Monday, 5 March 2012

The Storm Breaks

The meeting at Richmond House.

A couple of days before the release of the report all the key people involved were gathered at Richmond house to meet Alan Johnson, and discuss how the report was to be released. Drafts of the report had been circulating, giving different bodies a chance to respond to the sections that concerned them. Feelings were running pretty high. Someone, and we do not know who this is, brought to the meeting a new appendix, which raised the matter of “excess deaths” This – and we do not know the wording – apparently said that 400-1200 people may have died as a result of poor care.  The feeling of the room was very clear. These figures were an extrapolation from the HSMR figures which were generally known to be misleading for the reasons previously discussed. The extrapolation in itself is something that the HSMR system is not designed to do. It would be very damaging to public confidence, and it would be upsetting for people in Stafford who had lost family and were left wondering if they should have acted differently.
Recommendations were made to Sir Ian Kennedy Chair of HCC that the figures should not be published, and he makes it clear that he made up his own mind not to do so. The instructions were given that the appendix should be destroyed. 
The leak to the Mail.
The day before the release of the HCC report there was an article in the Daily Mail. This article brings together the Excess deaths, a quote from Bill Cash about the way in which Cynthia Bowers from the CQC and David Nicolson from the DoH were implicated in the tragedy, and stories from Julie Bailey.
The storm breaks.

This prepared the ground for the release of the HCC report and Stafford found itself at the heart of a major media storm, In which the Excess deaths of 400-1200 are quoted as simple fact, as the background to the expertly presented  stories of the bereaved.
SoS Alan Johnson made what can in hindsight be perhaps seen as a misjudgement.  He was I think completely right in ordering quickly the A&E expert George Alberti to go to Stafford and ensure that everything was put right as soon as possible. He was right to call in Dr Colin Thome to investigate why the early warning systems had failed, He was right to call for a case note analysis that would allow any patients or relative who had concerns to go through their records with an expert to see if mistakes were made.
I think that his reluctance to start talking about statistics was understandable, and it is infact not until I had seen the evidence at the public Inquiry that I really felt confident in saying why these figures were misleading. But by steering clear of these figures the idea of the excess deaths was allowed to take hold.
David Nicholson may also have made an error of judgement at this point. He again did not choose to challenge the excess death figures, It is clear from the evidence given by the DoH to the Inquiry that the understanding of the value and limitations of the HSMR figures within the DoH was at best uncertain, and of course Professor Jarman’statement that the Excess death figures were not something that he recognised would not be publicly available until the publication of the Francis report in 2010. David Nicholson did not question the HCC report, or more specifically the press coverage of the report. He made the assumption that whatever it was that had happened at Stafford this was a one off.
One of the big gaps in the Public inquiry from my point of view is that it did not interview Andrew Lansley. We have no idea of what he knew when, and who if anyone was briefing him, but the fact that no one was publicly questioning the media version of events meant that he simply may not have known that there was any reason to doubt them. The quality of information available to ministers is as the public inquiry shows us pretty variable. The quality of information available to the opposition is probably worse.   He continued to use the excess death figures, certainly up until the release of the Robert Francis report in 2010, and they were used either directly, or by implication in the conservative election campaign.
The Effect of the Storm.
The effect of the storm on Stafford should not be underestimated.  Whatever the problems that may have existed prior to March 2009, they were compounded by the level of attention from regulators and from the press. In Stafford we are still suffering the effects of this today, as the A&E is closed part time, and the hospital continues to fight to ensure it has a secure future. 

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