their worries go.

There were other people – the majority out of this group of 200- where issues were identified and were able to be fed into the independent inquiry process that began under Robert Francis in 2009. Dr Laker felt that for many of the people that he saw, this was important. They wanted to know that their experience counted for something, and that what they had seen would help other families in the future to a better experience.

This is not a clear matter of black and white - but hundreds of shades of grey.

One thing that Dr Laker talked about that made me feel very sad, was the way in which the media focus on the hospital stirred up unresolved issues for other people, theoretically outside the scope of the case note review. Some people came forward who had stories from 10 years ago or more. Some of these had been through every possible stage of the complaints procedure, the hospital, the healthcare Commission, even the ombudsman. Some of them had their complaints upheld by the ombudsman, but this had still not enabled them to let go of their grief or anger. They felt the need to come back and be part of the Case note review, even in cases where the notes had been long ago destroyed.

The Chairman Robert Francis wondered if in cases where people had held onto their grievance for so long, if that then made is much harder to find a way to let it go. Dr Laker said

I believe that is the case. The longer it goes on the more difficult -- the more protracted it becomes. The more difficult it becomes to deal with.

Robert Francis asked a hard question. He wanted to know if Dr Laker felt that the process had in anyway helped those involved. He thought about this clearly. And the answer was that he does not know. He never had any feedback. He does not know if any of the families felt any better for this process. Here is his answer. :

I think I've indicated earlier that I have difficulty knowing how effective this process has been, because for me the test would be whether at the end of the process it has allayed any of the issues raised by families or they're able to come to terms more with what happened. I simply don't know that. A number of comments were made to members of the teams that saw families initially, that suggested that some were deriving benefit from having the initial meeting.
Certainly the comment was made on more than one occasion that it was the first time that someone had listened sympathetically to the issues that the families were raising. But that's early on in the process, and I wouldn't form a judgment on that. I would want to know, after the process has been completed, whether families derived benefit from the independent clinicalnote review process, and I simply don't know whether they did or not.

Stafford Hospital Inquiry. - The Bill Cash Story.

I have indicated previously that I believe the press has played a major and malign role in the story of the Stafford Hospital. Last week I was there as the cracks in the case for the Inquiry finally became visible for all to see.

When it happened there were only two journalists there, I was aware of the enormous complexity of the story unfolding in front of us, and the real difficulties that this would give journalists in the tiny space that is available to them. I was not confident that the full story would be told, so let me tell you the story as I saw it.

Picture the Scene. The Stafford Borough Councils’ committee room is crammed with lawyers, their staff and some of the “core participants”. In the adjoining room there is the public – made up of the hard core of the protest group, the press and a scattering of people with some other interest. We were watching banks of video screens with live coverage of the inquiry, the written words that miraculously keep track with the hours of speech, and the occasional “exhibits”. We were able to peer through directly into the room where it was all happening. The space allocated to the audience is greater than it need be as the legal staff probably outnumbered the “public”.

I came because I wanted to judge for myself how thorough and well focused the Inquiry process is, and to see in particular how it went about holding to account the various MPs involved in the story.

What I saw was something intimate, forensic, careful, on occasions kind, on occasions merciless.

The first day that I saw was spent with David Kidney. The second was with Jeremy Lefroy, and Bill Cash. I have also read the transcripts from Tony Wright.
These days followed the appearance of two members of the local authority health scrutiny committee, who found themselves in the unfortunate position of having to admit that they had not actually read any of the major reports on the Hospital, and found themselves ridiculed by the press.

The press had its pre-conceptions on all of this. The Express and Star has throughout the two years of this story taken the view that David Kidney, who did not fully accord with their “local hero” was the villain of the piece, and that Bill Cash who had clamoured for the heads of a succession of people, and given the “local hero” his full support became an unlikely knight in shining armour. The press expected their view of the story to be borne out by the Inquiry room appearances. It is to the credit of the skilful people conducting these hearings that this is not what happened.

