The NHS in Chaos
Averil died while under the care of two NHS-commissioned organisations, both of which should have recognised the severity of her condition, and acted accordingly. At NCEDS, Averil was discharged too early from expensive inpatient treatment to less costly outpatient treatment, where despite being labelled a high-risk patient, her care was managed by the most junior member of staff in the unit. While we believe that the individuals involved were at least partially to blame, the errors made are the result of a deeper underlying problem: excessive cuts to the NHS. The impact of these cuts is clearly visible in mental health provision, and particularly that provided in East Anglia.
Cuts to the NHS
Since 2010, the Coalition Government has committed to two separate programmes of development for the NHS. First, a clear programme of cuts has required a freeze in real-terms spending. The “Nicholson Challenge” requires that trusts find £20bn in “efficiency savings” by 2015, in order to prevent a financial “black hole”. In an organisation which relies so heavily on its employees, this means paying fewer people, or paying them less. Stretched further and further to provide care for a growing population, the time and resources available for each patient decrease, leading to more mistakes.
Such cuts are visible in mental health provision. The Norfolk and Suffolk Foundation Trust has been criticised for cutting the number of beds available for inpatient mental health treatment, and across the country, an alarming pattern is emerging. Mental health services are being marginalised, and those that provide them are under pressure.
In Averil’s case, the results are clear. She was discharged too early from expensive inpatient care at Addenbrooke’s, and the less costly outpatient system to which she was transferred – NCEDS in Norfolk – was under pressure. Averil’s inpatient care co-ordinator was anxious to get her “picked up” as soon as possible by a newly appointed psychologist, suggesting that the others within the service had no additional capacity.
The second major programme of NHS reforms is that in the Health and Social Care Act 2012. The NHS, once a single organisation, has now been split into multiple trusts, which are given funding by NHS England, and which then contract with other organisations (public or private) to provide healthcare services. This has fragmented the services provided, preventing true accountability, as many of the individuals involved may be both commissioners and providers of care.
NHS Clinical Commissioning Groups pay bodies, whether foundation trusts or independent charities, to provide care within their region, which they must then supervise to ensure that a high standard of care is being provided. NNCCG commissioned CPFT to provide its NCEDS service within Norfolk, but did not sufficiently review its performance.
In submitting our complaints to the NHS, we have been in contact with seven separate NHS organisations, each of which must deal separately with the issues raised:
- NHS England
- Norfolk and Norwich University Hospitals (NNUH)
- UEA Medical Centre (UEAMS)
- Norfolk Community Eating Disorder Service (NCEDS)
- Cambridge and Peterborough NHS Foundation Trust (CPFT)
- North Norfolk Clinical Commissioning Group (NNCCG)
- Norfolk and Waveney Clinical Commissioning Group
While there is a duty of cooperation between these organisations and any relevant local authorities, we are required to deal separately with them, creating an additional burden where obtaining information is difficult.
The NHS Complaints Procedure
The NHS complaints procedure has been subject to multiple reviews in recent years, all of which have found it to be inadequate. Previous reports, including consultation papers by the Government itself, have concluded that the process is opaque, confusing, and liable to prevent complaints by individuals. In the most recent review, by Tricia Hart and Anne Clwyd, a clear call was issued for a truly independent review in serious incidents, and for greater complaints advocacy to assist patients.
Our experiences show that such changes are urgently needed. We have been unable to reach a true understanding of what happened to Averil while under the care of NCEDS and UEAMC because important questions remain unanswered.
At each stage we have tried to pose clear questions that may be answered with ease by those involved, yet common practice seems to be to answer some questions at the expense of others.
The Same Story Again and Again
On July 2nd, the Parliamentary and Health Service Ombudsman released the results of its inquiry into the death of Samuel Morrish. The three-year-old, from Torbay, died as a result of multiple failures to realise his kidney failure. While it is now known that incorrect information was recorded, and incorrect advice was given, it is the performance of the NHS complaints system, and its resistance to change or self-criticism that the family have succeeded in highlighting.
The inquiries commissioned failed to find answers and hold those responsible to account, and delays and refusals to answer questions made the process almost impossible.
The Morrish family persevered with their complaint over the course of three years, and eventually reached justice. We intend to continue to do the same, challenging inadequacies where we find them.
The principles of "openness" (set out in the "Being Open" framework) are not sufficient to guarantee the release of information to concerned families.