What does the analysis show?In eleven of the most marginal Conservative seats the NHS is becoming associated with an intense period of crisis. A steady stream of media reports and public controversy surrounds key healthcare institutions in these areas. Issues relating to understaffing, workload and financial pressure underpin these problems.

In all of the seats investigated, local hospitals or trusts have serious staffing shortages, which is having a clear impact on patient care.

Six of the constituencies are close to one of the eleven high profile hospitals that have been put under special measures for poor performance and high mortality rates: North Warwickshire, Sherwood, Broxtowe, Amber Valley, Thurrock and Lincoln.

Five of the constituencies are linked to hospitals that Monitor regard as having a high risk of financial failure: Sherwood, Broxtowe, Lancaster and Fleetwood, Morecombe and Lunesdale, and Amber Valley. Six are also close to hospitals that have Monitor’s highest warning for poor governance: Thurrock, Sherwood, Broxtowe, Lancaster and Fleetwood, and Morecambe and Lunesdale and Amber Valley

The impact of outsourcing NHS services to private companies has created problems and negative publicity in three of the areas. There is also evidence of public and staff concern throughout, and local pressure groups such as “Save our NHS” have been set up.

Many hospitals are struggling financially and the gap between top and bottom is widening. The NAO calculates that over 40 would have finished in deficit had it not been for additional funds. As it was, 25 hospitals finished in deficit (2012/13), down from 32 the year before but still up from 13 in 2010. The total is predicted to go up this year.

How was this analysis carried out?We investigated instances where local hospitals (those within approx 15 miles of the MPs constituency office or within reach for local patients) had performed poorly under inspection from the Care Quality Commission.

We compared hospitals in and around these constituencies with information from the CQC about units with inadequate levels of staffing.

We also compared the marginals with the list of eleven hospitals that have been placed under special measures for high mortality rates and poor performance as result of the Keogh inquiry. We looked at the workload, staffing and finance issues facing these units.

Similarly we looked at Foundation Trusts in the relevant areas that had been marked very negatively in the risk ratings produced by the health watchdog Monitor.

We looked for examples of public concern or negative media coverage, both locally and nationally of problems with the NHS in these areas.

We also investigated whether public concern had risen to the point where protests or pressure group activity had begun.

It should be noted that this report looks at the reputation and public view of the NHS in these areas. We do not draw any conclusions about the validity of the criticism of the individual health care bodies discussed, but focus on the common issues which they face.

IntroductionThe state of the NHS will be a crucial issue in the next general election. There are growing differences between the main parties on how to handle it. Controversy and a sense of crisis in the NHS has grown over the last year. Staff have spoken out about difficulties and surveys show that the public are concerned. Together these factors will make the NHS highly influential in the minds of voters and particularly in the closest fought constituencies. This report examines the pressure on the NHS and the problems with its performance in eleven of the most marginal constituencies held by the Conservative Party.

Under investigation •Nearby George Eliot Hospital NHS Trust in Nuneaton has

been placed under special measures for poor performane and high mortality rates.

•Arden Vale was an independent hospital providing care to people with learning disabilities and challenging behaviour. It was run by a private company exposed by Panorama for its shocking failings. The CQC failed Arden Vale on its ability to “care for people safely & protecting them from harm”. It was later closed after the company went into adminstration.

•Dr Foster reported a higher than expected mortality rate at University Hospitals Coventry & Warwickshire Trust. Life expectancy is significantly lower than the national average for both men and women in Nuneaton.

High profile issues (2013)George Eliot Hospital approved for potential private takeoverPlans which could see a private firm run a Warwickshire hospital have been recommended for approval by the Department of Health. The NHS Trust Development Authority said the George Eliot Hospital in Nuneaton could be taken over by “a non-NHS organisation” or another trust. In recent years, the hospital has been running a deficit of £5m a year and this year is expected to need a grant of £7.9m to bail it out.

Bed and staff shortages harming patientsSteve Wheaton,of West Midlands Ambulance Service said nearly 2,000 ambulances had waited more than an hour in February to hand over an A&E patient. He said the situation was the worst he had known in his 20-year career.

BBC identifies 13% A&E staff shortfallThe A&E department at Warwick Hospital is understaffed according to a recent survey which highlights shortcomings in staffing levels right across the country.

South Warwickshire A&E waiting times to be probedHospital waiting times in South Warwickshire are to be investigated by the health regulator Monitor. The watchdog said it would meet with the South Warwickshire NHS Foundation Trust over its “persistent breaches of A&E targets”. The trust has missed the target of 4-hour maximum waiting times in five out of the last eight financial quarters.

There is an active public campaign about the privatisation of the NHS and the impact of the recent NHS changes.

Reasons for public concernissues

Under investigation •The CQC identified dangerously low staffing at Royal

Cornwall Trust.

•Camborne Redruth Community Hospital failed a CQC test on its standards of care and treatment.

•CQC criticised standards of the outsourced GP out of hours service in Cornwall.

High profile issues (2013)MP calls for support for Royal Cornwall HospitalAndrew George, MP has called on Health Ministers to ensure that the Royal Cornwall Hospitals Trust is getting the support it deserves. Mr George highlighted the problems of excessive staff pressure, which was undermining morale, as well as bed and funding pressures.

Royal Cornwall ambulance admissions crisisAn average of about 10 ambulances a day were stuck waiting to deliver patients to the Royal Cornwall Hospital’s emergency department because of bed-blockersIn March, more than 300 ambulances had to wait more than half an hour before delivering their patients to hospital staff.

