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Last Updated: Wednesday, 20 July, 2005, 20:25 GMT 21:25 UK
Interview with Peter Coles
Before broadcasting this programme some of the footage filmed by Panorama's undercover nurse was shown to Peter Coles, the chief executive of Brighton and Sussex University Hospitals NHS Trust, which runs the Royal Sussex County Hospital where we filmed.

After he had watched the footage, we interviewed him for the programme.

This is an edited transcript of that interview.

You've seen some of the footage filmed by our undercover nurse. In that footage we see a woman with terminal cancer crying out in pain because she hasn't got her medication on time. We see a woman literally gasping with thirst because no one has given her anything to drink. We see someone who has been waiting for two hours for help to go to the toilet and nobody's come. And we see a male nurse speaking very harshly to a patient who's called for help. What's your reaction to what you've seen?

Well clearly they're very disturbing images and I was shocked to see them. The first thing I would like to do is to apologise on behalf of the Trust to those patients and their relatives for those lapses in quality of care that were uncovered at that time.

Were you aware of those lapses before they were brought to your attention by us?

Oh absolutely, we received a number of complaints in the autumn of last year, in November and December, and that triggered an internal investigation into the ward which was carried out by our nursing directorate in partnership with our patient and public involvement forum. That led to a whole series of changes on the ward culminating in a new ward manager being appointed in March, and I'm pleased to say that things have improved significantly since that time.

At the time that we were filming though there were still many problems that were identified by the nurse. I mean in particular there were no care plans in existence when she was working there. Surely that's a fundamental part of basic nursing care?

Yes, that was certainly one of the problems we identified as well and that is, as you're right to say, a fundamental part of good care. That's now been addressed.

When our nurse was working undercover on the ward, there were several occasions when she was in charge of the ward. She's a D grade nurse, a bank nurse, a low grade but experienced nurse yet she was left in charge of a ward of highly dependant patients. Why was that allowed to happen?

Clearly that is not something that we would ordinarily tolerate and I think it illustrates the problems that the ward was experiencing at that time. Clearly she was a competent nurse, experienced and the ward manager at that time took the decision that she could be left in charge of the shift, although she was a grade D. I think that's not something that we would tolerate and certainly that wouldn't happen now following the changes that we've introduced.

The ward did experience difficulties with recruitment of staff at that time. That was one of the factors that the internal investigation showed. We have increased staffing levels since that period so that now there are more staff on duty at any one time, and also their shifts are better planned and rostered so that people are starting and finishing during the busy times on the ward.

You talk about a review but that review does not wipe out what has happened in the past to the particular patients who were on the ward at that time, and some of the things that our undercover nurse saw, she found deeply distressing and seemed in many cases to ignore the basic human needs of some of the patients. For example, a woman who you see literally gasping for a drink because no one has kept fluid charts adequately, nobody has given her a drink for many hours, nobody seemed to be aware quite often from shift to shift what the particular patient's needs actually were.

Yes, nobody can excuse that and I certainly wouldn't want to do that. I think some of those lapses in care are inexcusable and again I'd like to apologise to those patients and to their relatives for those lapses. But I'm pleased to say that we did discover them. They were reported to us, to my office. I instigated this internal investigation and a thorough action plan, which has been implemented.

In another instance a woman was left for two hours having been given diuretics which obviously encourage her to go to the toilet, and had been calling out in increasing distress during that two hours for someone to help her go to the toilet and was told in a rather brusque way to wait even longer. The nursing guidelines that exist, the Department of Health guidelines, say that people shouldn't wait longer than five minutes and she'd been left waiting two hours.

Well I agree that that is unacceptable and it was complaints of that nature that we started to get in November/December of 2004 that triggered our internal investigation because things were obviously not right on this ward and..

Why weren't they right, what was going wrong in your view?

