Report reveals Stafford hospital surgery team was “dysfunction” and “frankly dangerous”

BMJ 2011; 342 doi: (Published 11 March 2011) Cite this as: BMJ 2011;342:d1581
  1. Clare Dyer
  1. 1BMJ

A Royal College of Surgeons team found “inadequate, unsafe and at times frankly dangerous” standards of general surgery at Stafford Hospital in 2009, a previously confidential report released by the public inquiry into standards of care at the hospital shows.

“The general surgical team is probably the most dysfunctional encountered by any member of the review team,” the report added. “Its members are polarised and this causes problems for nursing and support staff and, crucially, puts patients’ safety at risk.”

The experts from the college said the behaviour of many of the consultants was “unacceptable” and concluded: “The department must not be allowed to operate as it does currently.”

The report was commissioned by Mid Staffordshire NHS Foundation Trust after the appointment of a new medical director, Manjit Obhrai, in April 2009, but the trust never released it. The public inquiry into the standards of care provided by the trust chaired by Robert Francis QC, released the report and placed it on the inquiry’s website on 3 March after it was referred to in evidence.

Christopher Turner, a consultant in emergency medicine, told the inquiry that the emergency department at Stafford Hospital was “an absolute disaster” when he joined it as a trainee in 2007. Dr Turner, who had worked in Edinburgh, Manchester, Stoke, and Australia, said its culture was unlike any other he had experienced.

There was a culture of bullying and harassment by management towards staff, especially the nursing staff, he told the inquiry. There were too few staff and they were “utterly demoralised.”

Nurses would emerge in tears from meetings with managers and bed coordinators, having been told that their jobs were at risk if they failed to meet four hour targets for moving patients out of accident and emergency, Dr Turner said.

Staff were trying to satisfy the pressures on them and minimise the hard time they were given by managers, he added. “The effect was that the emergency department contained very significant numbers of patients in distress and, as a department, we were immune to the sound of pain.”

He said he started contacting the Healthcare Commission about problems at the trust around spring 2008.

In March 2009 the commission produced a damning report on the trust, which found at least 400 excess deaths between 2005 and 2008 (BMJ 2009; 338:b1141 doi: 10.1136/bmj.b1141). Dr Turner, who became a consultant and clinical lead for emergency medicine at the trust, left in late 2010 to take up a post as a locum consultant in Wolverhampton.

Philip Coates, a consultant in diabetic medicine who was clinical governance lead for the trust until he stepped down from the role in 2009, told the inquiry it was difficult to get consultants there engaged in governance. “Yes, there were clearly management failures but it was not management standing at the end of the patients’ beds caring, or doing the surgery,” he added.

Dr Coates said he was “shocked and surprised” that Monitor, the regulator for foundation trusts, did not expose the trust’s weaknesses when it considered its application to become a foundation trust. The status, which gives a trust greater independence, is reserved for “high performing” trusts.

“In my opinion if Monitor had done its job properly we would never have got foundation trust status,” he said. “It failed completely.”

Maggie Oldham, chief operating officer at the trust, said steps had been taken following the recommendations of the Royal College of Surgeons, including the appointment of additional surgeons. “We would like to reassure patients and their families that they are safe when they come to Stafford Hospital,” she said.


Cite this as: BMJ 2011;342:d1581

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