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Health Insight October 2001: Governance matters


The Commission for Health Improvement has recently published reports on the performance of several hospital trusts across the country. Heart and lung transplants at St George’s Hospital Trust in southwest London came under the CHI spotlight, following an increase in the death rate there. During the investigation, the death rate after transplants was eighty per cent – five times the national average. The report concluded that many patients had been picked for transplant operations when their physical condition should have ruled them out. A number of other serious criticisms were made. Recommendations made by CHI include the strengthening of national frameworks for patient assessment and selection. Health minister Lord Hunt said there were many lessons in the report for the NHS as a while. The hospital has stopped conducting heart and lung transplants. (A consultation document has been published by the DoH on heart and lung transplant services; health minister John Hutton said the standards of care proposed in the document would make the six centres where cardiothoracic transplants are still conducted among the best in the world.)

The CHI was severely critical of management at three hospitals in Warwickshire, which it said could be placing patients’ lives at risk. The University Hospitals Coventry & Warwickshire NHS Trust is responsible for the Coventry & Warwickshire Hospital, the Walsgrave Hospital (also in Coventry) and St Cross (in nearby Rugby). Two of the hospitals have A & E departments but the A & E unit to which seriously ill patients are admitted is in the third, requiring risky ambulance journeys for the most vulnerable patients. Cramped conditions on wards, an aggressive management style, and poor relations between doctors and managers were among the other problems. The CHI concluded that the situation needed urgent attention. A new ‘super-hospital’ is planned to open in Coventry in 2006.

Another CHI report has examined the events surrounding a conviction (in July last year) of a Loughborough GP for indecent assaults on patients. The report gives a number of recommendations for measures that would make it easier to act at an early stage against any GP who might commit similar offences in the future

The CHI has apologised for an error that exaggerated the death rates for elective surgery at one of the hospitals it has inspected – the Chesterfield & North Derbyshire Royal. The hospital has since been given three stars in the new rankings and its death rates are within the national targets, though higher than the national average. Many patients had refused to be sent to the hospital after the publication of the incorrect figures. CHI reports may be seen on www.chi.nhs.uk.
• Press releases (DoH), BMJ 22nd September, BBC Online

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