What all of the elected representatives at different levels would I think completely agree is that they are not experts on health, or statistics, or the structure of the NHS, or hospital finance, and that it can be difficult to understand clearly what is happening, especially when they are being confronted with reports assessments and ratings which are giving conflicting information. All recognise that this is an area where they have to be guided to some extent by the experts.

What all these people, and all the many other available sources of information that we have seen, will also agree is that the number of complaints that they received before the beginning of the Cure the NHS press campaign were minimal. They saw nothing out of the ordinary happening at Stafford.

Where the difference between the MPs was startling was in their activity levels. With David Kidney I already knew the colossal amount of work that he did to try and understand what the issues were, and to move things forward. I was glad to see at least a small fraction of this work was finally made visible by the Inquiry, though telling the full story of what he attempted will require a full book, which I may write at some point.

Jeremy Lefroy is clearly also committed to working hard for Stafford. What struck me from Jeremy’s testimony is the degree to which he whilst merely a candidate for Stafford he had to rely on the press for his information. This is highly dangerous. Over the last couple of years I have come to know many of the young journalists involved in covering this story. For the most part I like them. They are all decent people trying to produce good copy. They are also working under impossible pressures. It is putting an intolerable burden on them if we expect them be our main source of information about the “truth” about such complex matters, and it would be wrong to blame them too much if they sometimes get things wrong.

I am already approaching the new MP Jeremy Lefroy to request that opposition parties are given regular confidential briefings on issues of concern to ensure that battles based on garbled information are not in the future fought out through the press. In my opinion what has happened has been immensely damaging to Stafford and should never be permitted to happen again. Here or elsewhere.

What came as a shock to me, and I think to the public and the two journalists in the room with me, was the evidence from Bill Cash. For those who are not familiar with this story it was Bill Cash the MP for Stone, who acted as a mentor for the Pressure group, and was there at every available television interview, or Westminster debate to forcefully lead the demands for this Inquiry. I am giving here only a fraction of the content. You can get the full text here.

The questions began. As with all the MPs the inquiry wanted to know how much he might have known about any problems at the hospital before it became a matter of interest to the press. This was the usual story. He had just seen a trickle of individual complaints, no pattern, nothing at all remarkable.

The inquiry then looked at how he dealt with the complaints. Constituents with a problem, would either send him a letter, or visit his surgery. If they came to the surgery he would ask them to follow up this with a written account of their problem. He, or his assistant, would then take their letter, attach a standard letter to it and forward it, in the case of Health related problems to the Department of Health. At that point it would become a matter for the Department of Health to pursue with the hospital. This is in direct contrast to all the other MPs who take much more direct action, writing reports, contact the hospital, and following up the complaint.

The Inquiry wanted to know if he had found this an effective method of dealing with complaints, and if he ever felt the need for any direct contact with the hospital. Mr Cash thought that if constituents were not satisfied that they would come back to him.

The Inquiry wanted to understand Bill Cash’s level of interest in the hospital.

Q One of the criticisms that is sometimes made of MPs is that they don't get interested in something until there are headlines involved

The inquiry noted that Mr Cash had not met either Martin Yeates or his predecessor. They asked if he had visited the hospital between 2003-2008. He thought that he had not done so. They again asked if he had visited after 2008. He thought not.

The inquiry tested his knowledge of the ways in which the health service has been administered. Mr Cash has made a number of strong public comments critical of the organisational structure and of named individuals within in. It transpired that these criticisms were typically based on the opinion he formed of seeing a single report, or attending a single meeting. At the prompting of the inquiry he qualified some of his earlier statements.

It emerged that he had been invited to many seminars and briefing meetings that would have helped him to form a more rounded impression of the administrative process, and he did not attend.

He was asked about his understanding of the Mortality statistics that have formed such an important part of the entire case of the hospital.

A“I honestly can't pretend to have any scientific understanding of it at all.”

On the crucial matter of the co-morbidity coding:

Q Would you have any understanding as to whether the way in which patients were coded when first diagnosed would have upon the statistics?
A. Not at all.

