Addenbrookes, Monitor, Cuts, Compliance, Regulation, Targets and Pressure

17:07 Friday 23rd November 2012
Drive BBC Radio Cambridgeshire

CHRIS MANN: The health watchdog Monitor is having to take action against Cambridge University Hospitals NHS Foundation Trust. It’s after a number of failings at Addenbrookes Hospital, including botched surgeries where instruments were left in patients, and the wrong person being operated on. Yesterday on Drivetime and this morning on our Breakfast Show we heard how Addenbrookes was failing to meet targets when it comes to cancer treatment and A&E waiting times. Jane Ramsey is the Chair of Governors at Cambridge University Hospitals NHS Foundation Trust. She had this message for patients. (TAPE)
JANE RAMSEY: Don’t worry. Addenbrookes remains a safe hospital with excellent care, and we appreciate your commitment to the hospital. You know the staff are equally committed. We have some problems, but they are all doable. Obviously my job is to be concerned about all of it, because I’m the new Chair. I’m bringing a fresh pair of eyes to look at the things that we have to do to rectify this. But what I would say is that obviously patients always come first. That’s the case with Addenbrookes. (LIVE)
CHRIS MANN: Jane Ramsey there, Chairman of the Governors. Well Jag Ahluwalia is the Medical Director at Addenbrookes. Hello to you Jag.
JAG AHLUWALIA: Good afternoon to you. Hello.
CHRIS MANN: And Stephen Hay is also with us. He’s the Managing Director of Provider Regulation (at Monitor). Hello Stephen.
CHRIS MANN: Can you tell us a bit further as to why Monitor has had to step in in fact on behalf of the patients at Addenbrookes.
STEPHEN HAY: Well it’s reasonably straightforward. There have been a number of concerns about the delivery of government targets, the 62-day cancer target, A&E and RTT, which is the 18-week target. There have been a number of these “never” events, which I think Jag may speak a little bit more about in a minute. And there is some concern about the delivery of efficiency savings, to make sure that the financial performance of the Trust is strong and sustainable. And we didn’t feel that the Board, over the last year or so, have really got to grips with these issues, and ensuring that action plans put in place were delivering solutions for the patients of the Hospital.
CHRIS MANN: So this isn’t out of the blue. You’ve warned them repeatedly, and they’ve failed to meet your targets.
STEPHEN HAY: We have had a number of meetings with the Board of this hospital over the last eighteen months really, and have given them those warnings. And we don’t feel that appropriate action has been taken quickly enough to resolve them.
CHRIS MANN:┬áJane Ramsey says to the patients basically that, don’t panic, everything’s alright. It can’t be, can it?
STEPHEN HAY: No, everything’s not alright, because if it was we wouldn’t be putting them in significant breach, and requiring them to take the action that they’re going to be taking.
CHRIS MANN: Does the management need to be changed?
STEPHEN HAY: Well we have a new Chair. Jane has only just started on the first of November. And the Trust is, I understand, going to be appointing and announcing a new Chief Executive in the next week or so. So we’ve got new management coming in. And I’m very hopeful that that new management, working with the advisers that they’re going to need to look at the way that the Board is running the hospital, will fix these problems in the coming months.
CHRIS MANN: OK. Stay with us Stephen Hay. Let’s bring in Jag Ahluwalia the Medical Director at Addenbrookes. That’s a pretty damning indictment of what you’re doing there.
JAG AHLUWALIA: Yes I think it is. And we are naturally very disappointed but very concerned at these findings. We are taking these very seriously. We have been over the last eighteen months taking these very seriously in our meetings with the regulator Monitor. And we are doing everything in our power to make sure we improve our performances in these key areas, that we work both with our excellent staff and also with Monitor, to make sure that we perform against these target areas to a satisfactory level and beyond for the sake of our patients.
CHRIS MANN: Well how can you say that you’re doing everything in your power, and you’re listening to what they’re saying to you, and you’re taking action, when they said that you have repeatedly failed to meet the targets, and they’ve given a series of warnings?
JAG AHLUWALIA: Well if I may go through some of those issues with you in a serial manner, so, the 62-day cancer target, we have failed in three consecutive quarters, that is correct. That’s the basis on which the warning was issued. We are now improving with that to meet that target in quarter four, in January.
CHRIS MANN: Will you meet it?
JAG AHLUWALIA: We plan to meet it. We’ve been responding in part to this, to an enormous growth in kidney and bladder cancer surgery. We’ve appointed, or are in the process of appointing in some cases, new surgeons. We’ve built new theatres. We’ve opened new wards. But these things all take time to action. We have been doing our best to make sure these come on stream as quickly as possible. But I accept these take time to put into place.
