The plight of Addenbrooke's Hospital encapsulates the challenges threatening the NHS
Addenbrooke's Hospital, part of Cambridge University Hospitals NHS Foundation Trust, has been placed in special measures by the healthcare regulator Monitor. The decision followed recommendations from the Care Quality Commission (CQC), which found that the hospital was failing to meet key standards in staffing, equipment and patient safety.
Outstanding care in difficult circumstances
While its standard of care was rated as 'outstanding', the hospital was declared inadequate in terms of responsiveness, leadership and safety.
This raises worrying questions about the ability of frontline staff to deliver excellent service – there are fears that clinical staff are struggling to work with diminishing resources and under increasingly precarious conditions.
Seeing the hospital Trust at which you work hitting the headlines for all the wrong reasons must be hugely dispiriting for the conscientious staff that must make up the vast majority of the hospital. This is a problem repeated across the NHS, and a paradoxical one – as one journalist pointed out, the CQC had attacked Addenbrooke's over staff shortages, while Monitor delivered warnings over the costs of recruiting more staff. Addenbrooke's, and the NHS generally, is caught in a dangerous cycle.
Addenbrooke's has enjoyed a good reputation and, even now, retains a high cancer survival rate and low infection rate.
However, certain services were identified as falling short; one area of particular concern was ophthalmology, which is becoming a recurrent problem for NHS trusts across the country. Unable to provide services like cataract surgery themselves, trusts find themselves entering into agreements with private providers, sometimes with catastrophic results – the Vanguard failings at Musgrove Park Hospital are a recent, as yet unresolved, example.
As at Musgrove, where frontline staff raised concerns early in the failed contract but action was not taken by managers until days later, it would be surprising if concerns had not been raised at an early stage by an insider at Addenbrooke's. Despite ostensibly protective legislation, the role of whistleblowers in exposing concerns remains an uncertain and perilous thing.
The wider picture is that reporting mechanisms for failures are not robust enough, hampering improvements and leaving staff disenchanted.
What are the consequences for the NHS?
If a patient suffers avoidable harm as a result of NHS treatment, compensation claims are inevitable – patients are entitled to damages appropriate to the injuries they suffered. Funding for clinical negligence claims is under pressure, with the Government proposing to drastically curtail solicitors' ability to investigate complex claims on behalf of injured patients. Professionals and patient safety campaigners are rallying to oppose the changes.
The fear is that the cost of litigation arising from failings at Addenbrooke's will only further deplete the Trust's resources and exacerbate the crisis. The message, time and again, is that problems of this magnitude must be tackled early, through a well-funded, well-managed and open-cultured NHS. Clinical negligence claims are a blunt instrument for regulating the safety of hospitals, but under-funding, and what appears to be a disconnect between commissioners, managers and clinical staff, is exposing patients to injury and, as a consequence, leaving NHS trusts vulnerable to compensation claims.
The proposed changes to claims funding
If, as the Government proposes, funding options for most clinical negligence claims will be heavily restricted, the situation for patients only becomes worse. With a struggling NHS often unable to deliver necessary standards of care, injury rates are likely to rise. With a hamstrung clinical negligence profession, people who have suffered injuries that may be disabling or life-limiting will struggle to recover the vital funds they require to get their lives back on track. Those making claims may be forced to compromise on the damages to which they are entitled, paying greater contributions to meet their necessary legal costs. The patient is, therefore, disadvantaged on several fronts.
A root and branch approach to improving NHS services is essential to ensure the safety of its patients.
Alongside this, Michelmores is opposing the proposed new costs regime for medical claims as it currently stands – a regime that threatens to further erode access to justice for medically injured patients.