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A Dignified Revolution Newsletter: July 2013

”Never doubt that a small group of thoughtful committed citizens can change the world – indeed it is the only thing that ever does” (Margaret Meade)

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In the last month the Care Quality Commission (CQC), under the direction of its newly appointed Chief Executive, has come under fire following the publication of a report carried out by Grant Thornton on behalf of CQC. It reveals the failures in CQC’s oversight on University Hospitals Morecambe Bay (UHMB) in 2010. It highlights false assurances which were made to both the public and Monitor and the slow pace of action taken by CQC following the identification of failures at the UHMB. Police have now been asked to investigate allegations of the cover-up stemming from the health regulator’s failure to investigate an alarming rise in deaths in Morecambe Bay NHS Trust hospitals.

Roy Lilley’s assessment of the new brooms in the CQC makes an interesting read.

Christine Green, Chief Executive of Tameside Hospital NHS Foundation Trust in Greater Manchester has tendered her resignation amid claims of poor care. Tariq Mahmood, the hospital’s medical director, is also understood to have stepped down, but his resignation was agreed in April.

And, Betsi Cadwaladr Foundation Trust Chief Executive and Chairman are stepping down following a damming Welsh Audit Office report. It was reported that operations have been delayed and waiting lists allowed to grow at hospitals in north Wales to avoid financial problems getting worse and significant management failings risked patient safety for under-reporting infections.


Delivering Safe Care, Compassionate Care is the Welsh Government’s response to the report by the Francis Inquiry into standards of care at the Mid Staffordshire NHS Foundation Trust.  The measures include:

  • a commitment to update the current complaints procedures
  • a review of the Fundamentals of Care standards by focusing them on individuals and their needs
  • a continued ban on gagging clauses in the Welsh NHS

We like:

  • Annual quality statements for each NHS organisation.
  • The potential benefits of acuity workforce tools in nursing as a guide to staffing levels.
  • The measurement and reporting of patient and staff satisfaction
  • The use of feedback from patients based on The Listening Organisation
  • The system to examine in-hospital death records
  • 25% of the local workforce to be trained in quality methods (although 25% is too low and why not include Welsh Government staff?).
  • The regular publication of acute hospital level risk adjusted mortality figures
  • The mortality and transparency taskforce.

We are not keen on:

  • Lack of measurable outcomes
  • The reference to the results from the staff survey which show that 78% staff said their employer encouraged them to report incidents, without mentioning that 26% had seen an incident in the last month and that only 56% thought that their organisation would take action.
  • References to a plethora of other strategies – it makes it difficult to read and it means that’s there’s no single clear message.  What we want to know is, for example,  what are the most important five key things that will change?
  • Too many aspirations, such as “Achieving shared values and expectations”, and not enough SMART actions.
  • Well-worn clichés, for example “Doing the right things well”, which suggest a lack of critical thinking
  • Sound bite statements that can’t be evidenced – “We will be clear about our expectations, the standards we expect and what good looks like, with clear thresholds and tolerances. It builds on the many things that we already have in place in NHS Wales to drive continuous improvements in the delivery of safe, compassionate care.”
  • Too many soft actions:  “review”, “commitment”, “agree”, “develop”, “support”, “research”, “focus”, “consider”.

What do you think?  Please send us your comments and we will include them in the next newsletter.

Scroll down to read more news.



Each year The Winston Churchill Memorial Trust awards over 120 Travelling Fellowships to British Citizens from all walks of life and from all over the United Kingdom. Fellows gain experience abroad in a wide range of interests, and bring back benefits and positive change to their profession and the UK as a whole. The 2014 application process is now open and within the Medicine, Health and Patient Care category the Trust is specifically looking for people to apply with projects that have an emphasis on the respect for the dignity of the patient.



During the last month we have written to:

  • An Executive nurse at Abertawe Bro Morgannwg Health Board to ask what progress is being made regarding the review of the DNR policy following a complaint made by a patient’s family. To date, we have received no response
  • Healthcare Inspectorate Wales (HIW) to ask when the Morriston hospital action plan – in response to the recent report following an unannounced Dignity and Essential Care inspection – would be posted on the HIW website. On 13 June we were informed that “we published our Dignity and Essential Care Inspection (DECI) report in April 2013, however we are awaiting a completed action plan from Morriston Hospital in response to our report and once this has been received we will ensure it is published in due course”. 
  • We responded to ask whether a timescale is set for the Health Board to respond. HIW replied to say. “You are correct we do set a timescale for the Health Boards to provide an action plan in response to their DECI report.  In the case of ABMU, they have not met this timescale, however we are currently in liaison with the Health Board regarding both the delay and to ensure their action plan fully addresses the requirements of the recommendations we have made. Ultimately we aim to work with the health board to ensure their action plans fully meet the requirements as a priority over the promptness of their response. On 9 July there was still no sign of an action plan on HIW website
  • We wrote to Care & Social Services Inspectorate Wales (CSSIW) because we hadn’t received a response to an email of 23 May regarding Merton Place Care Home.  The response we received was as follows:

The Inspector and Area Manager attended an escalating concerns meeting where the issue of non-compliance was discussed and evidence was provided at the meeting confirming that compliance in the majority of areas had been achieved. The only area of outstanding concern was the one relating to medication and that was therefore the subject of a further focussed inspection to gain evidence to determine whether compliance had been achieved.

