The Cambridge hospital is the 24th to be placed into special measures since the Mid Staffs scandal official report in 2013

What has happened to Addenbrooke’s hospital?

The Cambridge hospital, one of the NHS’s biggest and until now one of its most prestigious care providers, has been put into “special measures” after the Care Quality Commission (CQC), the NHS care regulator in England, deemed its services overall as “inadequate”. It is the 24th hospital trust to be placed into special measures since the official report into the Mid Staffs NHS care scandal came out in early 2013. It means that more than one in seven of England’s 160 acute trusts have now been deemed so poor as to need very close supervision and external support to improve, such as being “buddied” by a high-performing NHS trust.

What problems did the CQC’s inspectors find at Addenbrooke’s?

They praised staff as “hard working, passionate and caring throughout the trust”, and for going the extra mile for patients. But they also highlighted threats and potential threats to patients’ safety, some of which had been known about since 2013 but not properly tackled, such as nitrous oxide (laughing gas) leaking inside the maternity unit. However, their most worrying finding was that “a significant shortage of staff” was affecting many of the hospital’s key areas of care, including its critical care and maternity services.

Recruitment and retention problems were leading to: staff being switched to work in areas of care which they were not specifically trained for; routine operations being cancelled; patients facing delays of up to 51 weeks for outpatient appointments; heavy use of expensive agency and bank staff; and, in respect of childbirth services, the maternity unit sometimes having to close.

Addenbrooke’s was also one of the worst-performing hospitals in England last winter, judged against the four-hour waiting standard for A&E care and was one of about 20 trusts to declare a major incident in January because it was struggling to cope with the level of demand.

Facebook Twitter Pinterest Accident & Emergency at Addenbrooke’s: one of the worst performers for waiting times last winter. Photograph: David Levene/The Guardian

How are the trust’s finances?

A: Very problematic. It is overspending by £1.2m a week and on course to end the year £64m in the red, according to Monitor, the independent regulator for foundation trust hospitals including the Cambridge University Hospital NHS Foundation Trust, which runs Addenbrooke’s.

Is the CQC’s judgement that Addenbrooke’s is “inadequate” fair?

A: Keith McNeil, its just departed chief executive, thinks not. He has called the CQC’s findings “wrong” and insisted that care there was “phenomenal”.

“Everywhere across the country people would be very envious of the sort of results we get day in day out. People’s lives are saved every day by that hospital. I cannot see why anybody would want to describe it as inadequate”, he said. McNeil, headhunted from Australia in 2012 to take on the post, also said, in a BBC interview, that he did not believe there was “any sane or rational interpretation of the word ‘inadequate’” that would fairly describe any aspect of his hospital’s operations.

How common across the NHS are the problems found at Addenbrooke’s?

A: Worryingly common. Another trust, East Sussex Healthcare NHS Trust, has also been put into special measures after the CQC found, among other things, low staffing levels in its surgery, maternity and pharmacy services. Every CQC inspection report confirms the problem, which can directly affect patients.

Why is staffing such a problem?

A: The NHS is facing significant shortages of many different types of health professionals, including GPs, A&E doctors, nurses, midwives, paramedics and radiologists. Hospitals and ambulance services are increasingly reliant on staff from all over the world, and are often in competition with each other for the same doctors and nurses at trade fairs in places such as the Philippines. However, despite hiring more overseas staff, shortfalls – and thus gaps in rotas – are still widespread.

Recent cuts to the number of nurses being trained in Britain have not helped. Years of pay restraint in the NHS, which is set to continue until 2020, and the stresses and strains of working in a service under visible pressure are factors, too. More staff, notably nurses, are choosing to work on a freelance basis, either as locums or through employment agencies. Such staff now cost the NHS £3.3bn a year.

Facebook Twitter Pinterest More staff, notably nurses, are now working freelance. Photograph: Christopher Furlong/Getty Images

Is the NHS in crisis?

A: There are certainly worrying signs about how the health service is performing even before winter – usually a testing time – has arrived. A&E waiting times are already worse than at the same time last year, following which they collapsed spectacularly in most places over the winter months. NHS bosses say that “the system is running hotter” than at this point in 2014.

The most recent official NHS performance figures indicate that the service in England is under intense pressure. Statistics published last week showed that the number of peope waiting for planned treatment in hospital has ballooned from 2.57m when David Cameron became prime minister in May 2010 to just under 3.5m in July this year.

In addition, many hospital trusts are also missing waiting times targets for treating cancer patients, while average ambulance response times to 999 calls are getting longer and the numbers of patients not being diagnosed within six or 13 weeks have soared almost five and ten-fold respectively since May 2010.

Was a former coalition health minister right to warn that the NHS could “crash” within two years?

In Sunday’s Observer, Norman Lamb warned that the the health service was on the brink of collapse unless it received an immediate multibillion pound cash injection.

The pressures are real and are building up, and winter could prove very difficult indeed. While Lamb was always one of the coalition’s most quotable ministers, the NHS is under unprecedented financial strain and likely to end the year with a deficit of around £2bn. The £2bn is unprecedented in its scale, reflects massive hiring of staff to fulfil political objectives around safer care and matters also because the NHS has until now made a surplus.

Addenbrooke’s managers are not to blame for hospital’s difficulties | Letters Read more

Jeremy Hunt, the health secretary, is adamant that the extra £8bn the Conservatives have pledged to give the NHS by 2020 is enough and that it must crack on with making the £22bn of matching efficiency savings NHS England boss Simon Stevens has promised. Hunt has ruled out a huge bailout to cover the £2bn loss.



The trouble is, no one in the NHS top brass or health policy world thinks £8bn will be enough, given the growing demand for care, and especially the ongoing decline in social care support to frail, elderly people. Nor do they think the NHS will realise anywhere near £22bn of savings.

The Comprehensive Spending Review, due in late November, may – or may not – give the NHS more money, or at least respond to calls for the £8bn to be “frontloaded”, ie handed over soon.

Will the £8bn cover the cost of meeting the Conservatives’ pledge that the NHS will be a fully-formed seven-day service by 2020?

Hunt seems to think that it will pay for that, but the NHS high command, groups representing staff and health think-tanks say additional extra money will be needed, as extra staff will be needed to make it happen.