Anomalies in outcomes and application of care of the elderly (cote) within Cheltenham General Hospital
The content of this website has been raised in order to report, in the public interest, that I have officially communicated to the Secretary Of State For Health And Social Care, Stephen Barclay, my concerns regarding the negative patient outcomes accruing on a single ward at Cheltenham General Hospital, part of Gloucestershire Hospitals NHS Foundation Trust, over a single twelve month period, at a (here unspecified) juncture within the last 5 years.
Also rejection on the part of Trust authorities of the depth, strength and extent of evidence supportive of complaints it did not deign to accept (right up to exclusion of data entirely admissible within its own internal systems); a refusal – responsively – fully to account for its actions, even in the face of ancillary health care regulators' written expectations; unsustainable (official ruling, ignored) denigration of complainants' motives; non-disclosure of medical detail (sepsis diagnoses), also other apparently anomalous maintenance/divulgence of patients' records to families/health regulators; and secrecy (even when challenged) in concealing from carers the rights afforded the Trust, in law, in terms of ongoing potential for withdrawal of active care from the 'mentally incapacitated'.
Shortcomings which might contribute to a loss of public trust in the complaints system, and therefore in oversight of medical systems and procedures within the hospital, in turn.
I would emphasise two matters.
The concerns raised here in no way relate to the excellent, day-to-day, nursing care that was available on the ward;
These are most carefully considered representations, in the light, not of 'knee-jerk reactions', nor pique, but of extended daily attendance upon it, on the part of ourselves, as (unofficial) 'carers', at the time; and of extended consultation, and comparison, since, around much of the rest of the country.
I now report I have latterly made representation to the Secretary Of State For Health And Social Care in the following respects:
“Our aim is for the families of all patients placed in palliative care over the year to be contacted, in order to be asked:
1(a) – Whether they considered maintenance and continuation of life on the ward was a sufficient priority in determination of treatment afforded its mentally incapacitated, and elderly, charges;
1(b) – Whether its daily care regime had come to be characterised by too reactive a culture of treatment, precipitative of excessive invocation of palliative care;
1(c) – Whether they harboured reservations or misgivings regarding prematurity of transition to, or improper withholding/withdrawing of intravenous fluids within, palliative care that might finally be freely expressed, and acted upon;
1(d) – Whether, in respect of the mentally incapacitated, families' proceduralised prerogative of counter-representation, that active treatment (and/or hydration) be maintained – as well as any proffered/requested in the course of routine care, such as opposition to application of anti-psychotic and sedative medication, and to clinical proscription of CPR (resuscitation) – was being taken into proper account, by comparison with other parts of the same hospital, as well as absolutely. ''
I have also enquired of the Secretary Of State whether improvements might not be able to be expected to be wrought to a system where, in deflecting complaints – and without oversight or restraints – accumulatively:
The Trust has refused to accept a direct request for a (potentially beneficial) transfer of patient care was made – and, further, not advanced for relevant independent consideration;
The Trust has refused to acknowledge the contentiousness of a closed meeting, dealing of enforced transition to 'End of Life' care, during which it was actually presented with the intention to call in police; and that its – unilateral - professional obligation to invoke a 'second opinion', in the wake of (extreme here, but, technically, any) opposition, was not, therefore, met;
The Trust, despite encouragement from the General Medical Council, has refused to provide answers as to what 'unusual factors' it considered merited alleged transgression of professional GMC guidelines, governing hydration in 'End Of Life' care;
The Trust refused to explain its rejection, of contemporaneous evidence, subsequently also 'signed off' by its CEO, which apparently contradicted – in writing - its (presumed – it will not say) defence prior indication had been given daily medical reviews promised within 'End Of Life' care might not be possible;
The Trust was disappointingly 'disinclined' to take action commensurate (no more) with the gravity of alleged personal misconduct, regardless of the assessable quality, depth and extent of evidence presented, even excluding some entirely admissible within its own personnel systems, and within Employment Law;
The Trust regrettably saw fit not to condemn reporting of usage of 'emotional entrapment', within the most sensitive of interactions with patients' families, at times of greatest grief, and stress, nor instances of other unacceptable behavioural patterns, besides;
The Trust did not act on well reported and recorded occurrences of alleged mental health and age discrimination set before it, which, to our mind, the import – and terminology - of its own responses also betrayed ('behavioural problems' crassly cited as a reason to withdraw active treatment);
The Trust provided feedback to family and the Ombudsman which in places either did not correspond to, or even incorporate, circumstances – and even events – to which the family had been made privy on the ward, or even personally attended, at the time (this the Ombudsman declined to seek to clarify). Record keeping was desultory, right up to the point of excluding sedation of the mentally incapacitated.
The Trust did not, across two reports aimed at explaining circumstances of, and factors behind, a death, disclose a working diagnosis of sepsis, over a period of ten months, until the case went 'external';
Senior elements of the Trust persisted – whilst, curiously, reaffirming our personal integrity – in denigrating complainants' (our) motives (including 'public interest'), when its own Information Governance appointees had ruled this 'unsustainable' and inapplicable; and when even the Chair of their own Board was simultaneously decreeing we were to be taken 'very seriously'. In conjunction with which, a 40 page document, listing details of 'Tribunal' cases, involving 'vexatious' correspondents, was sent to the address of a then 87-year-old 'Freedom Of Information' requester… ;
The Trust either permitted, or co-initiated, presentation before the police of the concept of 'harassment', a consideration decisively rejected – in writing - by Gloucestershire Constabulary, and requiring two interim visits from CID in person to excuse its disclosure / conveyance to us at all;
The Trust failed to respond to no fewer than twelve clearly, identically and singly directed representations for desired explanations (six from us, four externally – including a solicitors' letter, and three from its acknowledged 'Complaints Advocates', POhWER – and two internally, where sympathetic aspirations at higher Trust echelons were not to meet with fruition, either). In spite of the GMC also having indicated it felt the Trust could provide these, and of known representation from our local MP.
My ailing mother's final three-and-a-half years were absolutely blighted by what she not unreasonably saw as the heartlessness of these failures and refusals.
COTE at GHNFT
CONCEALMENT OF OPPOSITION TO ENFORCEMENT OF PALLIATIVE CARE ON OUR ELDERLY
‘We want (transfer of care to) a different doctor’
‘No, I’m his doctor’
‘Unfortunately it was not expressed
to the doctor…you had lost your trust in (the doctor)’
‘I’ll call the police’
‘Call the police’
‘There was no obvious conflict of opinion’
HOW SO?!
YOUR VOICE: DISBELIEVED
DISREGARDED
DISMISSED and
DISCARDED
‘L IVES BLIGHTED, HONOUR DEFILED’ ALL IN THE NAME OF
AVOIDANCE OF BLAME
FOR WITHHOLDING A SECOND OPINION
‘WHEN WILL THEY EVER LEARN?’ GHNFT