Public Interest Lawyers (PIL) have noted with concern a series of recent reports detailing serious failings within the National Health Service (NHS).
On 13th October, the Care Quality Commission (CQC) published the results of their inspection of 100 hospitals in relation to two vital aspects of healthcare for elderly patients: the respect and dignity with which such patients are treated and whether patients’ dietary needs are being met. In what are two of the most fundamental rights accorded to patients, the CQC found that 20 hospitals were unable to provide care to a satisfactory level. A further 35 hospitals did satisfy the assessment criteria but the CQC still made recommendations as to where improvements could be made.
Following the CQC report, the Department of Health published its first Summary Hospital-level Mortality Indicator (SHMI) statistics on 27th October. The measure has been introduced so that attention can be drawn to NHS trusts where death rates are unusually high. The indicator has, in part, been introduced in response to the hundreds of unnecessary deaths that were recorded in Mid-Staffordshire NHS Trust between 2005 and 2008; a scandal that later became the subject of a full public inquiry. This year’s release of SHMI statistics showed that 36 NHS trusts had higher than expected death rates and reviews have begun in a number of hospitals.
On 4th November, the National Health Service Information Centre published an interim report into the abuse of vulnerable adults within the NHS. The full report is to be published in March 2012, however the initial release of data provides a depressing and worrying picture.
The NHS Information Centre looked into 96 000 cases of alleged mistreatment reported to local Councils’ Adult Safeguarding teams through a twelve month period. The volume of reported cases is, itself, an alarming statistic however the provisional breakdown of the data reveals further distressing indications about the nature and level of mistreatment in the NHS.
Of the cases reported, 36% were allegations of physical abuse and 28% were allegations of neglect. The remaining cases involved financial exploitation, emotional or psychological abuse or some form of discrimination. It must be said that investigations showed that 41% of the cases were substantiated either partially or wholly with only 31% of cases unsubstantiated. The remaining cases were not determined or were categorized as ‘inconclusive’. Even allowing for the unsubstantiated cases, the statistics reveal a huge amount of already vulnerable adults suffering mistreatment as a result of their engagement with the NHS.
Finally, the Patients Association also published a report - “We’ve been listening, have you been learning?”- on 9th November 2011. The report provides accounts of patients’ ill treatment in 16 separate hospitals in the UK. As a snapshot of standards of care in the NHS, the report makes for depressing reading with problems ranging from a failure to attend to patients’ basic hygiene needs up to a failure to provide pain relief or to acknowledge a patient pressing on the emergency buzzer.
The Local Picture
As a Birmingham based law firm, PIL have been alarmed to learn of problems in NHS trusts in the local area.
PIL are concerned to see that the CQC identify Alexandra Hospital (part of Worcestershire Acute Hospitals NHS Trust) and Sandwell General Hospital (part of Sandwell and West Birmingham Hospitals NHS Trust) as the two worst offenders in their dignity and nutrition report. Both hospitals are said to be of ‘major concern’.
Worcestershire Acute Hospitals NHS Trust appears again amongst the NHS trusts with higher than expected death rates in the country. George Eliot Hospital in Nuneaton is the worst performer amongst all hospitals by this measure. Royal Wolverhampton Hospitals NHS Trust, Dudley Group of Hospitals NHS Foundation Trust and Burton Hospitals NHS Foundation Trust are also amongst NHS trusts with the highest unexpected death rates in the country.
As stated, the NHS Information Centre’s report on abuse of vulnerable adults has only been reported in an interim form at this stage. However, West Midlands Councils have reported figures to the NHS and the final report will provide interesting reading with reference to local hospitals upon its full release. With regards the Patients’ Association’s report, no case study is made of a West Midlands Hospital, however two harrowing stories are provided about substandard levels of care in Derby Royal Hospital and Glenfield Hospital in Leicester.
Although PIL seeks to provide support to the local community, the Patients’ Association report shows that regrettably these problems occur nationwide. As the introductory statement to the report makes clear:
[Reports of ill treatment] are not isolated to any one hospital or trust. We hear stories of bad care from hospitals up and down the country, including those that have a good reputation in their local community and beyond. This is what makes tackling poor care such a difficult challenge, but one that urgently needs to be addressed.
What Can Be Done?
Further reviews by Government departments, increased inspections by the CQC, continued pressure from support groups like the Patients Association and Age UK; all of these things are required to raise standards of care in NHS trusts. Raising awareness of the rights of patients and the duties of staff needs to be approached systematically and through all levels of hospital care and treatment.
However, the stark reality is that, in a number of cases, NHS trusts appear to breaking the law when it comes to the level of care being provided to patients. As Dame Jo Williams says in her introduction to the CQC reports, those reports alone show that; ‘Twenty hospitals were not delivering care that met the standards the law says that people should expect.’
PIL notes that family members are already pursuing legal action against Worcestershire Acute Hospitals NHS Trust for treatment their relatives were subjected to at Alexandra Hospital in Redditch.
That case is brought on the basis that patients’ human rights have been infringed as a result of the inadequacy of the treatment they received in hospital. Article 3 of the European Convention on Human Rights (ECHR) provides that: ‘No one shall be subjected to … inhuman or degrading treatment or punishment.’ Treatment is degrading if, for example, it arouses in the patient feelings of fear, anguish or a feeling of inferiority and the Government and its public bodies have an obligation to ensure that no one is subjected to such treatment.
As with the cases that led to the Mid Staffordshire NHS Trust inquiry (where damning conclusions were reached about the state of care in the Trust and compensation was ultimately awarded to victims and family members) legal action is one means by which to ensure the NHS meets their obligation to patients.
PIL will continue to campaign for higher standards of care in the NHS and will continue to advocate for the rights of patients within these Trusts. With a practice based on public and human rights law, PIL are aware of the suffering and pain experienced by participants in these cases. PIL remain sensitive to the needs of individuals whose fundamental human rights have been infringed.
Equally, as our work in public inquiries (such as the recently concluded Baha Mousa inquiry) as well as our recent challenges to the closing of libraries in Gloucestershire and Somerset and the Government’s introduction of new university fees show, PIL will seek to ensure that, even in times of austerity, public bodies do not forget their obligation to protect and uphold the rights of individuals within their care or jurisdiction.