NHS Trust Accepts Culpability for Mental Health Patient Suicide

An inquest into a suicide within the mental health system has found a series of failings at the centre of the issue.

Abbi McAllister, 23, fell from the sixth floor of a multi-storey car park in Birmingham city centre after absconding from her carers in April last year.

And now the father of McAllister has called for a deeper investigation into the issue, suggesting that the NHS significantly failed his daughter.

McAllister was being cared for by Birmingham and Solihull Mental Health NHS foundation trust, and was suffering from a borderline personality disorder, depression and extreme anxiety, and a history of self-harm.

The investigation into her death revealed that the patient had attempted to commit suicide on numerous occasions leading up to the incident, with the most serious being threats to jump from buildings.

McAllister had been due to attend an off-site therapy session, when she managed to escape from carers.

Having taken a taxi to the car park where she fell, staff took over an hour to inform police of her disappearance.

The inquiry also suggested that carers fail to mention to the authorities that McAllister had previously attempted to take her own life, which was indeed understood by the institution.

McAllister’s father, Calvin Bailey, suggested that “the knowledge that her death could have been avoided if the trust had not made so many basic mistakes in caring for her” had made the already considerable suffering that his family was forced to endure far worse.

“There has to be a full review of the whole system to make sure there is adequate training. Abbi’s death was absolutely preventable. If they had done what they should have done and people had been professional and if the nursing staff would have not been thinking she’s OK, they would have taken a more professional approach,” Bailey asserted.

In addition, Bailey also suggested that the NHS trust had failed to show adequate contrition for the issue, in particular failing to apologise for its role in her death.

“The only time I got an apology was 2.15pm on Thursday after the jury had gone out to deliberate. That on its own was very distressing. No one took responsibility for Abbi’s death at all,” Bailey stated.

Commenting on the issue, a spokesperson for the trust stated that the organisation accepted the findings of the enquiry.

“The death of Abbi McAllister was a very tragic incident, for which our trust has already admitted failure to provide adequate safeguards to a vulnerable young person. We immediately undertook a thorough review of the circumstances leading up to Abbi’s death, which identified unacceptable shortcomings in the care provided to her, including the failure to fully understand the risk of absconsion and the unpredictability of her illness.”

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NHS Tayside Continues to Face Massive Financial Problems

Managers in NHS Tayside are seeking millions of pounds of savings in an attempt to plug the gaps in its annual budget.

The health board must make £27 million of savings by the end of March – and has £3.6 million still to find.

High level meetings have been held in an attempt to address the situation, with possible areas for further cuts being explored.

NHS Scotland maintains a no compulsory redundancy policy so extra savings would have to be made through more efficiency savings.

Another possibility is that the NHS trust could reduce its overall expenditure by leaving existing posts unfilled.

After investigating the issues, bosses in Tayside believe that it could be possible for the savings to be made by reducing “waste and variation in our system”.

Commenting on the issue, a spokeswoman for NHS Tayside outlined some of the plans of the organisation.

“For 2015/2016, NHS Tayside has an efficiency savings target of £27 million. As at December 2015, we have identified £23.4 million of savings. As a board, NHS Tayside remains committed to a five-year programme of improvement and transformation which will sustain the delivery of person- centred, safe and effective treatment and care for all our patients and their families.”

The spokeswoman continued by outlining the areas in which management intends to save money.

“Through this programme we continue to focus on a number of key cost pressure areas where we are looking in detail at how we reduce waste and variation in our system. These areas include prescribing, procurement, our property plans and environments of care.”

The savings targets that bosses have made for NHS Tayside represent over 4 per cent of the annual general allocation of the board.

This level of saving is required in order for the organisation to break even.

The financial difficulties of Tayside have become obvious over the last few years, with the health organisation being forced to procure several massive loans.

In total, nearly £20 million of emergency government loans have been acquired in the last three years alone, and the NHS trust is still due to pay all of these back via property sales.