There was one quietly damning piece of paper. Because he had been alerted to the possibility there was a problem by articles he read in the press, he had requested a briefing from the SHA at the time when the Healthcare commission investigation into mortality rates at the hospital were beginning in March 2008. He had personally annotated a paragraph which indicates clearly that there are problems with the systems for measuring mortality statistics, and these were being actively investigated by Birmingham University, as a key part of the HCC investigation.

With regard to the Healthcare commission investigation, whilst the other MPs involved were providing all their background material on the hospital and writing full statements, Bill Cash did something different. Cure the NHS had made contact with him in December2008 and began making regular visits to see him. He asked them to produce a report which gave their version of events, and he then forwarded this report drawn up in January 2009 to the Healthcare Commission.

The Inquiry asked Bill Cash if the comments made in the Cure report represented his own views, but he did not think it was his role to form views. So Bill Cash’s “evidence” to the HCC will have been identical to that given by the pressure group, which was also identical to the material they will have made available to the press.

This very high level of agreement between the "different voices" in the story is something that I spotted in my recent excercise of reviewing all the local press coverage for the last two years, and it troubled me. It was often difficult to distinguish between the messages coming out from the pressure group, the reporters, the editors and various speakers in the Conservative party. Bill Cash's evidence clarifies how this happened. They were all coming from the same source.


The Inquiry moved on to the publication of the HCC report. It raised with Mr Cash that he had received a draft copy of the Healthcare commission report the day before publication, and that he was quoted by the press, in the article that uses for the first time the misleading “excess death figure” of 400, that was published on the day before the official report. This highly emotive figure then completely overshadowed the release of the healthcare commission report, which neither says nor implies these figures.

In the words of the Inquiry

Q. You did, however, I think, quote the figures on a number of occasions in the press. I think you quoted the 400 figure; do you remember that?
A. I don't actually, no.
Q. I mean, I expect you would agree that one has to regard these sort of figures both in a careful way and a responsible way, because they can raise high emotions?

Following these first visits to the inquiry I am left with more questions. It is not at all unreasonable for elected members to find the information they have been confronted with confusing. Anyone would! But how far should we expect them to go to find out the truth. David Kidney and Tony Wright both asked the complex questions and were given the complex answers which form the truth in this case. They then both actively involved themselves in working to find effective solutions to the real problems that existed. Jeremy Lefroy to all appearances is trying to follow their example. Bill Cash decided that the detail was beyond him, he decided to pass on the responsibility of understanding all this complex detail to a Public Inquiry. I am left asking the question, Has Stafford gone through two years of torment, at a huge expense to the tax payer, because Bill Cash took his information from the press instead of picking up a phone to ask people who understood the detail?

We have been in an echo chamber of misinformation. It began with a set of confusing statistics, and with key people who did not understand why the figures were problematic. The myth of the “excess deaths” simply grew, sucking in the press, cure the NHS, Bill Cash, the Conservative party, and then thousands of people in Stafford and throughout the county.

It is time to switch off the echo. Stafford is being used right now as the justification for destroying the structures of the NHS. There are real threats of Hospital closures. We do not want Stafford to be one of them.
Many of the proposals of the health bill are being shown as incoherent by the evidence to the Inquiry. We need to stop these proposals whilst we still can. Structures always need reform, and local accountability is to be actively encouraged. The evidence to the Inquiry has shown us a Health scrutiny that did not scrutinise, GPs who did not communicate any concerns, Patients forums that did not understand and could not perform their role. Bill Cash has his doubts about the ability of local elected representatives to be responsible for their hospital. I agree with him. This is “big society” fantasy land.

