7:00am 28th October 2014
A new report highlights claims of failings at two Surrey hospitals
In one instance, a fractured neck was apparently missed, in another a patient appeared to be given too little oxygen.
The Parliamentary and Health Service Ombudsman has published a summary of the two local investigations.
In one case, it claims a woman was discharged from the Royal Surrey after a car accident.
It was later found she had suffered fractures in her breastbone and her neck.
The report also claims a patient at Epsom Hospital was not given enough oxygen as he was transferred between wards.
In total, 161 summaries of investigations carried out between April and June this year have been published.
The ombudsman says it is making its findings public to encourage people with complaints to come forward.
Parliamentary and Health Service Ombudsman Julie Mellor said: “These investigations highlight the devastating impact failures in public services can have on the lives of individuals and their families.
“We are committed to being more open and transparent about our investigations and are publishing these summaries so people can see the types of complaints we look into.
“We hope this gives people the confidence to come to us to complain and shows how complaining makes a positive difference to the complainant and public services.”
Chief Nurse at Epsom and St Helier Hospital, Pippa Hart, said: “On behalf of the Trust, I would like to offer my heartfelt condolences to the family and loved ones of Mr P.
“While today’s report recognises the high standard of clinical care provided to Mr P, I fully acknowledge that the actions of one individual severely let him and his family down, and caused unnecessary distress during an already very difficult time. For that, I sincerely apologise.
“This incident was deeply concerning to us and does not reflect the high standard of compassionate care that our staff aim to provide for every patient.
“As such, we did not hesitate to act and suspended the nurse in question. Her contract with us has since been terminated and the incident referred to the Nursing and Midwifery Council.
“In addition, we have put a number of additional measurements in place to help ensure a similar incident can never happen again.
“This included a full review of our policy around transferring patients, regular unannounced spot checks during patient transfers and additional staff training.
“I also asked the matrons from across our hospitals to personally review the way in which their staff transferred patients.”
In a statement, the Royal Surrey said: “This investigation concerns a patient who was involved in a road traffic accident in 2010. The x-ray examinations performed here, at the time of the accident, did not identify injuries subsequently diagnosed on a CT scan performed at another hospital.
“The Trust has written to the patient to offer our sincere apologies that we failed to diagnose the patient’s injuries at the time of her admission. We are very sorry that this resulted in a prolonged and unreasonable period of discomfort for her.
“Since the patient’s admission the Trust has made major changes to its trauma care pathway as a recognised Trauma unit the London South West and Surrey Trauma Network. It is now an expected standard that patients involved in serious road traffic accidents should have a CT scan which is a more sensitive investigation to detect injury than the X-rays performed in this patient.
“We now perform a CT scan within one hour of a patient’s arrival in the Emergency Department and all trauma patients are now reviewed by an A&E consultant. As part of the governance of the Trauma Network group and the Clinical Commissioning Group, the Royal Surrey is subject to frequent robust reviews of its trauma care and we are confident that the failings identified by this Ombudsman report will not be repeated.”