The stats
The disturbing inferences presenting themselves from these stats, and which the hospital was made aware of several years ago, need publicly accounting for and sharing.
How was it that so many mighty percentage increases in negative patient outcomes of all kinds were suddenly and inexplicably able to accumulate on a single ward, then, equally without reason, once complaints started to be received by Trust management, were able to be reversed, at a time when no scope for reductions of any sort appeared to exist anywhere else nationally?
These patients included my own father…
WHY DO THE DEPARTMENT FOR HEALTH, MY MP, THE COUNTY COUNCIL AND GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST NOT WANT AN EXTERNAL INVESTIGATION? SO THAT WE THE PUBLIC KNOW WHAT WENT ON?
Linkage to these events persists.
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The (financial) year in focus was (April) 2016 – (March) 2017.
Over the course of these twelve months, and by comparison with their predecessors, (April) 2015 – (March) 2016, on the ward:
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The death rate rose by 38% (to the highest point in existing records).
With guidelines for hydration overridden
Sepsis diagnoses not disclosed
And second opinions not being offered to families disputing ‘end of life’
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Assignments to end of life (palliative) care rose by 82%
In so doing, palliative care referral rates more than doubled (a 109% increase), then more than doubled again (a 108% increase), by successive six month periods within the year (April 2016 to September 2016, then October 2016 to March 2017) (again to the highest point in existing records)
And, by the end of the latter (March 2017), the figure stood more than four and a third times higher than it had been at the end of the corresponding six month period just a year before (Mar 2016). A staggering 435% increase. A variation outside the realm of statistical possibility. And for decisions stemming from (clinical) judgement.
And, from 1 assignment to palliative care for every 4 deaths on the ward (over the whole of the period April 2015 – March 2016), prior to the start of the year, the figure rose to 1 for every 3 over the next six months (April 2016 to September 2016); and then – between October 2016 and March 2017 – over no less than 6 months averaged 4 such assignments for every 5 deaths.
Why was official policy routinely to bring such decisions forward?
Even when potential for recovery was still being openly acknowledged?
Fact – to accommodate patients’ doctors’ and consultant’s absence from the ward over the week-end.
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Failed discharges (static, or even reducing, within the wider Trust) rose by 16% (again to the highest point in existing records)
Within which re-admissions within 1 day of discharge had risen by 85.7%
And the 13.3% increase in 30 day re-admissions recorded over this one year represented, in one go, no less than 66% of the total rise (of 20%) accruing nationally over an entire 4 year period (2014-18) (Source: Healthwatch)
Intriguingly, at the same time patient turnover rates soared also. Over 2016-17, the ward saw an increase equivalent to a 69% part of the total increase over a full half decade (2013-18). To put it another way, more than double that marked up over the 4 years either side of it, put together
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No external factors were identifiable to account for any of this. Year on year, patient numbers had risen by a mere 10% . But what we do know is this.
The precise period (Oct 2016 – March 2017 inclusive) for which we sought ministerial assurance adequate focus on active maintenance of life, and on length of admission, was being displayed on the ward, at Cheltenham General, coincided exactly with the clawing back, by Gloucestershire Hospitals NHS Foundation Trust – of which Cheltenham General is a part – of £8 million from its budget deficit.
The figures quoted throughout are as they stood mid-2019, and were extracted from a protesting Gloucestershire Hospitals NHS Foundation Trust under Freedom Of Information.
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After complaining, and over the course of the next year, 2017-18, it somehow proved possible for these figures substantially to be brought down – by in the order of 20% (although, even then, the death rate remained a full 20% higher than on its ‘sister’ COTE ward in the same block). There had been no fall in admission rates from one year to the next to account for this; they had remained constant. There had been no identifiable external factors, that perhaps had pushed up the stats the one year (2016-17), and which were no longer present the next (2017-18).
In fact, due to 50,000 excess deaths nationally over 2017-18, owing to the extreme prolonged spell of bad weather (dubbed ‘The Beast From The East’), and a mini flu epidemic, not one of 26 other Trusts consulted nationally at random could identify any comparable ward (by size, function and usage) where any reduction in any of the above categories of negative patient outcomes had been achievable at all that year – let alone across them all, as at Cheltenham.
What was happening on the ward in 2016-17 to give such markedly unique scope for achieving reductions over 2017-18?
This is a question I believe it in the overwhelming public interest to raise. And for it to be accounted for.
No one has done so over the last six years……
WHY DO THE DEPARTMENT FOR HEALTH, MY MP, THE COUNTY COUNCIL AND THIS TRUST (GHNFT)
NOT WANT AN EXTERNAL INVESTIGATION
SO WE KNOW WHAT WENT ON?
DOES LINKAGE TO THESE EVENTS PERSIST?