NHS Trust fines – Causes, Consequences and lessons learnt.

Agreement: 
I Agree
Body: 

Dear Editor

I was saddened by your news item (1) which prompted me to reflect on the causes, consequences, and lessons we can learn of such sanctions placed on public bodies. The coroner “found that staff were too overwhelmed to provide proper care and an unsafe culture had been allowed to develop”. I set out to identify other such sanctions imposed on the NHS through your pages. Using the advance search function word search of “fined” in the title and abstract yielded 48 hits and “fine” 124 hits. Reading the titles revealed eleven reports of NHS organisations being fined in the BMJ so far. Information was extracted to meet the objectives of identifying causes, consequences and lessons learnt.

In Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust (2) due to mix up of a scan report key abnormal findings were missed, and the patient died of cardiac arrest and the trust was fined £60000 in a prosecution brought by the Care Quality Commission (CQC). CQC prosecuted Rotherham NHS Foundation Trust (3) which was fined £200,000 for failing to spot possible non-accidental injuries and take safeguarding actions. This was due to failures in policies, training, and oversight of safeguarding. Shrewsbury and Telford Hospital NHS Trust (4) was fined more than £1.3 million for its failure in care which resulted in two deaths. There were failures to train staff in setting up bariatric beds and ensuring that staff were trained to follow guidelines. Dudley Trust (5) was fined £2.5m over deaths of two patients from infection and for failing to provide safe care. There were errors in the hospital’s initial assessment of the patients, failings in its implementation of the sepsis pathway, and failings in how both patients were monitored and information captured about their condition. Overcrowding was also a factor.

East Kent Trust (6) was fined £733 000 for unsafe care of mother and baby. Some of the failures included delivery by an inexperienced locum doctor and delays in resuscitation and independent enquiry report has been published (7). The report identified poor team working, failures of professionalism, compassion, failure to listen and many missed opportunities. Plymouth Trust (8) was fined £12565 for breaching duty of candour when an endoscopy went wrong, and the patient died of perforated oesophagus. Southern NHS Trust (9) has been fined £2m after admitting “systemic failures” regarding the deaths of two vulnerable patients. Ineffective policies and procedures and poor leadership were identified. Shrewsbury and Telford Hospital NHS Trust (10) was fined £333 000 over the deaths of five patients from falls. Inadequate risk assessment, handover procedures, and enhanced care arrangements led to the deaths. Mid Staffordshire NHS Foundation Trust (11) was fined £500 000 linked to the deaths of four elderly patients treated at Stafford Hospital. Poor record keeping, internal practice and the lack of a robust management system for safeguarding patients. Mid Staffordshire NHS Foundation Trust (12) was fined £200 000 when a diabetic patient died after nurses failed to give her insulin. The reasons included lack of proper handovers between nursing shifts and proper record keeping. Southampton University Hospitals NHS Trust (13) was fined £100 000 for failing to supervise junior staff.

It is shocking to note that two trusts appear twice in this infamous list. Lack of training, supervision, not adhering to policies and protocols, lack of proper communication and documentation are frequently identified. No doubt the list will continue to grow as health care is complex but addressing issues identified above through System Quality Groups (14) will help to reduce the next trust being fined with disastrous consequences for the patient and family who entrust their life and limb with the NHS.

Padmanabhan Badrinath, Retired Consultant in Public Health Medicine
[email protected]

Disclaimer: The views expressed here are the professional views of the author and in no way represent the views of any organisation the author has been associated with at present or in the past.

Conflict of interest: The author is a strong proponent of patient safety, clinical quality and governance.

References:

1. Dyer C. Nottingham trust is fined £800 000 for unsafe care of mother and baby BMJ 2023; 380 :p226
doi:10.1136/bmj.p226

2. Dyer C. Trust is fined £60 000 for death of patient after scan mix up BMJ 2022; 379 :o2974 doi:10.1136/bmj.o2974

3. Dyer C. Rotherham trust is fined £200 000 for failing to take safeguarding action in the case of four babies BMJ 2022; 379
:o2577

4. Dyer C. NHS trust is fined £1.3m over deaths of two patients linked to safety failings BMJ 2022; 377 :o1253
doi:10.1136/bmj.o1253

5. Dyer C. Dudley trust fined £2.5m over deaths of two patients from infection BMJ 2021; 375 :n2864
doi:10.1136/bmj.n2864

6. Dyer C. East Kent trust is fined £733 000 for unsafe care of mother and baby BMJ 2021; 373 :n1589
doi:10.1136/bmj.n1589

7. Kirkup B. Reading the signals Maternity and neonatal services in East Kent – the Report of the Independent Investigation.
[Internet]. [cited 2022 Oct 19]. Available from
https://assets.publishing.service.gov.uk/government/uploads/system/uploa…
the-signals-maternity-and-neonatal-services-in-east-kent_the-report-of-the-independent-investigation_print-ready.pdf

8. Dyer C. Plymouth trust is first to be fined for breaching duty of candour rules BMJ 2020; 370 :m3737
doi:10.1136/bmj.m3737

9. Torjesen I. Southern Health is fined £2m over deaths of two patients BMJ 2018; 360 :k1411 doi:10.1136/bmj.k1411

10. Dyer C. Trust fined £333 000 over the deaths of five patients from falls BMJ 2017; 359 :j5606 doi:10.1136/bmj.j5606

11. Dyer C. Mid Staffordshire trust is fined £500 000 for “corporate failure” linked to four deaths BMJ 2015; 351 :h6892
doi:10.1136/bmj.h6892

12. Dyer C. Mid Staffs hospital is fined £200 000 over “avoidable” death of diabetic patient in 2007 BMJ 2014; 348 :g3020
doi:10.1136/bmj.g3020

13. Dyer C. Hospital is fined £100 000 for failing to supervise junior staff BMJ 2006; 332 :930
doi:10.1136/bmj.332.7547.930-a

14. National Quality Board. National Guidance on System Quality Groups. [Internet]. [cited 2022 Jan 21]. Available from
https://www.england.nhs.uk/wp-content/uploads/2022/01/B0894-nqb-guidance…

No competing Interests: 
No competing interests
The following competing Interests: 
The author is a strong proponent of patient safety, clinical quality and governance.
Electronic Publication Date: 
Tuesday, January 31, 2023 – 15:37
Workflow State: 
Released
Full Title: 

NHS Trust fines – Causes, Consequences and lessons learnt.

Check this box if you would like your letter to appear anonymously:: 
Last Name: 
Badrinath
First name and middle initial: 
Padmanabhan
Address: 
Colchester, UK
Occupation: 
Consultant in Public Health Medicine (Retired)
BMJ: Additional Article Info: 
Rapid response
Twitter: 
@ukbadri

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