We have had this hugely expensive inquiry to see why none of the bodies with a responsibility for the hospital agreed with Cure the NHS. Why could they not see that hundreds of people were dying unnecessarily, as the pressure group thought the Dr Foster statistics were telling them. It may be months yet before Robert Francis gives us his considered opinion, but I believe a careful reading of the evidence given by Bill Cash, in conjunction with all the previous evidence given to the inquiry, now gives us the answer. We are looking at a statistical anomaly. The pressure group were completely right in identifying some problems in basic care which still remain a real challenge both in Stafford and throughout the country. There were also a small number of tragic medical accidents, which occur sporadically throughout the country, and which have left real people with a huge burden of grief. After studying this matter now for three years I have seen no evidence at all to support the idea of large numbers of “unnecessary deaths”.

The reasoning behind the Inquiry may have been muddled, but Robert Francis will bring something good from this, as he did with the Independent Inquiry. The focus must now shift from looking for blame for the mythical 400 to working out how we can protect our health service from the chaos the health bill threatens.

Can BBC substantiate their claims on Stafford Hospital?

Here we go again!


It was of course predictable that the Health and Social Care bill should bring Stafford Hospital back into the spotlight again. The public perception of what happened at Stafford, fostered by two years of press and media coverage, has been part of the "mood music" played by the Conservative party to justify the NHS reforms, with Stafford campaigners appearing on the party conference stage as evidence of the NHS at its worst.


There are certainly things within the bill that will help with the unique set of circumstances that existed in Stafford. The complaints structure was not strong enough to be able to satisfy a determined individual that their complaints had been fully addressed, so a system that is strong enough to be able to draw a line under a complaint is going to be good for all concerned.


For me the flash point when I see all these press stories regurgitating old material is my frustration that it appears to be impossible to stop the BBC using material which is factually inaccurate. This is their latest report.


Like most of the reports it refers to the numbers of excess deaths caused by poor care, with the claim that the Healthcare commission report says that 400-1200 people died as a result of poor care. This material has appeared in thousands of press and media reports.


It happens to be untrue. The Healthcare Commission report does not say this. The Robert Francis Independant Inquiry Clearly states that these figures are unsafe and the Public Inquiry has clearly indicated the source of these highly questionable "excess death figures".

More or Less, the Statistical programme broadcast by the BBC looks at the issue in some detail.

I have spent a lot of time and energy over the last two years asking the BBC and the press to produce the evidence for these figures. So far no one has obliged. The answer I normally get is "but everyone uses these figures!"


The details of all this are a very long story. I have written a detailed report which is currently with the Midstaffs Inquiry, The press complaints commission and the BBC. I will make more of this public in due course.

My concern at present is the way in which press, media and politics act as an echo chamber bouncing inaccurate material backwarks and forwards, and perpetuating misunderstanding.

I believe there is a need for a much higher standard of accuracy to avoid misreporting in the first place, and a need for a connected media complaints system, which is capable of dealing effectivly with an explosive, complex and political story which appears in a range of different places at once.

I have sent another in a series of complaints to the BBC

Factual Error or Inaccuracy
Excess death figures 400-1200 used in BBC report
do not come from Healthcare Commission report.

The BBC is continuing to make the claim that the Healthcare Commission
report on Stafford Hospital says that 400-1200 people died as a result of poor care in Stafford Hospital. This is not true. The report does not say this.

The figures are the result of a leak from an unidentified source, based on a misunderstanding of some flawed statistical material. The Robert Francis Public inquiry quite clearly states that the figures are unsafe.

I have also conducted extensive research which I have provided to the BBC to show the role played by the press and media in developing this story, This also looks at the role which the Conservative party may have played. The report that I have produced is currently also with the Press Complaints Commission and the Midstaffs inquiry.

Damage is being done to Healthcare in Stafford by this continued misreporting. There is a threat to downgrade the A&E services - due to the loss of public confidence which the misreporting has brought about.

It is time that the BBC took this matter seriously.

If anyone would like to help with this process I think it would be useful to
contact the BBC and ask them for the page reference in the Healthcare Commission
report which backs their claim of the excess deaths. It would also be useful to
know why they have not acted on the clear statement from the Midstaffs
Independant Inquiry that these figures are unsafe.