Exposed: How patients are dying needlessly from bedsores and the hospitals where you're most at risk
Pamela Goddard, an 82-year-old music teacher who conducted an amateur choir, had battled breast cancer for 50 years.
Yet it was not the cancer that killed this grandmother of five — it was a bedsore.
Three years ago, Mrs Goddard was admitted to East Surrey Hospital for breathlessness connected with heart failure.
Scroll down to see the hospitals where you're most at risk
Bedsores kill almost as many as the hospital superbug MRSA, and cost the NHS up to 2 billion a year in care costs. Even when they don't kill, they inflict terrible pain and rob thousands of patients of their mobility
As her son Adrian, 55, recalls: ‘Her notes reveal that she was assessed as being at high risk of developing bedsores, yet within three days she had developed sores on her heels and a serious sore on her back because they simply did not take any preventive action.
‘She was in a lot of pain. But despite the fact that there were staff around the ward all the time, and we kept mentioning the sores to them, nothing seemed to change in her care. They were more focused on getting her out of hospital.’
The bedsore at the base of Mrs Goddard’s spine became infected — ‘probably because despite being diagnosed with a bedsore, she was left sitting in her own excrement,’ says Adrian — and four weeks after being admitted to hospital she died of septicaemia.
Bedsores are caused when a patient lies immobile for a period of time, unable to shift their weight or get up and move around. This puts pressure on certain areas of the body — often the heel, back and elbows — reducing circulation and cutting the supply of oxygen and vital nutrients.
The tissue begins to bruise, and if a patient is not moved or ‘turned’, it dies off. In severe cases, such as Mrs Goddard’s, this can leave a gaping hole that is not only extremely painful and distressing, but can prove fatal.
Bedsores, or pressure ulcers as they are officially called, are thought to affect 412,000 patients annually.
More than 27,000 people died with bedsores or infected wounds in 2010, according to new figures from the Office of National Statistics. Bedsores kill almost as many as the hospital superbug MRSA, and cost the NHS up to 2 billion a year in care costs.
Even when they don’t kill, they inflict terrible pain and rob thousands of patients of their mobility and independence.
The elderly are particularly at risk — simply because they tend to suffer more with poor circulation and because they are less mobile. In some cases, bedsores can develop in as little as four hours.
Younger people can also suffer them.
Former nurse Andrea McGoverin, 44, developed a severe pressure ulcer after being in labour for 24 hours. She’d been admitted to St James’s Hospital in Leeds to be induced to give birth to Luca, now three.
‘I was suffering from a condition called pelvic girdle pain and was unable to walk about, and because of the epidural I wasn’t able to shift myself up. This meant that I was lying in the same position for 24 hours.
'During this time, I wasn’t assessed for pressure ulcers and wasn’t turned.’
After giving birth, Andrea mentioned to her husband that the base of her spine was very painful, and when she was turned over staff discovered a large pressure sore that took four months to heal.
The elderly are particularly at risk – simply because they tend to suffer more with poor circulation and because they are less mobile
The travesty is that bedsores are preventable, simply by ensuring the patient is regularly turned and pressure areas checked for signs of tissue damage.
‘In this day and age, no one should acquire a pressure sore in hospital — it demonstrates a lack of basic care,’ says Peter Walsh, from charity Action Against Medical Accidents.
‘People too often look for high-tech solutions to problems, but the solution here is about getting back to basic nursing care.’
David Kerry, of Attwaters Solicitors, which specialises in medical negligence cases, says: ‘With proper attention and care, these pressure sores should not occur.
‘The moment you hear someone has a pressure sore, you know, as a solicitor, the chances are you are going to win a medical negligence case. I’ve come across only one case in 31 years where an expert has said a pressure sore was not preventable.’
The Government concurs. Last year, in his first major speech after becoming Health Secretary, Andrew Lansley named pressure ulcers as an example of unsafe care.
Despite this, there is no national database for recording the incidence of bedsores.
‘It is astounding that there is no mandatory monitoring of pressure sores, like there is for MRSA,’ says Katherine Murphy of the Patients’ Association.
‘Bedsores cause untold pain and misery for thousands of patients, but are completely avoidable. Yet the information on how the NHS deals with this growing problem is still sparse and patchy.’
As this Good Health investigation reveals, bedsores are a major problem in the NHS.
We sent Freedom of Information requests to every hospital trust in the UK, asking for the number of patients who had developed bedsores in hospital.
The presence of any bedsore has been linked to a four-fold increased risk of death; but more severe bedsores are more dangerous, so we also asked the hospitals for the grades of bedsores.
There are four grades or categories, starting with a reddening or bruising of the skin (grade one); broken skin and shallow ulceration (grade two); and large, deep ulceration (grade three).