Commenting on the seriousness of the issue, Alison McInnes, the Scottish Liberal Democrat MSP for North East Scotland, indicated that the Scottish government must provide support to NHS Tayside in these troubling times.

“The health board has done well to identify such a significant proportion of the savings required given the continued tightening of the public belt but departments are likely to continue feeling the pinch. I just hope the Scottish Government is standing by it to make sure it receives the right resources at the right time so patient care isn’t compromised.”

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Monitor to Unveil NHS Whistleblowing Policy

Monitor has announced that it will publish plans for a national whistleblowing policy.

The health regulator will insist on every organisation within the NHS adopting this new policy.

This singular whistleblowing policy, that will thus operate across the NHS, has been drawn up by a collaboration of three organisations.

Monitor, the NHS Trust Development Authority and NHS England drafted the policy co-operatively as a result of the Freedom to Speak Up review published earlier this year by Sir Robert Francis QC.

The proposed policy provides a guideline for health professionals with regard to whistleblowing action in the future.

In particular, there are provisions contained within the legislation to ensure that bullying or acting against a whistleblower is an act liable for disciplinary action.

A key aspect of the policy reads thus:

“Don’t wait for proof. We would like you to raise the matter while it is still a concern. It doesn’t matter if you turn out to be mistaken as long as you are genuinely troubled. If you raise a genuine concern under this policy, you will not be at risk of losing your job or suffering any form of reprisal as a result. We will not tolerate the harassment or victimisation of anyone raising a concern.”

The policy continues:

“Nor will we tolerate any attempt to bully you into not raising any such concern. Any such behaviour is a breach of our values as an organisation and, if upheld following investigation, could result in disciplinary action.”

The intention behind that policy is to ensure that individuals can feel comfortable in coming forward to legitimately reveal inside information about the health service.

Anyone acting in good faith can therefore be confident that they will not be punished.

On the other hand, malicious rumours are not to be encouraged, and this is also outlined explicitly in the policy.

Monitor revealed in the document that it has consulted with numerous organisations in order to produce this critical policy.

“Having listened to organisations representing whistleblowers and employers, we believe this policy expresses the spirit and intent of the Freedom to Speak Up vision. Our intention is that the policy should be adopted by all NHS organisations in England except for primary care providers. We hope it will also be adopted by independent providers of NHS healthcare,” it is stated in the document.

Meanwhile, a consultation process is currently taking place ahead of the finalisation of the document.

This will be included on 8th January, but a provisional version of the document will be published in the next 24 hours.

Commenting on the policy, Dr Kathy McLean, medical director at the NHS Trust Development Authority, emphasised its importance.

“We know that when trusts take concerns seriously and investigate them properly they are often the ones which provide the best standard of care and treatment to patients. It is hugely important that trust boards are able to listen to what their staff have got to say and then use that to take action to deliver improvements for patients. This policy should help them do just that.”

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South West Yorkshire NHS Chief Executive to Retire

In news that will lead to a reorganisation of NHS services in Yorkshire, a major health figure has announced that he will step down from his existing position.

Steven Michael, Chief Executive of South West Yorkshire Partnership Foundation Trust, has announced he will retire at the end of March next year.

Michael is also currently employed as chair of the NHS Confederation’s Mental Health Network, and he has announced that he will similarly step down from this position as part of his retirement.

The retirement of Mr Michael represents something of the end of an era for the NHS in south west Yorkshire.

Michael has worked within the health service since 1985, and has been an extremely successful Chief Executive in the decade in which he has been in charge of the mental health trust.

The supremo was appointed to the position of Chief Executive at the South West Yorkshire Mental Health Trust back in 2006, and has presided over a successful nine years for the organisation.

However, despite the fact that Michael has signalled his intention to stand down, he still has one particularly important duty to carry out before annulling his relationship with the NHS.

Michael will oversee a forthcoming Care Quality Commission inspection in March 2016, indeed just weeks before his final retirement.

Just days after the Care Quality Commission has assessed the efficacy of the South West Yorkshire Trust, Michael will hand over the reigns to a successor.

