As the row over who knew what and when in the Mid-Staffordshire tragedy grows, it’s worth taking a close look at the data involved. When you consider the Mid-Staffs scandal across the timeline of the previous government, the findings present extremely uncomfortable evidence for which the Labour party must be held to account.
There are two key measures. These are the number of ‘expected deaths’, weighing up the age and condition of patients admitted to hospital, against the actual total number of deaths occurring. The difference between the two figures is known as ‘unexplained deaths’. We have this data for Mid Staffordshire dating back to 1996- and overall, it is this data which has been used to generate the headline figure of ‘1,200 patients dying unnecessarily’.
But what has been overlooked is the rate at which these deaths occurred. The first graph below shows the number of actual deaths at Mid-Staffs compared to the expected number of deaths, while the second demonstrates the total number of unexplained deaths across each year since 1997. The latter shows quite clearly that Mid-Staffs had clear problems long before they were picked up. In particular, what we can see clearly is that whereas in 1997, Mid-Staffs actually had eight fewer deaths than expected, by 2002 this had reversed with there being 120 excess ‘unexplained deaths’. That figure from 2002 rose higher still, to peak at 187 excess unexplained deaths in 2006.
For years, this damning mortality data should have rung alarm bells in the Department of Health, and yet there was nothing but silence. Instead, in February 2008, the trust was granted Foundation Trust status after supposedly meeting all of the department’s targets.
If one wants to get a clear picture of what exactly was going on in the department under the stewardship of Labour health secretaries, Volume Two of the Francis Report, chapter 19 is essential reading. It details a catalogue of errors made by the department, letters warning of the awful situation at Mid-Staffordshire that were never read by senior officials, or simply passed across a desk. But where were the ministers who were meant to be running the department? As the graphs demonstrate, the number of unexplained deaths was rising steadily from 2002. It was not as if Labour ministers hadn’t been warned before. In 2006, 90 people died of C.difficile infection unnecessarily as a result of overcrowding and poor hygiene at Maidstone hospital. The report into the scandal found that the total number of deaths may even have been as high as 240. With this important prequel to Mid-Staffs in mind, there is one piece of evidence in the Francis report which remains overlooked:
‘On 4 February 2009, Rt Hon Alan Johnson MP, Secretary of State for Health, met Sir Ian Kennedy for a routine “catch-up”. Mr Johnson was caused considerable concern by being warned by Sir Ian about the import of the impending report on the Trust and having received no prior warning of this in his briefing for the meeting. Mr Johnson was moved to write:
“Hugh needs to know that there will be a very difficult report from the Healthcare Commission on Mid Staffs which not only says emergency patients died unnecessarily but implicates Cynthia Bower, the CQC secretary [sic]. It wasn’t even mentioned in my briefing for the meeting with Ian Kennedy and my office has no knowledge of it, but somewhere in the Department this draft report is ticking away like a time bomb. Shades of Maidstone and Tunbridge Wells.”’
(Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry, Vol. 2, p.1319)
In all, it paints a picture of a Health Secretary embattled, with a dysfunctional office, but a man still concerned what might happen to his reputation and the officials around him. Alan Johnson never gave evidence at the Francis Inquiry. One wonders why not. Like Andy Burnham, he did not believe it was worthwhile to hold a full public enquiry into the disaster that he knew in 2009 would be a ‘time bomb’ and in his own words, akin to the appalling levels of care at Maidstone and Tunbridge Wells.
We must not ignore how early on the failings at Mid-Staffs began, how a target culture driven from the top allowed for the Trust to be awarded Labour’s flagship status as a Foundation Trust, and how, when Labour ministers finally discovered news of what had gone on there, their first thoughts were to prevent a full public investigation of what had occurred, refusing 81 separate requests for a public enquiry. The blame must be turned squarely on Labour health ministers who have been allowed to slip through the net.
Chris Skidmore is Conservative MP for Kingswood and a member of the Health Select Committee.
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