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Thursday, 31 July 2014

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Hospital trust made ‘error of judgement’

A BELEAGUERED hospital boss has admitted his trust made an “error of judgement” when it failed to share the results of an internal review.

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MISTAKE: Tony Halsall, chief executive of the University Hospitals of Morecambe Bay NHS Foundation Trust, which runs Furness General Hospital.

Tony Halsall, chief executive of the University Hospitals of Morecambe Bay NHS Foundation Trust, was grilled by members of Cumbria County Council’s health and wellbeing scrutiny committee in Kendal yesterday.

The trust, which runs Furness General Hospital, is subject to probes into maternity, emergency care, governance and paediatrics.

And Cumbria police is carrying out an investigation into a number of deaths at the maternity unit.

Councillors had called for answers over why the recommendations which came out of an internal review carried out in 2010, called the Fielding Report, were not shared with the primary care trust until September the next year.

The trust’s chief executive, Tony Halsall, admitted it was down to an “error of judgement” on the part of the UHMBT and assured the committee drastic improvements had been made and would continue to be.

Representatives from the primary care trust, health watchdogs, top professionals and regulators noted a “change in culture” of midwifery staff at the UHMBT, but doubts have been cast over the long-term sustainability of an obstetrics unit.

The UHMBT has put together a comprehensive strategy, bringing a number of reviews and reports together to create one action plan, which includes re-training 150 members of staff in risk management.

This comes on top of the recruitment of 11.4 full-time equivalent midwives – 50 per cent of whom will work at FGH – and an obstetrician who will be based at the Barrow hospital full-time.

Therese Chapman, a midwife with Imperial College Healthcare NHS Trust in London, was drafted in to work on the “shop floor” with staff at FGH and the trust’s other two sites towards the end of last year.

She told the committee: “I carried out a number of visits in October, November and December for seven days at a time, rather than just capturing the nine to five, to get under the skin of services.

“Over the three months I was visiting I could see a significant change in the cultural sense from midwifery practice, perspective and decision-making. Staff were articulating the course of their decision-making and able to verbally account for it, as well as on paper with records. There has been a very positive shift in direct practice and professional accountability.”

Helen Pearce, midwifery adviser for the Nursing and Midwifery Council, said: “We support what they are saying. When our review team came back, the supervisors were enthusiastic, motivated and knew what was required.”

Dr Mike Bewick, medical director at NHS Cumbria, has been part of the “gold command” team overseeing a number of issues at the trust.

He told councillors: “I suppose the question you all want to ask is whether we are as convinced as the hospital? Well, the answer to that is yes.”

While the feedback councillors received was largely positive, all parties confirmed improvements were still in the early stages.

Mr Halsall also used the meeting to voice concerns over the long-term future of the obstetrics unit at FGH.

He said: “There are going to be major changes to the clinical model for obstetrics, which will make it very difficult to sustain a small unit which needs high-level senior doctors looking after a small number of patients.

“It’s all very well to say we’ll be OK for the next couple of years, but we need to put together a plan which will ensure the longevity of the unit.”

Trust board members and primary care trust representatives assured the meeting no decision had been made and the public would be consulted on the matter.

Have your say

It is my firm belief that the reason why the Fielding report was not disclosed to PCT (or anyone else), is because Tony Halsall was concerned that such serious issues about the safety of maternity services might damage his trusts application for Foundation Trust status. So very sadly, and with tragic consequences, the report was buried and its recommendations not implemented with sufficient pace. My thoughts are with those parents who lost babies at FGH due to issues which the Fielding report identified but sadly, were not addressed in time. I am sure that they will find little comfort from Mrs Halsalls admission that this was an error of judgement. Mr Halsall should hang his head in shame and resign immediately.

Posted by Steve on 2 February 2012 at 09:03

It wasn't 'an error of judgement'. It is clear from the statements made by Monitor when it had to step in and force various reviews and external advisers on the trust in October, that this report was concealed not only from the PCT, but from the full Trust Board as well. It doesn't come any more deliberate than that, but if it hadn't been for the South Cumbrias Coroner's letter after the Titcombe inquest, the management would probably have got away with it.

Posted by WilliamT on 1 February 2012 at 19:45

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