Finally, grade four ulcers are so deep that in many cases the skin and muscle has completely worn away, revealing bone, and sometimes internal organs.
The findings were shocking. In the table down below we reveal the trusts with the worst incidences of bedsores in the 12-month period June 2010 to June 2011 (measured as a percentage of the patients treated who developed a bedsore).
The hospital with the highest rate was George Eliot Hospital NHS Trust in Nuneaton, Warwickshire (875 patients developed a bedsore, which is a rate of 2.1 per cent). Liverpool Heart & Chest NHS Foundation Trust has a similar rate.
At first glance, the figure of 2.1 per cent may not seem especially troubling — but it is. It means that one patient for every 50 admitted into the hospital developed a bed sores, potentially leaving them in excruciating pain and increasing their risk of death.
As a comparison, Oxford University Hospitals NHS Trust, which treats more than four times the number of inpatients as the George Eliot, still had one of the lowest rates of all the trusts in the UK — just 0.1 per cent, 20 times lower than George Eliot’s.
At other hospitals in our table, one inpatient in every 100 to 200 develops a presssure ulcer — which should be entirely avoidable.
HOSPITALS WITH THE HIGHEST BEDSORE RATES
Our investigation showed the following hospital trusts had the highest rates of bedsores over a 12-month period.
The first figure is the number of patients who developed a bedsore; the second is the percentage of inpatients who developed a bedsore.
A 2 per cent risk means one in 50 inpatients develops a bedsore.
George Eliot Hospital NHS Trust, 875 patients, 2.1 per centLiverpool Heart and Chest NHS Foundation Trust, 255 patients, 2 per centNorthern Devon Healthcare NHS Trust, 405 patients, 0.9 per centWeston Area Health NHS Trust, 232 patients, 0.8 per centCity Hospitals Sunderland NHS Foundation Trust, 874 patients, 0.8 per cent Wirral University Teaching Hospital NHS Foundation Trust, 785 patients, 0.7 per centMid Essex Hospital Services NHS Trust, 553 patients, 0.6 per centEast and North Hertfordshire NHS Trust, 541 patients, 0.6 per centRoyal Liverpool and Broadgreen University Hospitals NHS Trust, 600 patients, 0.6 per centScarborough and North East Yorkshire Health Care NHS Trust, 237 patients, 0.6 per centEpsom and St Helier University Hospitals NHS Trust 481 patients, 0.5 per centThe Hillingdon Hospital NHS Trust, 271 patients, 0.5 per centHeart of England NHS Foundation Trust, 1,247 patients, 0.5 per centCentral Manchester University Hospitals NHS Foundation Trust, 687 patients, 0.5 per centHull and East Yorkshire Hospitals NHS Trust, 1,014 patients, 0.5 per cent
The full list is below
While any bedsore is dangerous, grade three and four bedsores are particularly worrying. We found there were more than 6,000 grade three pressure ulcers among the hospitals, and nearly 4,000 grade four.
Pennine Acute Hospitals Trust, in Greater Manchester, wasn’t one of the worst hospitals overall, but it did have the highest rate of grade four bedsores, with a total of 199.
Around two-thirds of the trusts we contacted in England, Scotland, Wales and Northern Ireland provided information.
Some of the others said they did not hold the data, while others — including leading trusts such as University College London Hospitals Trust — did not reply to our Freedom of Information request.
We should point out that the way in which bedsores are monitored and recorded varies widely between trusts.
For instance, some hospitals record only grade two or above, others only grades three and four. So it may be that some of the hospitals in our worst offenders list have better quality detection and reporting.
Our data was obtained to provide an insight into patient care in Britain, and is not intended to represent a scientific study.
But the fact remains, patients in the care of NHS hospitals are still suffering pressure ulcers that are avoidable.
The Mail’s GP Dr Martin Scurr describes this as ‘scandalous’, asking: ‘How can patients in this era of amazing medical advance still be getting — and dying from — bedsores’
One of the main problems is that sometimes the elderly are not properly assessed for their risk of developing them, says solicitor David Kerry.
‘And even if they are assessed on admission to hospital and considered at risk, they’re still not turned and given interventions, such as air mattresses, which are much softer than normal mattresses, and so do not exert the same pressure on areas such as the heels and back.
‘There also seems to be a situation arising where nurses think they are over-qualified to do basic tasks, or are over-burdened with bureaucracy.
'Sometimes nursing becomes so much of a form-filling episode that they don’t have time for basic care.’
Andrea McGoverin, who now teaches communication skills to medics, believes ignorance is also a factor.
‘I think the problem was that many of the junior midwives simply didn’t know about pressure sores,’ she says.
