Analysis

Gosport scandal: what it means for older people’s nurses

The duty of candour and support for whistleblowers would make it easier for nurses to raise concerns today, say experts

The duty of candour and support for whistleblowers would make it easier for nurses to raise concerns today, say experts

  • Independent panel’s report questioned nurses’ conduct and criticised NMC over delays
  • Still hard for junior staff to speak out even though nurses are now more empowered
  • Duty of candour and support for whistleblowers help make another Gosport less likely

Picture: Alamy

Coverage of the deaths of older people at Gosport War Memorial Hospital in Hampshire has largely focused on the actions of one person, Jane Barton.

Ms Barton, a GP who was clinical assistant at the hospital, oversaw the prescribing of ‘dangerous’ amounts of diamorphine, according to the independent panel that examined the deaths of patients between 1987 and 2001.

456

patients had their lives shortened as a result of inappropriate use of opioids

Source: Gosport Independent Panel

The panel’s findings also have implications for nurses – and especially those who work with older people.

Nurses raised alarm

It was nurses who first tried to raise the alarm. Staff nurse Anita Tubbritt told the local RCN branch in early 1991 that she and others had concerns about the use of diamorphine and syringe drivers.

Discussions were held with a number of nurses, leading to a meeting with senior managers and Dr Barton that had the effect of ‘silencing the nurses’ concerns’. This, the panel said, was a ‘missed opportunity’.

But the conduct of nurses was also questioned by the report. The records, it said, showed that nurses in the hospital administered drugs and continued to do so for many years, although the link with the pattern of deaths would have been apparent to them.

‘Potentially it could be very damaging to the reputation of all those who work with older people’

Nicky Hayes, nurse consultant for older people

A number of nurses were referred to the Nursing and Midwifery Council (NMC), which decided not to proceed in any of the cases.

The report criticised the regulator for excessive delay and poor decision-making, prompting an apology from the NMC, which admitted it had ‘badly let down’ families involved.

200

more patients whose records were missing or incomplete may have had their lives shortened

Source: Gosport Independent Panel

British Geriatrics Society nurses and allied healthcare professionals council chair Clifford Kilgore says it is a ‘mixed picture’ for the profession. He says although some staff tried to raise the alarm others carried on doing things that they knew were not right: ‘It feels like Mid Staffordshire all over again.’

Better support in place

So could this happen today? And would it be easier for nurses to speak out if it was happening?

Mr Kilgore believes the structures put in place over the past five to ten years have helped.

These include the introduction of a duty of candour, which places a legal duty on trusts to inform patients and families when harm may have been caused, as well as greater support for whistleblowers through the creation of Freedom to Speak Up Guardians in all NHS trusts.

‘We don’t want people reacting badly by not prescribing these drugs when they are needed’

Clifford Kilgore, British Geriatrics Society

‘The doctor had such authority that people felt unable to question her,’ Mr Kilgore says. ‘We now have much better support in place, but it can still be difficult for the most junior members to speak out.’

How the system has changed since Gosport

  • A duty of candour has been introduced, which places a legal duty on all healthcare organisations to inform patients or their families when problems with care cause harm
  • Freedom to Speak Up roles have been established across the NHS to support whistleblowers
  • The Healthcare Safety Investigation Branch has been established to support NHS trusts’ own investigations, as well as carrying out their own
  • A new regulator, the Care Quality Commission, has been set up and oversees a tougher, Ofsted-style inspection regime
  • Independent medical examiners will scrutinise every NHS death in the future – a move recommended by the Shipman inquiry
  • Responding to the Gosport report, health and social care secretary Jeremy Hunt said the culture was ‘changing’ and he believed problems would be identified much sooner now, but he acknowledged there was still ‘a long way to go’

North Middlesex University Hospital NHS Trust assistant director of nursing Nichole McIntosh agrees.

She says there is still a great deal of variation between organisations in terms of openness and honesty.

‘Some have done more than others,’ she says. ‘It takes a while for staff to feel safe to put their head above the parapet.

‘For nurses to be articulate, bold and courageous there need to be good nursing role models from board to ward to ensure the nursing voice is heard.’

Reluctance to prescribe

Mr Kilgore is also worried that the negative headlines generated by the case could lead to NHS staff becoming scared to prescribe pain relief.

‘We know that people with dementia and at the end of life tend to have pain undermanaged, not overmanaged.

'We don’t want people reacting badly by not prescribing these drugs when they are needed.

‘There is strict guidance about how they should be used, starting with minimum doses. Staff need to feel confident that they can follow that.’

King’s College Hospital NHS Foundation Trust nurse consultant for older people Nicky Hayes shares this concern. ‘Potentially it could be very damaging to the reputation of all those who work with older people,’ she says. 

‘There is so much great care going on, and since this happened things have changed greatly’

Nicky Hayes, nurse consultant for older people

‘We saw something similar when there was the controversy over the Liverpool Care Pathway. It made the public suspicious.

‘But we have to remember that this is the exception. There is so much great care going on, and since this happened things have changed greatly.’

9

years passed between nurses raising alarm and a decline in the number of patient deaths

Source: Gosport Independent Panel

Nurses more empowered

As well as patient safety measures, she believes the greater responsibility and senior roles for nurses over the past 20 years will have made nurses feel more empowered.

‘We have seen a move towards creating senior advanced nursing positions where nurses are prescribing and taking a lead in multidisciplinary working for older people’s care, particularly in community hospitals. That is for the best because medically-led care is not necessarily the right thing for frail older people.

‘It means it is much easier for nurses to question the way things are done than it was. But that doesn’t mean something similar could not happen today.’

Summary of the Gosport panel’s findings

The Gosport Independent Panel, chaired by former Bishop of Liverpool James Jones, was set up to address concerns raised by families of patients who had died at Gosport War Memorial Hospital. Here is a summary of its findings:

  • The panel initially looked at just over 100 deaths, and found 71 patients were given opioids without justification. Many had not been admitted for terminal care
  • The panel broadened its investigations to more than 2,000 deaths between 1987 and 2001
  • The inquiry’s final report, published in June, found 456 patients had their lives shortened between 1989 and 2000
  • It said 200 others may have suffered a similar fate, although records were missing or incomplete
  • Jane Barton, a GP who was clinical assistant at the hospital, oversaw the practice of prescribing on the wards
  • Consultants and nurses would have been aware of the inappropriate use of diamorphine
  • Nurses failed in their responsibility to challenge prescribing that was not in the interests of the patient
  • The panel concluded there was a ‘disregard for human life’ and a ‘culture of shortening lives’
  • The only person to face disciplinary action has been Dr Barton, who in 2010 was found guilty of serious professional misconduct by the General Medical Council. It did not remove her right to practise medicine
  • Police and the Crown Prosecution Service are reviewing whether criminal charges should be brought against any staff

Nick Evans is a freelance writer

More articles related to Gosport

Further information

This article is for subscribers only

Jobs