What went wrong at Addenbrooke’s?

I agree with the comments by Sir Mike Richards. It is unfair to criticise the inspection process (which also rated Addenbrooke's as 'Outstanding' on one measure).

There are a number of former Addenbrooke's staff who perceived at first hand the disconnect between management and staff working on the ground highlighted in the CQC report. Addenbrooke's was witness to the unfair dismissal of three Indian consultants in two years, with no attempt to seek or show respect for the views of clinical staff or patients, a refusal to have external scrutiny of whistleblowing concerns, and an insistence on dismissing staff by a process which a judge said might be thought to resemble a 'show trial' (and Sir Robert Francis described, with reference to hospital disciplinary hearings in general, as a 'kangaroo court'). The fact that Addenbrooke's never apologised for its mistakes or changed its procedures after it was found to have behaved wrongly in these three cases further points to a culture that was not in the interests of patient safety or staff well-being.

With 6% cuts to general practice, 14% cuts to social care, up to 25% cuts across secondary care, 7,000 hospital beds cut, 6,000 nurses cut, 550 general practices closed, 66 A+E and maternity units cut, £14bn spent on a more costly health market, 80-90% of Hospitals across the country consequently expected to end the year in debt with a total deficit of £2bn - what on earth DOES CQC expect to find with its new "tougher" inspection regime?

England is operating the most austere healthcare regulatory regime of anywhere in the world - perversely, setting up to fail one of the world's best and most desirable healthcare systems.

Is CQC happy to be seen as the blind instrument of Govt, one that ratifies the destruction of the NHS, measuring the footprints while our humane endeavours are trampled out of existence by the elephant in the room?

I strongly refute the statement by Keith McNeil that CQC inspectors “came in with a preconceived idea of what they wanted to find”. We were aware before the inspection that performance and the financial position at Addenbrooke’s had declined markedly in the year prior to inspection, but we were not expecting to find safety, quality and leadership issues of sufficient severity to merit a rating of Inadequate.

Although we find that elevated mortality is generally a reliable marker of poor quality (as evidenced by the outcomes of the Keogh reviews in 2013), absence of elevated mortality is not a reliable marker of good quality. CQC has rated more than a dozen trusts as inadequate despite mortality being within normal limits.

Alongside mortality we look at the results of national clinical audits. In medical care at Cambridge, performance on the national inpatient diabetes audit and the heart attack audit (MINAP) were both below the national average. The stroke audit (SSNAP) was scored as D (on a scale of A to E). Risk assessments for venous thromboembolism were conducted in 79% of patients against a national average of 96%.

An inadequate rating means risks to safety are real and immediate. In maternity services we found serious concerns relating to the environment, equipment, lack of recording of risk assessments and substantial midwife shortages. There were continued incidents reported relating to foetal heart rate monitoring with limited evidence of changes in practice to improve safety. Early warning score assessments were not being completed. Staff raised concerns to us that the maternity record system was potentially unsafe due to a combination of electronic and paper records being in use and being used inconsistently.

We found that staffing levels in critical care fell below nationally recommended guidelines. Staff were aware of this, but initially our findings were refuted by the chief executive.

The poor ‘grip’ on flow that we observed in Cambridge and other trusts leads to more beds needing to be opened, dilution of permanent staff across more wards, patients not being cared for with the appropriate expertise, more agency staff being required and a downward financial position.

Many staff throughout the trust informed the CQC inspection team about the disconnect between ward and senior executives. This is also corroborated by the NHS staff survey results for Cambridge for 2014 in which the trust had 16 of the 28 items in the bottom 20% and none in the top 20%.

The trust has responded positively to our report and I have confidence that it will take the actions needed for improvement. If it does, I agree with the article’s optimistic note that the trust could come out of special measures within a year.

This is not the first Trust ( what a description), not the first Teaching Trust, to have gone down.

If the Parliament wants to halt the infection, its Health Select Committee ought to summon lay officers and consultants, nurses, who worked in the failures of today but successes of yester years and interrogate them.

Why did the hospitals like Addenbrookes, Whipps Cross flourish in the past? And fail today?