High mortality rates a concern at Lanarkshire Hospitals

Last Thursday (12th September) in Parliament I questioned the Scottish Government over the revelations that two NHS Lanarkshire hospitals recorded the highest levels of mortality in the country. I asked the Cabinet Secretary for Health and Wellbeing Alex Neil what action the Scottish Government was taking to ensure patient safety at Monklands, Wishaw and Hairmyres hospitals.

My question came shortly after the news that Monklands, in the Cabinet Secretaries own constituency, and Wishaw were singled out for their ‘high standardized mortality ratios’ in the official data on hospital deaths published on the 27th August.

Whilst these figures must be met with a great deal of scrutiny, we must look underneath the numbers and find out what is really going on.

I welcome the news that a review will be carried out by Healthcare Improvement Scotland and I look forward to reading the findings of their investigation. In the meantime I would urge the Scottish Government to do everything in its power to ensure that all the necessary steps are taken to reverse this worrying trend. The priority here is that the highest quality of care is provided to the people of Lanarkshire as patient safety is paramount.

My question and the response I received can be read on pages 6 and 7 of this document.

Nothing but respect for Monklands Hospital

In an article and letter in this week’s Airdrie and Coatbridge Advertiser I was accused of having some kind of “agenda” against Monklands Hospital.

The accusation related to the Modernising Mental Health proposals currently undergoing review by NHS Lanarkshire at the behest of the Cabinet Secretary for Health and Wellbeing, Alex Neil (who is also MSP for Airdrie and Shotts).

This accusation is, to be frank, complete and utter nonsense. As a young child I spent a lot of time of at Monklands, and I have nothing but respect and gratitude for the hospital and its staff.

It saddens me that some people – including those who should know better – feel the need to turn any debate about health provision within NHS Lanarkshire into a debate about Monklands Hospital.

For what it’s worth (and as I made clear in the response I gave to the Advertiser) at no point have I ever called for services to be removed from Monklands Hospital. What I do want, however, is what is best for patients throughout the whole health board area.

NHS Lanarkshire’s Modernising Mental Health proposals were the product of a lot of hard work and a lengthy consultation process. They were supported by health professionals and service users and the previous Cabinet Secretary for Health, Nicola Sturgeon MSP. They were also in line with the Scottish Government’s own Mental Health Strategy.

As such, I was surprised and disappointed that just 10 days after becoming Cabinet Secretary for Health, Mr Neil ordered NHS Lanarkshire to suspend and review the proposals. The cost of that decision can be seen by the fact that, almost six months on, no alternative plans have been produced.

Some people will continue to resort to petty and personal attacks. I prefer to deal in facts.

I believe decisions over local health services should be taken locally; that Scottish Government policy should not be changed at the drop of a hat (or the reshuffle of a cabinet); and that a health board has a duty to act in the best interests of all of its patients, wherever they happen to live.

Consistency is key in provision of health services

I was pleased to have the opportunity to speak in last week’s debate in the Scottish Parliament on the Scottish Government’s Mental Health Strategy. My contribution to the debate can be viewed here, at 44.50.

Mental health is still dogged by stigma and ignorance, with many people still unwilling to admit its legitimacy or potential severity.

Mental health problems are closely linked to, and exacerbated by, stress and anxiety. With the economy stagnant, jobs at a premium and welfare reforms and revised capability assessments cutting away at the social fabric, today’s society is, for increasing numbers of people, especially in poor and deprived areas, a worrying place to be.

It comes as no surprise, then, that a study conducted by a group of Glasgow based GPs has reported a stark rise in the number of patients reporting with poor mental health.

Against this backdrop, I welcome the Scottish Government’s commitment to improving Scotland’s mental health, as outlined in its Mental Health Strategy.

But a Mental Health Strategy is of little practical use if it is not adhered to.

For the past few years NHS Lanarkshire has been working to improve its mental health services and to shift the emphasis of care from inpatient to community based provision (as recommended by the Mental Health Strategy).

NHS Lanarkshire’s Modernising Mental Health proposals, which had the full support of the previous Cabinet Secretary for Health, Nicola Sturgeon, as well as that of local service users, were due to be presented to the NHS Lanarkshire board in September 2012.

However, the new Cabinet Secretary for Health, Alex Neil MSP, intervened and instructed NHS Lanarkshire to revise the proposals. According to an email sent last September (2012) by officials in the Scottish Government’s health department, a final decision will be made “soon”. It is now Janauary 2013, and we are no further forward.

As a local MSP – for Airdrie and Shotts – Mr Neil was a vocal critic of NHS Lanarkshire’s proposals. However, as the Ministerial Code makes abundantly clear, Ministers should exercise extreme caution before intervening in portfolio matters within their own constituencies (a fact that Mr Neil recognised, albeit belatedly).

Given that the plans were supported by Mr Neil’s predecessor, I find this apparent volte face by the Scottish Government both frustrating and confusing.

Consistency is a valuable commodity in politics, as in life. This is perhaps especially so in the provision of health, where the right decisions are not always the easy ones.  

There is little use in publishing a Mental Health Strategy only to refuse to implement it in practice, whatever the underlying reason.

I do not know what the future holds for the future of mental health provision in NHS Lanarkshire. All I want is what is best for service users. That is what they deserve, and I hope that is what they get.

Monklands Hospital report makes for sobering reading

The report published by the Health Inspectorate following its announced inspection of Monklands Hospital was a sobering read.

Although the report highlights some areas of strength, it also identifies significant shortcomings, including:

• A lack of training with moving and assisting patients, with examples of patients being “heaved” and “pulled” up the bed. Records show that staff had not received the appropriate “mandatory” training since 2010.
• Non-compliance with the national policy on Do not attempt Cardiopulmonary Resuscitation (DNACRR), with nurses in one ward uncertain as to which patients were identified as not for resuscitation. Confusion arose after patients were moved between rooms.
• A failure to ensure that all older patients admitted are screened and assessed for cognitive impairment, an inconsistent approach to implementing and following care plans for those patients assessed as cognitively impaired, and no reliable system to monitor the number of bed or ward moves (“boarding”) patients with dementia are subjected to.

Of the issues highlighted, the most eye-catching is the confusion regarding which patients are classified as Do Not Resucitate. There are national guidelines in place to ensure that confusion does not arise, and it is the responsbility of senior staff and management to ensure that these guidelines are complied with at all times.

The lack of training afforded to nurses in moving and assisting patients is also  worrying. It is vital that nurses know how to move patients without causing unnecessary injury or indignity.

Finally, and as the report makes clear, all older patients admitted to Monklands must receive the appropriate screenings. Being in the unfamiliar environment of a hospital can be disorientating and distressing under normal circumstances, and these feelings are likely to be accentuated where the patient is suffering from some form of dementia or cognitive impairment. For this reason, it is also important that the practice of “boarding” (moving patients around different wards to free up capacity) is kept to an absolute minimum, or abandoned altogether.

It is absolutely not my intention to cast aspersions on the hard working clinical staff at Monklands. In common with hospitals across Scotland, Monklands has suffered from five years of Scottish Government cuts to its budget and frontline staff. It is clear that these cuts are having an adverse upon upon morale, training and standards.

The vast majority of staff at Monklands are doing an excellent job under difficult circumstances. However, in order to provide first class care, they must receive appropriate support and guidance from the Scottish Government.

Nicola Sturgeon says she is protecting the NHS. The evidence says otherwise.