As Michael has only just made his retirement known to the trust, this successor has yet to be identified.

Commenting on his career within the NHS, Michael was extremely positive about his role as a Chief Executive in particular.

“It’s been a great privilege to occupy this position for nearly a decade. I’ve thoroughly enjoyed my time here and I’m extremely proud of the organisation that it has become. I will leave next year with many happy memories to look back on, particularly of working with fantastic service users, carers, partner organisations, and an excellent group of staff,” Michael commented.

Stephen Dalton, Chief Executive of the MHN, was effusive about the contribution that Michael had made to healthcare in the south west Yorkshire region.

“Steven has made an important and sustained contribution over a long period of time, not only to his own trust and community, but also to the wider community across the country. He will be greatly missed by his colleagues, who will hope that he hasn’t left the stage completely.”

The South West Yorkshire Mental Health Trust was first established back in 2002, and thus Michael has filled this critical role within the organisation for the majority of its existence.

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Monitor Removes Tameside General Hospital from Special Measures

The Monitor regulatory body has taken Tameside General Hospital out of special measures after significant improvement in its performance.

Monitor indicated that it was no longer necessary to regulate Tameside General Hospital to the same degree after the hospital began to move in the right direction.

Tameside Hospital NHS Foundation Trust, which is responsible for the hospital, has made significant progress with regard to the running of it, and the healthcare that it provides the public.

The foundation trust, which is one of 151 spread across England, provides a range of elective, emergency and specialist services for around 250,000 people in the borough of Greater Manchester.

Although Monitor has taken the decision to formally remove the trust from the special measures process, the regulatory body has emphasised that it still expects the Tameside trust to continue to develop its operations.

In particular, the foundation trust agreed a raft of steps with Monitor in order to ensure that it can build on recent improvements.

The Tameside Hospital NHS Foundation Trust will firstly work with a raft of partners in the health economy in order to take forward the proposals outlined by the Monitor Contingency Planning Team.

This is intended to ensure that the trust remains clinically sustainable and becomes financially viable in the future as well.

The trust will also progress and develop the Contingency Planning Team’s proposed implementation plan in partnership with commissioners and local stakeholders.

Monitor has also indicated that the foundation trust must work closely with the commissioners in order to further examine how to address residual long-term challenges.

These were identified and outlined in a report submitted to Monitor by the Contingency Planning Team.

Speaking on the positive news for the Tameside Hospital NHS Foundation Trust, David Dean, Senior Director of Transformation and Turnaround at Monitor, commented that staff could be particularly pleased with their efforts in reversing the fortunes of this body.

“Staff at Tameside have worked incredibly hard to turn this organisation around and improve things for patients. It is good news we have been able to take the trust out of special measures and our decision reflects the progress that’s been made. However, there is still a lot of work to do and we will continue to support the trust to ensure that its progress maintains,” Dean warned.

The decision taken by Monitor follows on directly by a recommendation made by the Chief Inspector of Hospitals, Sir Mike Richards.

Richards indicated in his role of overseeing the Care Quality Commission that there was still room for improvement at the hospital, but that significant improvements have nevertheless been made.

With a model having been put in place to integrate healthcare and social care, the trust can look to the future following the implementation plan that it has put in place.

The full Contingency Planning Team report and summary can be read here.

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Monitor Begins Black Country Financial Investigation

Monitor has launched an investigation into the Black Country Partnership NHS Foundation Trust after it became clear that its financial sustainability was dubious.

The investigation into the Black Country Partnership is just the latest in a long line of Monitor examinations, as it becomes increasingly clear that the NHS faces funding difficulties.

With Prime Minister David Cameron having recently suggested that the NHS should develop a radical seven-day culture, such issues as the Black Country Partnership investigation will only bring the logistics of these plans into sharper focus.

The health sector regulator was forced to engage in the action regarding the Black Country Partnership NHS Foundation Trust in order to investigate whether it was delivering services adequately to those that rely on them.