Well the investigation found a series of issues, some of which I've mentioned in terms of staffing numbers and staffing deployment within the ward. There were issues of ward leadership and management which we addressed. Policies and procedures were not as thorough as they should have been. These included the training and development of staff, implementation of policies and procedures like fluid balance charts, named nurse and so on. These things were not as they should have been and we took action to sort that out.

You have a new ward manager starting in mid-March I think, but when our nurse was here on the ward at the beginning of May she was certainly saying to us at the time that nothing seemed to have changed. She was still aware that there were issues with fluid balance charts that weren't being dealt with, there were still no care plans. Many of the problems she had witnessed when she was here before Christmas hadn't been resolved. How long does it take to change a very basic thing like making sure a fluid balance chart is written up properly?

I know that the nurse concerned spent a very small number of shifts on the ward after the change of leadership and the implementation of the changes. She certainly spent more shifts on the ward during the period of difficulty that we're referring to. But I can tell you things have improved dramatically under the new ward leader. You're right to highlight that change can't be brought about overnight, it does take a period of time for things to be properly imbedded and made comprehensive across the whole ward.

How long did it take to fix very basic things? You say it takes time but during that time patients are being cared for on the ward, new patients are coming in and if things are not right, they're the ones who are having to put up with it.

Well we first identified the problems in November and December of 2004. We immediately instigated an investigation. It takes time to get to the bottom of the issues and to understand the concerns being raised by patients and relatives and by other staff.

Charts not being written up properly; observations not being done properly; patients being left without drink; patients not helped to eat: those are very basic simple things. Surely they don't take long to fix?

I agree and those matters have been addressed and fixed.

Completely?

Yes. We've had very few complaints since the changes that we're talking about have been introduced, certainly compared with the period beforehand. Concerns raised about this ward are probably in line with what we would get about any other ward.

Why were there no care plans in existence on the ward?

There were care plans in existence but there were lapses clearly in a number of instances. No one can seek to defend that and I'm certainly not here to do so. The reasons for the problems were breakdowns in communication. There was a lack of clarity on the ward from the ward manager downwards about the policies and procedures that should be there and how they were to be implemented. People were not properly trained in the policies and procedures that we had implemented across the Trust. Those were the issues that we sought to put right and I'm pleased to say we are now doing that.

So how would you describe the state of care and the way that these two wards were run at the time you started your investigation?

Less than satisfactory. There were problems, major problems, major lapses in care and they were identified, as I said, through a series of complaints and concerns being raised within the Trust.

So you do accept that there were major lapses in care?

Yes.

These things happened under your watch as chief executive of this hospital. How do you feel about that?

Well clearly the fact that the initial problems were identified gave me grave cause for concern. I take a personal interest in the quality of care within the wards. I actually take a particular interest in the quality of care for older people because I think sometimes in our caring services older people don't get as high a priority as they should, so clearly that was of grave concern to me. I am pleased however that these problems were identified. We didn't just let things continue in that way, we triggered an internal investigation which has led to a dramatic transformation in the quality of care on this ward.

One of the incidents which came to light, and obviously these things happen from time to time on a hospital ward, was that an old lady died in her bed and it was a while before anybody had noticed that she had died. In fact it was one of our team who found her dead. It would have been a very simple thing, wouldn't it, for somebody on the ward to have phoned one of her close friends and just said, look, I think you should come and be with her. That didn't happen.

No and that is the type of thing that is important. As you say, people obviously die in hospitals and I know that some of the images that are being shown on the programme are quite shocking of old people dying, but regrettably old people do die in hospital. A lot of the patients on this ward have terminal illnesses, but care of the dying is important to us and it is one of the recommendations that came out of our review actually, that we need to improve our palliative care and the inclusion of relatives and carers when people are coming to their final hours. So we have addressed those concerns.

Do you have more nurses working on these wards now?

Yes, we do. Yes.

How many more?

Only one more but the greatest improvement has actually been through improving rostering so that we're actually matching the nursing availability to the periods of peak demand which previously wasn't the case.