CHRIS MANN: You know the headlines that people will hear is botched surgery, instruments left in patients. How can that happen?
JAG AHLUWALIA: It shouldn’t happen. And I make no defence of it. These “never” events just should not happen. I have never made any defence of these, and nor has anybody in the Trust.
CHRIS MANN: Will you explain it?
JAG AHLUWALIA: I can begin to explain some of it. I think we have to understand the context in which these things happen, without it sounding on my part or indeed anybody else’s in the Trust.
CHRIS MANN: Briefly if you could. Is there a reasonable explanation?
JAG AHLUWALIA: I think it’s to do with making sure that we standardise our processes and procedures. We do 38,000 operations a year, and 65,000 hours in surgery. These “never” events were fewer than ten. In that sort of context. We need to improve the way we standardise our processes. We need to focus on how we train our staff even further. We have already made significant changes to our safety check lists, how we mark the side of surgery, how we make sure the right patients are being operated on ..
CHRIS MANN: And these are all basic things, I would hope anyway, in any hospital. The wrong person being operated on. Now how on earth had that happened?
JAG AHLUWALIA: I’m afraid these things do happen from time to time. I don’t think it’s acceptable. They are in part due to the fact that we are …
CHRIS MANN: Can you explain how it happened?
JAG AHLUWALIA: We are dealing with human systems. And we do have from time to time changes in the list order, and this is how these things occur. We are making sure ..
CHRIS MANN: Well that’s .. frankly that’s terrifying. It really is. Did the person who was operated on come to harm?
JAG AHLUWALIA: No they didn’t come to harm. It was recognised immediately. Corrective actions were made straight away.
CHRIS MANN: But let me bring in Stephen Hay at this point. People will be horrified to hear that particular story Stephen.
STEPHEN HAY: Yes, and that is exactly why we’re taking the action we are taking today.
CHRIS MANN: This has happened in other hospitals?
STEPHEN HAY: There are other hospitals that do have “never” events .. but .. had a “never” event in the course of the year is obviously concerning for us.
CHRIS MANN: So what you’re saying is it’s failing.
STEPHEN HAY: What we’re saying is the Board has not got the grip on this hospital. It needs to get on it over the next few months.
CHRIS MANN: Now we’ve heard some assurances there from Jag. How do they fit with you, with your very in-depth knowledge of what’s going on at Addenbrookes?
STEPHEN HAY: Well we will be looking to the Board and to Jag and his colleagues to put in place the plans and procedures to fix the problems that have been announced today. And we’ll have to review where we are in a few months time to make sure we don’t need to take any further regulatory action.
CHRIS MANN: Some unions will be saying this is all because of the NHS cuts, because of the pressure being put on the system, that it’s money that matters, not people.
STEPHEN HAY: I don’t think this is about money. I think this is about the grip of the processes and procedures within the Hospital, that the Board has not had over the last six to twelve months.
CHRIS MANN: Are there people there at the moment who need to consider their positions?
STEPHEN HAY: As I say there is a change of leadership going on at Cambridge, and we will be looking to jane the new Chair and the new Chief Executive to ensure these issues are fixed for the benefit of patients of Cambridge, and don’t reoccur.
CHRIS MANN: And if not ..?
STEPHEN HAY: Well if these things don’t get fixed over the coming months, then Monitor has the power to take further regulatory action through what’s called Section 52, and we would take those actions necessary to protect patients.
CHRIS MANN: So what would you do?
STEPHEN HAY: Well we can .. you know .. we can if we had to start to remove people and replace them with interims.
CHRIS MANN: And how close are you to that?
STEPHEN HAY: We’re not close to that at this stage, because as I say we’ve got a new Chair and Chief Executive starting at the hospital. And I’m hoping that they, working with the advisory help they will get, and with Jag and his tream, will fix these issues in a way that is sustainable and won’t reoccur again.
CHRIS MANN: Ok Stephen Hay. Thank you for joining us. He’s the MD of provider regulation. Jag Ahluwalia. I’ll give you the last word, the Medical Director at Addenbrookes.
CHRIS MANN: You’ve got thirty seconds here to assure people that this is going to get fixed.
JAG AHLUWALIA: It is already being fixed and getting fixed. We’ve had an internal review done, particularly relating to the surgery that you described as botched operations. The view of the external expert who was in for two days, the significant distinguished surgeon, was that much progress has been made since the last visit in April, particularly relating to these so-called “never” events; that staff are fully engaged in making sure that future risks are mitigated as much as possible, and that in the view of the external reviewer, that we were not an outlier compared to other hospitals, but that we did have a cluster of these events against which we are taking appropriate action.