Based in the West Midlands, the trust covers Sandwell, Dudley, Walsall and Wolverhampton, and has reportedly recorded a deficit that was larger than anticipated.

Although it is unfortunately common for NHS trusts across the country to accumulate significant proportions of debt, it seems that the Black Country Partnership has indeed exceeded what would be considered acceptable levels.

According to early estimations on the subject, it is believed that the finances of the Black Country Partnership NHS Trust will continue to deteriorate in the coming months and years.

With Monitor having stepped in to investigate the situation further, the health sector regulator will be assessing the situation in the Black Country, and deciphering whether or not this NHS trust is delivering an acceptable level of service.

In particular, Monitor will be attempting to understand the underlying financial risk inherent in the organisation, the challenges that the trust faces in the future in order to become relatively solvent, and what needs to be done to improve the financial existing situation.

Speaking on behalf of Monitor, Marianne Loynes, the Regional Director of the organisation explained why the investigation has been initiated.

“We have launched this investigation to find out more about the financial situation at the trust and to establish what can be done to improve things for those who use its services,” Loynes stated.

The Regional Director also indicated that although reports on the Black Country Partnership are not exactly positive, that Monitor remains open-minded about the future of the trust.

“No decision has been taken about whether further regulatory action is required and an announcement about the outcome of the investigation will be made in due course,” Loynes asserted.

The Black Country Partnership in fact published an extensive financial plan to take the organisation to the end of the decade just last year.

In the document, the trust acknowledged that “the public sector environment is expected to remain challenging for the next five years. The Trust identified at an early stage the financial gap in a ‘do nothing’ scenario. This presented a financial shortfall of around £13m by 2019. As a result of this, the Trust developed a Sustainability Action Plan including a detailed review of Trust service lines, to identify the actions required to close the forecast financial gap. Much of this work has been used to inform this Strategy.”

But it seems, pending the results of the Monitor investigation, that despite the plans that the trust has not been successful in its fiscal aims.

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Monitor Rejects Devon Commissioning Bias Complaints

A recent Monitor investigation has discovered that Northern, Eastern and Western Devon Clinical Commissioning Group (CCG) has not breached NHS commissioning regulations.

But the CCG will be suspended from carrying out further duties as the next phase of the investigation is concluded.

Monitor has since published the results of the investigation, after question marks were raised regarding the process for selecting community service providers in east Devon.

The sector regulator for health services in England was called upon to explore how commissioner selected Royal Devon and Exeter NHS Foundation Trust as its preferred provider of community services for adults with complex care needs.

But the investigation revealed that the commissioner did indeed satisfactorily consider patient needs and the service improvements required.

The process designed by the commissioner was thus deemed to be satisfactory to enable an adequate number of proposals to be considered appropriately.

However, the CCG still has further work to do in order to establish that the requisite level of value for money is being achieved before finally confirming the contract.

Catherine Davies, Executive Director of Co-operation and Competition at Monitor, noted that “patients are likely to be better off as a result of our investigation because the CCG will do further work before awarding the contract, especially around ensuring value for money.”

Monitor found that the CCG’s process was entirely proportionate, and thus the provider selected from the available options was appropriate according to Monitor’s conclusions.

Thus, the CCG’s process did not breach transparency requirements. “Having set out its vision for community services in the local area, NEW Devon CCG chose between providers in a way that was tailored to its needs,” Davies explained.

However, the Executive Director did point out that this particular process might not be applicable in other cases. “The approach NEW Devon CCG took won’t work in all cases, but it shows that commissioners can be flexible in their processes for selecting providers,” Davies opined.

In conclusion, Monitor found that there was no discriminatory or unequal treatment of potential providers in the process, and that it was unaffected by conflicts of interest.

Monitor had begun an investigation after it received a complaint from Northern Devon Healthcare NHS Trust.

The trust is currently responsible for community services in the region, having been awarded the contract to provide them.

