Difficult times ahead for the hospital and its clinical school?Rob Johnson

“Addenbrooke’s puts patients ‘at risk’”. “Addenbrooke’s hospital put into special measure”. “Serious staff shortages at Addenbrooke’s.”

These were the headlines that greeted us on 22nd September as a report by the Care Quality Commission (CQC) branded the Cambridge University Hospitals as overall inadequate. The sheepishly apologetic response from the Chair of the CUH NHS Foundation Trust read: “I would like to say sorry to our patients for a lack of effective systems and processes across our trust...”

However, this failure had been showing signs of coming to a head well in advance of the recent report. Although within it staff were praised and rated as excellent, it has become apparent that those same staff had been very unhappy with the management at the hospital for a long time, with an anonymous insider indicating that every major managerial resignation was “not unexpected”.

Monitor, the organisation that placed the trust in special measures, predicted a budget deficit of £64 million for 2015/16, but more shocking perhaps was the report that the hospital had been overspending by £1.2 million a week. This led to the resignation of the Chief Financial Officer Paul James in anticipation of the report.

This is not the only major resignation the hospital has seen. Insiders report a few members of the trust’s board resigning since July, with the final nail in the coffin coming from Dr Keith McNeil, previous chief of Addenbrooke’s, who resigned in mid-September. The same insider at the hospital also said that his resignation had been on the cards for some time before he finally stepped down. It is rumoured that Dr McNeil’s family moved back to his home in Australia in anticipation of his resignation.

Yet for all of the reports on the hospital and its failings, little consideration has thus far been given to the impact the developments will have on those students who receive their medical education at the hospital.

A survey of 46 medical students studying at Cambridge carried out by Varsity found that a remarkable 71 per cent felt that the CQC report was damaging to the hospital, and while many commented on the great levels of care they see at the hospital, the management was often the target of criticism.

Medics receive a great deal of practical teaching from the hospital in their clinical studies, and of those surveyed, 30 per cent agreed that their education at Cambridge had been undermined by the report, with one student even telling us some of their contemporaries were considering not staying on because of the report.

The Cambridge Medical School has declined to comment on the report.

The lack of trust uncovered by the report is very disturbing, and may well prove to have lasting damage on future students training to be medical professionals. Considering the medical profession relies heavily on junior doctors, any kind of lack of confidence in their medical education may well be detrimental to any medical practice in the future.

Just under 50 per cent of the people surveyed also felt like the CQC report undermined the University of Cambridge directly; a damning statistic given Cambridge’s aim to be the best university at which to study medicine. For any potential students coming to study at the university, the report is hardly a fitting welcome.

Furthermore, the findings of the report are not isolated cases in Addenbrooke’s history. Earlier in the year, it was revealed that Addenbrooke’s A&E department was the worst performing of its kind in the country. Only 75.2 per cent of patients were seen in the standard four hour waiting period, with the national target standing at 95 per cent. In light of this, the interim Chief Executive, David Wherrett, insisted: “Our services continue to be recognised nationally and internationally for their safety and patient outcomes.”

However, by far and away the biggest concern the report raised was the lack of funding and staffing at the hospital. One medical student commented: “The CQC report is absolutely meaningless as all it highlights is that there is a lack of funding but the care given by the doctors and nurses is outstanding...the politics side is what needs sorting out.”

Another student made the point that the hospital isn’t getting enough funding to keep up with changing times: “They don’t have enough money to supply adequate resources so Addenbrooke’s is of course in need of more staff...there aren’t enough resources for an ageing population and the system can’t cope.”

The lack of funding for Addenbrooke’s is an area that has been addressed before, more recently by Daniel Zeichner, Cambridge’s Labour Party MP. Commenting on January’s inadequate A&E figures, he said: “The latest figures, showing that a third of people are waiting over four hours are deeply disappointing – and at a hospital in the constituency of former Health Secretary Andrew Lansley should be a source of deep shame for the coalition government.”

Speaking about the CQC report, however, Zeichner also noted: “The Conservatives promised extra for the health service. We haven’t seen it.”

This was also a point widely addressed by the medical students surveyed, with many citing the NHS funding cuts as an aggravating factor.

In light of the recent student protests against the government’s proposed changes to junior doctors’ contracts, this report only confirms some people’s view that the NHS is being cut too deep to function properly. As one student put it: “[The report] seems just a small part of the wider issue of an increasingly underfunded NHS which is hurtling towards the edge.”

The reasons behind the trust’s difficulties are generally agreed to be financial and managerial. Addenbrooke’s was ordered to switch to the American eHospital system, the first hospital in the UK to do so. Having faced issues when first implemented, it lead to a 20 per cent drop in A&E performance, as well as having cost the hospital £200 million. These changes were being made at the same time that the government was ordering the NHS to cut £2 billion from its effective budget.

While it is still clear that the level of overall care and ability of the medical staff at Addenbrooke’s is very good, the lack of trust in the hospital among medical students is worrying. Even though the majority of students did not think that the report would make them lose faith in the medical education they are receiving, the fact that this is a prospect for 30 per cent of those surveyed is itself cause for concern.

So while the interim chief of the hospital, David Wherrett, may praise the “success” uncovered in the CQC report, for many medical students that may not be enough to regain their trust at this difficult time.