INSPECTORS descended in a “busload” to begin a thorough examination of the levels of care at Basildon Hospital – and on the day when a nurse was suspended after a litany of shocking incidents in the hospital’s children’s wards – its chiefs found themselves in the firing line before a watchdog committee who expressed severe concern about their ability to turn the troubled organisation around.
It was certainly a stark Monday for hospital Chief Executive Clare Panniker (above right), Hospital Trust chairman Ian Luder (above left) and Diane Sarkar, Director of Nursing, who were quizzed by members at a joint meeting of Essex and Thurrock Health and Wellbeing Overview and Scrutiny Committees held at Thurrock Civic Offices.
They were asked about many aspects of the hospital’s governance and specifically about the mistakes that led to the death of a child in the hospital’s care last year – an incident that precipitated a first visit by the Care Quality Commission to review paediatric care.
That visit produced a review of the hospital’s procedures which stopped just short of suggesting the administration be taken out of the hands of the current hospital board, but the CQC inspectors were back this week to undertake a major review, focusing in particular on the children’s wards and the accident and emergency department.
Mrs Panniker told members that as she and her colleagues were leaving Basildon for Thurrock “a busload of inspectors with experts from all over the country were descending on the hospital.”
The inspectors’ visit would not have been unexpected, as the hospital had been instructed by the Commission to make a number of improvements to its services and compliance with directive was due by 13 January.
Addressing the scrutiny committee, which included councillors from Essex, Basildon and Thurrock Councils – Mrs Panniker told the committee the Hospital had a succession of compliance issues since November 2009, culminating in the death of a child at the hospital in October last year.
“It was a very unfortunate incident and there were a number of issues across a number of areas,” she said.
Members were told the death, together with other problems, prompted an immediate visit by Care Quality Commission inspectors, who found a number of wide-ranging concerns at the hospital.
Since then, she said: “We have made changes to the way we handle paediatric care across the whole hospital.”
Mrs Panniker, who took over at the hospital in September, detailed some of the historic problems it had suffered and added: “One of the problems with paediatric care in Basildon is that it has outgrown its environment. There were plans to spend millions of pounds that the previous board pulled the button on. That work has now been considered and there will be considerable spend.”
She went on to outline other problems facing the hospital, including compliance with Legionella and the hospital was facing prosecution and the likelihood of a substantial fine for failures in counteracting it.
Other problems concerned ‘bank staff’ (the Trust has its own in-house staff bank which offers flexible working opportunities to existing employees and other healthcare professionals who like to work on a temporary basis) and complaints to management and safeguarding issues throughout the hospital.
Mrs Panniker said the hospital historically had a “failure to recognise its own problems and it has requested external agencies to point out its deficiencies.”
Now, those problems were being managed within the hospital, she said, and the Trust had established a compliance team to identify and manage issues.
Mrs Panniker also identified a major problem with the emergency capacity at the hospital, saying it was having to operate far in excess of expected demand. She said: “In terms of emergency capacity we have had some difficulties this year and a large spike in demand, It’s difficult to work out exactly what is going on but we are trying to work out what is going to happen and keep demand at the horizontal.
“We have opened 24 additional beds and have identified 12 more but none of the things we have done to try and address the demand has made a difference.
“For example we went into Christmas Eve, a time when the hospital is traditionally at its lowest capacity, with no beds, in fact we were running at minus four beds. Since then we have looked at internal management systems which are now very much enhanced but we have to look at other areas where our consultants can work with other services to avoid reliance on a hospital bed.”
She added communication within the hospital and morale was also a problem, saying: “What we are trying to do as well as reactive fixing is build a culture that is more open and staff are involved in proactively. There are key areas where we need to see considerable change. We need to create a culture of valuing each other and we need to work at fixing the service.”
After her address, the Chief Executive was hit with a number of searching questions from members, with Graham Butland, representing Essex’s scrutiny committee, first into the fray, asking her what she thought of the hospital when she arrived.
Mrs Panniker said: “I was aware this was a hospital in difficulties but perhaps didn’t grasp the depth of those difficulties.”
Mr Luder added: “As the press and public are present I have to be careful what I say but you will be aware there have been some significant changes, the most important being the appointment of Clare, followed by the appointment of a new medical director. You will also be aware I accepted the resignation of the estates director.”
Another Essex representative, Nigel Offen, wanted to know about the chain of command and responsibility within the hospital, asking how clinicians were involved in the management “when the troubles occurred”.
That prompted Mrs Panniker to admit to problems in the time leading up to the child’s death, saying: “There is a clinical lead for paediatrics but she was struggling with some issues. There were people in the chain of command missing and she herself was suffering from a bereavement.”
She was then quizzed on operational issues and the time it took for children admitted to hospital to be seen by a doctor, admitting that around 40 per cent of children were not seen within an hour, prompting Mr Butland to say: “An hour’s wait for a doctor could mean you die,” though Mrs Panniker and Mr Luder were quick to point out that any child admitted to the hospital in an emergency would automatically be treated through A&E procedures and would see a doctor straight away. The hour’s wait related to children taken to the hospital for medical assessment, not life-threatening issues.
For the best part of an hour the three hospital chiefs fielded questions from the committee, who questioned many aspects of the hospital’s administration, including its public profile.
That came up after Mrs Panniker was quizzed by Jullian Reeves about how the hospital board ensured the “right issues are raised.”
Mrs Panniker responded by saying: “I don’t want to be hearing about staff problems through the CQC or the front pages of local newspapers. There has been a custom of taking problems outside of the organisation. We want to change this and encourage people to come forward to us.”
Reflecting on coverage of the hospital’s woes she said: “ We don’t have a proactive media or internal comms strategy. Things are not there in a usable form,” while Mr Luder warned there would still be issues coming into the public domain, saying: “There are still some bad news issues still to be heard and I fear for the impact of morale from these issues.”
Committee chair, Cllr Wendy Curtis, from Thurrock summed up by reflecting on the hospital’s poor image, saying: “I am a lay person representing residents who frequently ask me about Basildon Hospital and they want to know what action I can take to hold it to account. What can I tell them?”
Mrs Panniker answered by saying she could say that “There is a wealth of evidence that the hospital is improving on a daily and weekly basis,” and she offered to share that information with councillors to take back to their residents.
At that point the three hospital chiefs left the meeting, while committee members debated their action – and it was clear that they remain to be convinced.
Mr Offen said: “I have not heard enough to persuade me that the management and the hospital board is in control. From a clinical or quality point of view it is not where it should be. I can see a situation where we might wish to refer this to the Secretary of State.”
Mr Butland echoed his view, adding: “The right words are coming out but we have heard something similar before, though the fact that we now have people in charge who do not have to defend their past actions makes a difference. That perhaps gives the strongest indication of the sea change that is required.”
Basildon councillor Stephen Hillier, who had challenged the role of the hospital’s board of governors after being told that of the 50 appointed, only about 30 were active, also expressed concern that old faults were in danger of being repeated but he agreed with colleagues who recommended that they await delivery of the hospital’s own report on compliance and that of the CQC inspectors currently at the hospital, before delivering their definitive verdict on the hospital’s performance.
When the management team returned, Cllr Curtis told them: “We wish to know the outcome of these reports and after that we would like to meet with you again when we will consider where we want to go.”
