Hospital chief executive 'steps down' amid concerns over patient death rates
Major investigation underway at Royal Bolton Hospital, ManchesterFour times as many cases of blood poisoning were recorded than would normally be expected at the hospital in a yearRaised fears over whether some patients may have been recorded as dying from septicaemia when they also had other serious conditions Jackie Bene, acting chief executive of Bolton NHS Foundation Trust and the person in charge of recording the information, has 'stepped aside'
Robert Francis renews call for a NHS culture change starting today
He said: 'Wrong that hospital security and cab drivers face more regulations than worker 'cleaning the bottom of your grandmother'

, although a similar-sized trust would expect to have just 200.

This has raised questions about whether some patients may have been recorded as dying from septicaemia when they also had other conditions that should have been treated or prevented.

A death from septicaemia is classed differently to one from, say, pneumonia, where more questions are likely to be raised as to why it happened.

A major investigation is now under way and Dr Jackie Bene, acting chief executive of Bolton NHS Foundation Trust, has stepped down. Dr Bene was in charge of recording the information.

It came on the eve of a crunch meeting for much-maligned NHS boss Sir David Nicholson, who is refusing to quit despite presiding over catastrophe at Stafford Hospital.

Sir David’s fate lies in the hands of the 19 directors on the NHS Commissioning Board, which will hold its first meeting since the Francis report into the Mid-Staffordshire scandal on Thursday.

Campaigners
whose loved-ones died unnecessarily at Stafford and other hospitals are
expected to picket the Manchester conference tomorrow morning.

In a speech to health professionals today Robert Francis QC said that workers should not wait for
Government recommendations to implement a change of attitudes towards
care in the health service.

The discrepancies at Bolton were identified by the independent health watchdog, Dr Foster, which compiles mortality statistics for all trusts each year.

Four times as many deaths were recorded as from septicaemia - and not included in mortality figures - than would normally be expected at the Royal Bolton Hospital, Greater Manchester.

Four times as many deaths were recorded as from septicaemia – and not included in mortality figures – than would normally be expected at the Royal Bolton Hospital, Greater Manchester.

Today in a statement, Bolton NHS Foundation Trust said: 'The issue
is the way in which some conditions and some causes of death were
recorded on the Trust’s administrative system. It does not change the
number of people who have died.

'And it does not change the facts or reliability of a patient’s death certificate.'

It continued: 'We do not believe that
there are any clinical concerns regarding the care of patients, but
rather there are questions that need answering about how the trust
reports information about their care for administrative and financial
purposes.

'The steps we have taken will provide
the Trust and our community with information about what has happened,
any steps that need to be taken and any lessons that may need to be
learned. The Trust will report back on this in public.'

If Bolton NHS Foundation Trust's deceased patients
have been coded incorrectly as dying from septicaemia – when they had a
different cause of death – it could have a drastic impact on the Trust's
death figures.

The coding could also affect income, as
hospitals receive money for results and types of illnesses – and septicaemia
receives a higher payments than other infections.

Dr Foster and Bolton's Clinical Commissioning Group (CCG) are now investigating the septicaemia cases.

Their
report, which is supported by NHS Commissioning Board and Professor Sir
Bruce Keogh, the UK's national medical director, is expected to be
completed on March 6.

It
is too early to say why the Trust had so many cases of septicaemia, but
the CCG said its interim findings for 50 of the cases show 'cause for
concern'.

It is believed patients' records could have been coded incorrectly causing the 'discrepancies'.

Pressure: NHS boss Sir David Nicholson will face protests at a Commissioning Board meeting tomorrow as he resists calls to resign

Pressure: NHS boss Sir David Nicholson will face protests at a Commissioning Board meeting tomorrow as he resists calls to resign

After six years as one of the worst performing trusts for death rates, Bolton recorded a significant improvement in 2011 and the death rate was in line with expectations for a trust of that size, according to Dr Foster figures.

On Monday,
the Trust's interim chairman David Wakefield informed staff that Dr Bene
had 'stepped aside' to 'allow a fully independent view to be taken'.

Mr
Wakefield, who was appointed by health watchdog Monitor after the Trust
was put in the highest risk rating for governance and finance, said an
independent team would be brought in to look at coding practices.

He
said the Trust wanted to 'rule out any serious issues as soon as
possible' and make sure the way they code patient outcomes meets
'highest quality standards'.

He stressed the 50 cases would be
reviewed by clinical staff to rule out any serious issues, and if there
were any concerns with care then families would be contacted.

But
he added: 'We do not believe that there are any clinical concerns
regarding the care of patients, but rather there are questions that need
answering about how the trust reports information about their care for
administrative and financial purposes.'

Dr
Wirin Bhatiani, chairman of Bolton Clinical Commissioning Group, said
it first became aware of the 'unusually high' number of septicaemia
cases in October and commissioned Dr Foster to carry out an independent
audit.