Northern Devon Healthcare NHS Trust claimed than the CCG had carried out a process that was inadequate and unfair, but this notion has ultimately been rejected by Monitor.

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CMA Provisionally Clears NHS Trust Merger

The Competition and Markets Authority (CMA) has provisionally cleared the proposed merger between two hospital trusts, following an extensive investigation.

Ashford and St Peter’s Hospitals NHS Foundation Trust (ASP) and Royal Surrey County Hospital NHS Foundation Trust (RSC) will form a new organisation should the merger go ahead.

The two trusts previously provided clinical services in Ashford, Chertsey and Guildford.

Mergers in the NHS can be controversial owing to the fact that competition is considered one of the most important factors in providing quality services.

Thus, the merger of the two trusts was referred for an in-depth phase 2 inquiry in February after the initial CMA investigation concluded that the proposed acquisition could reduce healthcare competition.

Patients currently have the opportunity to choose which hospital to attend for consultant-led outpatient appointments.

This form of patient choice therefore has a positive knock-on effect on the quality of healthcare, as competing hospitals strive to provide a superior service in order to attract patients and, concurrently, funding.

However, the CMA examined evidence from ASP and RSC about the provision of healthcare services in the area of the merger, and found that the proposal will not result in a significant reduction in competition.

Speaking about the decision, Simon Polito, Chairman of the inquiry group, was keen to emphasise that the investigation had diligently considered the merger, owing to its importance for NHS care.

Polito stated: “Choice of hospital for patients and commissioners has an important role to play in the NHS, as do a number of other factors that help to maintain and improve the quality of services. Indeed, we have been struck throughout this investigation by the commitment and professional pride in the provision of high quality care for patients shown by the many different NHS representatives we have encountered.”

The Chairman was also keen to outline the methodology behind the decision-making process: “The impact of a hospital merger on competition will largely depend on the number and strength of alternative service providers in the local area. There are a number of hospitals nearby which currently attract significant numbers of patients from the local area. We consider that these are viewed as credible alternatives by patients and GPs.”

Concluding, Polito was adamant that the correction decision had been reached: “Against this background, and following a detailed investigation, we are satisfied that in each of the services where the hospitals overlap, the merged trust will face significant competitive pressures from other local hospitals.”

Tasked with carrying out investigations into mergers, the CMA is the UK’s primary competition and consumer authority. Launched in 2013, it is an independent, non-ministerial government department.

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Monitor Investigating Finance of Cheshire-Based NHS Trust

The government body Monitor has announced that is it to undertake an investigation into the financial conduct of Mid Cheshire Hospitals NHS Foundation Trust.

Finances at the trust have deteriorated significantly, and the regulator will examine the reasons for this, and also attempt to establish an approach that will lead to an improvement.

Monitor intervened after it became evident that the trust was experiencing financial difficulty.

The Mid Cheshire Hospitals NHS Foundation Trust had, in fact, reported a surplus during last year’s accounting period, but its financial position has since declined significantly. Reports suggest that the trust will accrue a £5.4 million deficit for the 2015/16 financial year.

The trust is responsible for Leighton Hospital and the Victoria Infirmary, and plays a major role in one of England’s largest and most prosperous counties.

Speaking on the issue, Paul Chandler, Regional Director at Monitor, stated that the government body is concerned about the financial health of the Mid Cheshire Hospitals NHS Foundation Trust.

“The trust’s finances have deteriorated and the most recent projections show that things could get worse over the coming year,” Chandler warned.

“Patients in and around Crewe, Northwich and Winsford rely on the services this trust provides, so we’re investigating to find out more about the problem and what can be done to improve the situation,” Chandler continued.

Chandler emphasised that no decision has yet been made on whether regulatory action would be necessary, but he did indicate that such a decision could be expected imminently.

Independent NHS trust are intended to provide care on a sustainable basis, and it is a major part of Monitor’s duties to ensure that this remit is being met adequately.

In the case of the Cheshire trust, the degrading financial position of the trust has been a massive red flag to the government body that further investigation is vital.

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