Five errors which '˜never should have happened' at Blackpool Vic

Surgery on the wrong body part and botched eye operations at Blackpool Victoria Hospital are among the mistakes that should never be allowed to happen, it can be revealed.

Wednesday, 8th March 2017, 6:00 am
Updated Friday, 24th March 2017, 11:06 am

Five errors described as ‘never events’ were recorded between April and December, The Gazette can reveal.

Only three hospital trusts in England had more ‘never events’ last year.

Elaine Thomas, whose mother Doreen Buckley was given an unnecessary emergency chest drain in 2015, said: “It’s extremely disappointing this is continuing to happen and I’m just frustrated that it is.”

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Blackpool Victoria Hospital

Mrs Thomas added: “Is this NHS that we love under such terrific strain that these events are happening, or is it down to the competency of the doctors?”

The major blunders, which all happened between April and the end of December, came as the hospital struggled with a cut in funding, a surge in patients, and a shortage of staff that saw nurses being asked to volunteer for more shifts.

It makes the hospital the joint fourth worst in England for never events along with several other trusts.

Deputy medical director Dr Nick Harper said in a statement the trust had apologised to those affected by the errors, and said they had been kept ‘fully informed’ about what had happened.

Blackpool Victoria Hospital

“They did not come to harm but we take these events extremely seriously and we have put changes in place to prevent this from happening again,” he said.

“If a ‘serious incident’ or ‘never event’ occurs at the trust, we carry out a detailed and comprehensive investigation, sharing the outcomes with the patient or family concerned.

“Resulting recommendations are designed to reduce the risk of recurrence, taking action in the relevant services and sharing learning across the organisation as well as with the wider NHS when appropriate, in order that lessons are learned.”

Estephanie Dunn, regional director for the Royal College of Nursing (RCN) in the North West, added: “Healthcare employers, front line staff and patients are naturally concerned about all so called ‘never events’ or medical mistakes so serious they should never happen.

“Although never events are rare, just one ‘never event’ is one too many and can have a devastating and lasting effect on a patient and their family. Like the Blackpool Trust, RCN members will be very concerned that there have been five such incidents at the Blackpool Victoria Hospital.

“The NHS needs to learn from mistakes and ensure that the appropriate action is taken to prevent similar incidents from being repeated.

“The NHS is also facing a period of unprecedented pressure with ever increasing demand from an ageing population with complex needs.

“Therefore it must tackle the current nursing and workforce crisis and insufficient social care provision to ensure that there are the appropriate number of nurses with the right skill mix to ensure safe, quality care for patients.”

Blackpool South MP for Labour, Gordon Marsden, said: “It’s obviously concerning, even though it’s a very small proportion of all the procedures, that these five events have taken place, and had the potential to cause harm.

“I hope the hospital trust will be able, if not to give us chapter and verse, to say how they will prevent the number of these events in the future.”

And Blackpool North and Cleveleys MP for the Conservatives, Paul Maynard, added: “I’m sure the trust management will share my concern at such a high number of so-called never events.

“While they can’t turn the clock back, I would expect management to review its policies and procedures, and make reducing this number a mission critical target over the coming year.”

Katherine Murphy, chief executive of the Patients Association, said she was concerned after national figures showed 314 never events were recorded between April 16 and December 31 last year.

She said: “Never-events are precisely that, events that should never, ever happen.

“The fact that they are occurring should ring alarm bells in trusts, with Clinical Commissioning Groups (CCGs), NHS England and the Department of Health.

“There are no excuses for failing to follow medical protocols as it could be the difference between life and death.

“While patients and the public understand that medical professionals and support staff are under pressure and have increasing workloads, this is not an excuse for allowing never-events to occur.

“Ultimately, most patients will be anxious or at any rate, unwell, and so they should not have to have the added stress and burden of worrying about issues like never-events.”

Dr Mike Durkin, NHS National Director of Patient Safety, added: “All patients deserve high quality, safe care.

“We expect organisations to investigate and learn from mistakes, and the fact that more and more NHS staff take the time to report incidents is good evidence that this learning is happening locally.”