Investigation: Death rates at trusts all over the UK are being looked at after up to 1,200 patients died unnecessarily in Stafford Hospital between 2005 and 2008

Investigation: Death rates at trusts all over the UK are being looked at after up to 1,200 patients died unnecessarily in Stafford Hospital between 2005 and 2008

Pressue: Groups like 'Cure The NHS' have been created in the wake of the scandal, led by campaigner Julie Bailey, pictured in front of a memorial wall for the dead

Pressue: Groups like 'Cure The NHS' have been created in the wake of the scandal, led by campaigner Julie Bailey, pictured in front of a memorial wall for the dead

CCG chiefs
discussed concerns with the Trust, Monitor, quality experts from the
Strategic Health Authority in the North, NHS Greater Manchester and the
Care Quality Commission on January 24.

Dr
Bhatiani said: 'While we are keen to wait for the final report, we are
sufficiently concerned by the interim findings to commence further
investigations, and to inform the chair of the trust.

'When
the final report is available on March 6, we will present the findings
openly and transparently, reflecting the fact that the Bolton public are
our main concern and priority.'

The new scandal comes just weeks
after a public inquiry into Mid Staffordshire NHS Trust found up to
1,200 patients died needlessly between 2005 and 2008 because bosses put
government targets ahead
of patient safety.

The NHS chief executive is already under pressure to quit after presiding over the scandal.

Sir David Nicholson was previously head of West Midlands Strategic Health Authority
between 2005 and 2006 – the body supervising Mid Staffordshire – but
failed to pick up on the horrific standards of care.

Campaigners
whose loved-ones died unnecessarily at Stafford and other hospitals are
expected to picket the Manchester conference tomorrow morning.

Campaigners have called for him to quit his 211,000 post, which
he has held for six years, following the public inquiry into the
failings.

Tomorrow morning Cure the NHS will stage a silent
protest outside the meeting in Manchester to demand Sir David be held to
account. Its founder, Julie Bailey, said the campaign group would
demonstrate at every board meeting until the under-fire civil servant
resigned or was sacked.

Meanwhile the chair of the
public inquiry into the 'disaster' at Stafford Hospital said culture change in the NHS must happen immediately.

Robert Francis QC today reiterated some of his
recommendations in the damning report this month, including his call for a registration database for
healthcare support workers.

'Isn’t it odd that the security
guard at the door of the hospital, the driver of the minicab who takes
you there, have more regulation attached to them and more sanction
available to their supervision than does the support worker who is
cleaning the bottom of your grandmother' he said.

'NHS CULTURE CHANGE MUST HAPPEN NOW', SAYS STAFFORD REPORT QC

Robert Francis QC

Culture change in the NHS should happen immediately, the chair of the public inquiry into the 'disaster' at Stafford Hospital said.

Robert Francis QC (right) said that healthcare workers should not wait for Government recommendations to implement a change of attitudes towards care in the health service.

Mr Francis’s report into Mid Staffordshire NHS Foundation Trust highlighted the 'appalling and unnecessary suffering of hundreds of people' between 2005 and 2009.

He made a total of 290 sweeping recommendations for healthcare regulators, providers and the Government.

In his first public appearance since publishing the report, Mr Francis told healthcare professionals at The King’s Fund: 'We are of course waiting for the Government’s response to the recommendations.

'But why are we waiting There is much in this report that doesn’t require a change of law, it doesn’t require a policy guidance from the Care Quality Commission.

'It doesn’t require anything other than a change of attitude on the part of people.

'Everyone in this room who has a job in the health service can walk out and actually start doing something that makes a difference.'

Mr Francis said the 'first and foremost' thing that healthcare workers could do was to listen to those who have complaints because 'there is almost always something you can do about it'.

He also reiterated some of his recommendations, including his call for a registration database for healthcare support workers, saying: 'Isn’t it odd that the security guard at the door of the hospital, the driver of the minicab who takes you there, have more regulation attached to them and more sanction available to their supervision than does the support worker who is cleaning the bottom of your grandmother

'We have to have a system where those who are unfit for the job are excluded from doing so.'

He said that patients should be put first in a set of values which each healthcare worker should commit to.

He also said there should be “no tolerance” for breaches of fundamental standards in care.

Quoting Florence Nightingale, who said it was a strange principle to have to say that the very first requirement of a hospital is that it should do the sick no harm, Mr Francis said: “Also in 1860 there she was saying ‘what can’t be cured must be endured is the very worst and most dangerous maxim for a nurse’.

'Unfortunately we have now found that it was a maxim that was prevalent in the National Health Service at numerous levels even today.'

NHS Medical Director Professor Sir Bruce Keogh said: 'If we’re to have an open and accountable NHS, where patients and the public know how NHS hospitals are doing, those hospitals must behave openly and honestly about their performance.'

'There are clear national guidelines on how death rates should be recorded, and I expect all NHS hospitals to follow them.'