‘But when I trained as a nurse it was a crucial part of our teaching.
‘Now, Leeds University, which has links to the hospital, asks me to come back every year to explain to their newest intake of midwives about the danger of pressure sores, and the maternity unit assess all patients for risk of pressure ulcers.’ Andrea also now researches the problem through the Pressure Ulcer Research Service User Network (PURSUN).
A lack of training and basic equipment such as hoists and mattresses are often cited by healthcare professionals as key factors that can lead to the formation of pressure ulcers.
So, too, is lack of staff, says Mark Collier, a NHS tissue viability nurse, speaking on behalf of the Royal College of Nurses.
‘Moving and turning patients is incredibly labour-intensive. Even with a hoist it requires two nurses. Since the Eighties, the number of fully trained staff on a ward has gone from five or six to two per shift.
‘And whereas nurses have around six hours of training in pressure ulcers, healthcare assistants may get only one hour.’
Another problem is the lack of specialist care. Under Department of Health rules, all incidences of grade three or four bedsores must be investigated by the hospital.
This involves calling in a specialist — a tissue viability nurse — to find out what went wrong and prevent the problem in future, as well as helping treat the patient.
However, these specialist nurses are over-stretched: last year, a report from the Patients’ Association revealed that each NHS acute trust (which can be responsible for more than two major hospitals) employs an average of 1.6 tissue viability nurses.
This compares to 5.2 infection control nurses, who are charged with preventing deaths from hospital-acquired superbugs.
Three months ago, it was announced that pressure ulcers will be included in a list of 60 ‘patient outcome measures’ in an NHS Operating Framework that will be used to assess quality of care.
These will be introduced throughout this year and 2013. Trusts will also lose some of their budget if they fail to meet their pressure ulcer targets.
In response to our report, Health Minister Simon Burns said: ‘We are determined to create a safer NHS, one where substandard care will not be tolerated. Bedsores are avoidable. We want to make sure that fewer and fewer patients suffer them.’
Will this be enough to tackle these unnecessary and hideous injuries
Katherine Murphy, from the Patients’ Association, says: ‘Time after time we are told that tackling bedsores is being made a priority, but still they continue to plague patients. What we need is mandatory monitoring of pressure sores.’
Bedsores ‘epitomise the deeply worrying rot at the heart of healthcare in this country’, says Dr Scurr.
‘It’s time something was done about it.’
The hospital where Pamela Goddard was treated has since apologised for the poor standard of care she received, but three years on, time has not diminished her son’s anger.
Adrian says: ‘My mother was a staunch defender of the NHS, which made it even more tragic when the system she championed let her down so badly and allowed her to die from something that is completely preventable.’
In response to our investigation, George Eliot Hospital NHS Foundation Trust said: ‘We firmly believe we are taking the correct action by recording all identified pressure sores, and would urge colleagues nationally to take the same approach and for standardised methods to be adopted across the NHS.’
Other trusts with the highest rates replied in a similar vein, and said that their vigilence was responsible for their high rates.
Trusts also disputed the findings on the basis that some hospitals didn’t record all four grades of pressure ulcers, meaning results will vary.
Just over a third of trusts who replied to our request either did not record grade one or only recorded grades three or four, and these are marked in the full table of results down below.
East and North Hertfordshire NHS Trust added: ‘As a trust, we report all pressure ulcers, from grade one to grade four. If you were to strip out the grade ones, this gives us a rate of 0.38, which is very much lower.’
Pennine Acute Hospitals Trust, which had the highest rate of grade four pressure ulcers, said: ‘We have been working closely with a number of our wards and have introduced several new measures. This work has led to a 50 per cent reduction in pressure ulcers on these wards.’
Health Minister Simon Burns said: ‘We are determined to create a safer NHS, one where substandard care will not be tolerated. Bed sores are avoidable. We want to make sure that fewer and fewer patients suffer them.
‘The new NHS Operating Framework includes measures to help hospitals tackle bed sores and monitor progress closely.’
See how your local hospital performed
Here we reveal the total number of inpatients who developed bed sores in the 12 months between June 2010-May 2011. It also shows the percentage of all inpatients the trust treated who developed a bed sore.
The third column shows the number of patients who developed just grade three and four bed sores – the most serious kind, which can lead to muscle loss and even reveal bone.
‘X’ means there is no data for that entry.
** These hospital trusts only provided data on bed sores from grade 2-4.
*** These trusts only provided data on bed sores from grade 3-4.
Note that even though some trusts did not record all grades of bed sores, they still ranked poorly in our table, suggesting that if the lower grades had been included their bed sore rates would have been even higher…
HOSPITALS ONE TO 42
HOSPITALS 43 TO 84
HOSPITALS 85 TO 114