Sure, but to many viewers it may come as a surprise that somebody who has presided over such a shambles, if I can call it that, might still be working in your Trust.

I can't really go into individual details of Trust employees and their employment records and current deployment within the organisation. I think that would be a breach of confidentiality. All I can say is that issues of staffing and performance have been dealt with in line with our policies and procedures.

This is a Trust with zero stars and a large financial deficit, did that financial deficit contribute to the quality of care on these two wards at the time it was happening?

No, I'm confident that wasn't the case. The financial deficit is still here. We have financial challenges but the quality of care has improved dramatically.

One of the things that the new ward manager said very clearly to our nurse when they had the conversation was that these wards were overspent to the tune of 108,000.

I've seen that clip and you know that conversation obviously took place, but I can assure you that wasn't a contributory factor for the lapses in quality of care that were identified.

What priority does the care of elderly people have in your hospital?

It has a high priority. As I mentioned earlier it's a particular interest of mine that older people should receive the same standard of care as everybody else, and often as has been highlighted in various documentaries and programmes older people don't get a fair crack of the whip, but within this organisation we are raising the profile of the need to provide high standards of care for older people. The wards in which the undercover filming took place are not the best wards. In fact they're some of the worst wards in the hospital in terms of their layout and size and so on and the degree of privacy which they afford to patients but we are going to address that. We are putting together plans to rebuild this whole block to provide better standards of accommodation for all of our patients, obviously including the older patients.

One of the other things that we observed was that on many occasions patients were left to lie in bed all day without being got up, without being able to wear their own clothes. They were left in bed wearing hospital gowns and not encouraged to get up and get out and about and to get better.

Well clearly patients should be encouraged to move around as much as possible, as much as they want to and are able to do as well, and clearly if there are examples of patients not being encouraged to do that then we would want to address them. Part of our action plan that's been implemented since these problems were first uncovered has been to improve physiotherapy, occupational therapy and rehabilitation services available to patients on this ward so that they can mobilise and become active in that way.

So if I went back on the ward now I wouldn't see patients languishing in bed all day wearing hospital gowns, I'd be seeing patients who were encouraged to get up, move about, wear their own clothes and be active.

You'd certainly see patients encouraged to get up but of course some patients may choose to stay in bed all day in hospital clothes and that's their choice. I'm sure you're not saying that we should force patients to get up out of bed if they don't want to or are not able to.

On a number of occasions when our colleague was filming, they observed nurses and other members of hospital staff eating food that was clearly intended for patients.

Yes, I've seen some of those clips and obviously if there's further evidence of that then I'd like to see it. The hospital policy is that staff should not eat food which is intended for patients, either before it's reached them, at the time when it's being served or even afterwards if there are leftovers. So clearly that is a breach of hospital policy and procedure.

And what will happen to those members of staff as a result of what you've seen?

Well any instances like that will be dealt with through our own internal policies and procedures and...

Will they be disciplined?

Well that's a matter for the managers concerned to consider in line with policies and procedures. Once we have the evidence from the undercover filming then we'll take those issues into account.

This is a hospital that's part of the 'better hospital food programme' and yet there seems to be clear indication that on many occasions patients were not getting food that they liked to eat. They were not being helped to eat food. On one occasion there was a woman who was blind who was left for some considerable time with nobody coming to help her eat the food, and by the time she was given it, it was cold.

Well that's unacceptable clearly, patients should be assisted to eat and that is part of the responsibility of the nursing and ward housekeeping team to make sure that patients receive proper nutrition.

Improvements have been made following our internal investigation. Measures have been introduced to make sure that patients get better nutrition and that they get their food and drink at the time when they need it.

How would you describe the quality of care on this ward now?

Greatly improved from the position that your undercover staff witnessed. I would say that there is still room for improvement as there is in many wards and departments. We're far from complacent but I would say that this is a ward that I would be happy to receive care in myself or for one of my relatives to receive care in.

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