  • We do not routinely report on when compliance has been achieved as this would necessitate the production of a further report which would supersede the inspection report.
    We feel that it would be helpful if CSSIW posted this information on its website to show that improvements have been made. We have been in contact with the Director of Care & Support from the home who has confirmed that “there has been a strong commitment both in terms of learning lessons and ensuring our residents receive high quality care. We have come a long way and this has been recognised by all concerned, the home is also almost fully occupied now”.



The Newsletter makes for compelling, though uncomfortable reading. Yet again I have circulated to all Directors and Heads of services.

Thanks again for highlighting some awful practices (and awful people).  It is only by being open and making people aware that things will change for the better.  Another good, informative, and in some cases, somewhat disheartening newsletter.

Keep up the good work.

So much still going on – it’s quite unbelievable that older folk are being treated so poorly.  These are the people who helped our country through the war and have paid into the NHS just like everyone else – and yet when they become a certain age, are treated as though they should just put up with being ignored of their rights. 

Thank you once again for all the help that your organisation is doing for the care of the elderly. It means so much that there are people who are so caring.

We have two problems with care in this country….bad care workers/nurses who don’t give a damn….and secondly a system that fails/refuses to expose the truth. As someone who has reported care abuse I know exactly what I am talking about. The elderly in this country have been disgracefully let down and it’s going to get a lot worse  because of the inactivity of government to do something about it.

I have been looking around for a few weeks now and I think it is very useful. Carry on with the excellent work folks. There are many interesting and knowledgeable discussion threads in this forum. The forum community has the knowledge and sense about the discussion topics.



Dying well at home: the case for integrated working

This SCIE guide is about enabling people who want to die at home to do so and improving the quality of care they receive.

Dying Matters to launch in Wales

The work of the Dying Matters coalition is to be extended to Wales as part of the Welsh Government’s new End of Life Care Delivery plan.

Listening to patients will help improve care

A new white paper from 1000 Lives Plus explains how listening to patients and understanding what it feels like to experience care is a key way for NHS Wales can improve its services. Click here to download a copy

Information Now – The Newcastle Older People’s Website

Information Now has been re-launched.  Click here to see the exciting new features in action and discover how Information Now could be useful to you and the people you know or work with.



Mike Richards to become first chief inspector of hospitals

A doctor credited with instigating significant improvements in NHS cancer care has been appointed as the first chief inspector of hospitals for England. Source: Guardian.

Duty of candour: supporting nursing students in practice

support service at the University of Southampton has found students have an important role in improving the quality of care. Source: Guardian Health News.

Medical students set bad example by doctors

Research from Cardiff and Dundee universities suggests that young medics often witness behaviour, or are asked to do things, that they don’t agree with. Surveys and interviews with hundreds of British medical students show that some senior doctors setting far from a good example. Source: BBC News.

Surgeon allowed to work despite inquiry into 10 deaths

A surgeon was allowed to operate on patients by an NHS trust even though he was under investigation over at least 10 deaths. Source: Telegraph

Continuing NHS Healthcare framework delivers improvements but more progress needed

A new report from the Wales Audit Office says that the implementation of the Framework for Continuing NHS Healthcare has delivered some improvements, but more needs to be done to ensure consistency and fairness across Wales

Review into wrongly charged care costs announced

A review into whether people are being denied funding for nursing care has been announced by the health secretary. It follows a BBC Scotland investigation which discovered thousands of people were wrongly told they did not qualify for funding for nursing home fees. Source: BBC Scotland News

Ways and Means

This DEMOS report highlights factors which contribute to inequalities in end of life care.

Palliative and end of life care for black, Asian and minority ethnic groups in the UK

This Public Health England commissioned report highlights the growing need to make end of life care more accessible and appropriate for minority ethnic groups.

Hospital staff share knowledge to improve patient experience

Dorset County Hospital is using staff knowledge to improve patients experience and implement new ideas. Source: Dorset Echo.

Patients asked to vet standards of hospital care

Patients are being asked for their views on a radical overhaul of care standards for NHS hospitals in England. The Care Quality Commission (CQC) has outlined its new plans to judge doctors and nurses on key patient rights such as the right to enough food and drink. The aim is to avoid another scandal like that at Stafford Hospital, where hundreds of patients died amid appalling levels of care. Source: BBC News.

Audit shows patient experience continues to improve

Patient satisfaction on aspects of care including nutrition, personal hygiene, dignity in care and communication with staff continues to improve according to the latest report from the Chief Nursing Officer for Wales.

Fear of raising concerns about care

CQC survey has  people are unlikely to raise a concern or complain about poor care because they did not  want to be thought of as a trouble maker and that it wouldn’t make a difference if they did. A small number said they feared their care would get worse if they spoke up.

NHS governance of complaints handling

This Parliamentary and Health service Ombudsman publication reports the results of a survey of NHS trusts across England and found that the majority of leaders of NHS hospital trusts believe that they are failing to use information from complaints as well as they should because the data boards receive lacks the right quality and detail.

Hospitals block patient complaints on legal grounds

Hospitals are routinely using the threat of legal action to block investigations into medical blunders, patient safety campaigners have claimed, as they threaten a legal challenge against the Health Secretary. Source: Telegraph.

NHS negligence claims rise by 20 per cent in just one year

Official figures show the number of cases registered has increased by almost 20% in just one year – and by 80% since 2008.  Source: Telegraph.

NHS chief Sir David Nicholson admits culture of denial

The NHS in England has a culture of denial and defensiveness when it comes to handling complaints from patients, Sir David Nicholson has admitted. Source: BBC News

NHS chief denies gagging order ‘cover up’

Sir David Nicholson, the head of the NHS in England, has strongly denied being responsible for a cover-up over the use of gagging orders to prevent staff speaking out about conditions in hospitals.

Bullying ‘creates toxic NHS culture’

culture of bullying and secrecy has created a toxic working environment in the NHS, doctors say. Source: BBC news

Confidentiality clauses and special severance payments

This NAO report suggests that there is a lack of transparency, consistency and accountability in the use of compromise agreements in the public sector, and that little is being done to change this situation. It cites the whistleblowing over emergency care in the Mid-Staffordshire NHS Foundation Trust and other NHS bodies as examples.

Hospitals have spent £2m on gagging orders for staff

Hospitals have spent £2m on more than 50 gagging orders preventing staff speaking out, a Freedom of Information Act request has revealed. Source: Guardian

The NHS needs a culture change

The health service’s response to the Francis inquiry should be to engage and empower both staff and patients. Source: Guardian.

Doctors admit problems with Liverpool pathway for dying

Members of the British Medical Association said dying patients may have been put on the Liverpool Care Pathway when it was not appropriate because hospitals were offered financial incentives to use it. Source: BBC News

Hospital apologises after 100-year-old woman dies of dehydration

Leicester Royal Infirmary has apologised for a catastrophic error after a 100-year-old great-grandmother died from dehydration on one of its wards. Source: Guardian

How important is compassion in healthcare?

Parts of the NHS have come under fire in recent months, with David Cameron among those calling for health professionals to show more compassion. But Tom Shakespeare asks if there are dangers in placing too much emphasis on empathy. Source: BBC News magazine

Older patients at high risk of hospital falls

Healthcare professionals should consider patients aged 65 or older, and those aged over 50 with underlying conditions such as stroke, at high risk of falling while in hospital care, according to updated guidelines from NICE.

Walsall Manor Hospital admits three patients died after falls

Three frail patients have died after falls at Walsall Manor Hospital, in the last three months. Walsall Healthcare NHS Trust admitted numbers of falls remained “unacceptably high”. Source: BBC News.

Dementia Awareness Week: a family carer’s message to professionals

Carers should be recognised as advocates and their views integrated into assessments and care packages. Source: Guardian

Statutory Framework for Advocacy

Gwenda Thomas, Deputy Minister for Social Services has issued a written statement called Framework for Advocacy indicating her commitment to table an amendment to the Social Services and Well Being Bill (Wales).

Research reveals extent of elder abuse

HelpAge International has published the results of research which that reveals the high levels of violence and abuse experienced by older women and men around the world.

Mid Staffordshire

Stafford Hospital deaths: Wreaths to be laid in memory

Hundreds of people who died needlessly at Stafford Hospital because of poor standards of care have been remembered at Westminster. Source: Central ITV.

Failure of care nurses keep job

Two nurses at Stafford hospital who failed to give basic life support to a dying pensioner and recorded in notes that he was sleeping when she was actually dead have been allowed to keep their jobs. Source: Express & Star.


Stafford Hospital campaigner Julie Bailey sells cafe

The woman who led the campaign to expose failings at Stafford Hospital has sold her cafe. She has said she wants to leave Stafford because of safety fears due to lies about her wanting the hospital closed. Source: BBC news

Social and Residential Care


CCTV footage reveals domestic care neglect

The BBC has obtained footage showing multiple failings in the home care provided by a company to one woman – as ministers warn the next abuse scandal may come in the sector

MP urges care home abuse law change

An MP wants a change in the law after the collapse of the UK’s biggest investigation into alleged abuse at old people’s care homes in south Wales. Operation Jasmine started in 2005 and cost £11.6m, but was put on hold after Dr Prana Das, the homes’ owner, suffered brain damage in a burglary. Source: BBC News

Care staff suspended over abuse claim

A number of staff members have been suspended at a Limavady Care Home as the PSNI investigates allegations relating to the abuse of vulnerable adults. Source: UTV.

Care Quality Commission monitoring deaths in homes

Death rates in care and nursing homes in England are to be monitored by the Care Quality Commission to try to identify problems at an earlier stage. Source: BBC News

Call for resuscitation clarity after disturbing death

Five organisations have received coroner’s letters highlighting the disturbing death of a woman after paramedics were called to a care home. Source: BBC News.



If you have any information that you would like to share with others please let us know and we will be happy to circulate it in the next edition of the newsletter.

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