Serco’s GP out-of-hours service in Cornwall ‘substandard’A committee of MP condemned falsification of data and fact that underperformance only came to light because of whistleblowers. The scandal was reported widely in the national media.

Pensioner kept waiting for surgery on a hospital ward for almost 12 weeksGordon Tift, 69, walked into the Royal Cornwall Hospital in Truro three months ago to undergo surgery to remove blockages in his heart and an angioplasty on his legs and groin. Now his family has been told that his body is too weak for surgery to be possible, and the only option may be hospice care.

Reasons for public concernissues

Under investigation •Basildon and Thurrock University Hospitals has been

placed under special measures for poor performance and a high mortality rate.

• It failed CQC inspections on standards of care and its ability to protect patients.

•The trust watchdog Monitor judged “the governance risk rating for this foundation trust remains at RED because the trust remains in significant breach.”

HIgh profile issues (2013)Basildon hospital slammed over Amie Miller’s deathAmie Miller, 15, was taken to Basildon Hospital A&E in November 2008 after suffering headaches while studying for her GCSEs. She died from a brain condition three days later and an inquest heard the hospital missed several opportunities to save her life.

Basildon Hospital ‘failed patients’ over legionella casesTwo patients died in 2007 and 2010 after contracting Legionnaires’ disease at Basildon Hospital in Essex. Six more were infected during the same period. The hospital admitted failings under the Health and Safety at Work Act.

Basildon hospital chief makes statement on high death ratesChief executive Clare Panniker said the hospital would invest £1.8m on new staff by the end of the year and increase its bed capacity after concerns were raised over the hospital’s ability to deal with emergency admissions.

Crisis in A&E as hospitals grapple with staff shortagesAt Basildon and Thurrock hospitals patients were left in ambulances “stacked” outside A&E” as the hospital failed to cope with demand, while others were waiting for 14 hours in casualty.

Darent Valley Hospital forced to close its A& E to admissionsDarent Valley Hospital closed to admissions on 3 January for six and a half hours. Ambulance crews were diverted to neighbouring hospitals in Gillingham, Maidstone and Tunbridge Wells.

Reasons for public concernissues

Under investigation•Sherwood Forest hospitals has been placed under special

measures for poor performance and a high mortality rate.

•The risk of financial failure for this foundation trust remained at 1(high) in August 2013. The governance risk rating of RED for this foundation trust has remained unchanged from the previous quarter.

•Kings Mill hospital failed a CQC inspection on its management.

•A report by the Royal College of Pathologists about the breast screening facilities at King’s Mill concluded “Problems with inadequate laboratory staffing levels and their difficulty maintaining consultant and scientific oversight of this service together indicate that in-house ER testing should not be recommenced at King’s Mill Hospital.”

•Queens Medical Centre was asked to take action after a CQC investigation in July on its standards of staffing and management.

•Two privately-run centres have come in for criticism from the CQC:

1. Partnerships in Care Limited runs Annesley House. CQC enforcement action taken on 3 out of 5 standards, with a further standard currently requiring improvement.

2. Four Seasons Health Care running The Huntercombe Centre-Sherwood: improvements proposed on 4 out of 5 areas assessed by the CQC.

High profile issues (2013)Nottinghamshire hospital trust faces £26million shortfallA report by Sherwood Forest Hospitals Trust said it would start the next financial year with a £26m shortfall. The trust was one of 11 to be placed in special measures, following concerns over high death rates.

Staffing levels in England’s A&E departmentsSherwood Forest Hospitals NHS Foundation Trust is currently understaffed in its A&E departments.

Hospitals rapped over major failingsSherwood Forest Hospitals NHS Foundation Trust was one of 11 hospital trusts put into special measures following the Keogh report. The trusts were identified as they had the highest death rates in 2010-11 and 2011-12.

Shortage of beds’ at Nottingham NHS hospitalA trade union has warned of a shortage of beds at Nottingham’s Queens Medical Centre (QMC). Unison said 26 people were waiting for beds at the Accident and Emergency unit on Tuesday.

Queen’s Medical Centre closes infected cancer wardA children’s cancer ward in Nottingham was closed after a fungal infection was detected in the ventilation system. Nine children were moved from the ward at the Queen’s Medical Centre after the discovery was made.

A Save Our NHS group is actively campaigning in Broxtowe against NHS privatisation and the closure of Kirkby hospital.

Queen’s Medical Centre,Nottingham

Reasons for public concernissues

Under investigation •The risk of financial failure of University Hospitals of

Morecambe Bay NHS Foundation Trust (which runs the Queen Victoria Hospital in Morecambe and the Royal Lancaster Infirmary) was rated 1 (high) by Monitor and its governance was also given its most negative rating, RED.

•Blackpool Victoria Hospital failed a CQC inspection by not responding adequately to patient’s complaints.

•Westmorland General Hospital in Cumbria is one of seventeen NHS hospitals that have dangerously low staffing levels, according to rulings by CQC.

Recent high profile issuesMorecambe Bay Trust ‘not meeting targets.’The University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) met seven of 40 suggestions from the Care Quality Commission for Furness General Hospital and Royal Lancaster Infirmary. (Sep 2013)

Morecambe Bay NHS trust ‘insolvent’ without £30m cutsThe University Hospitals of Morecambe Bay NHS Foundation Trust, which runs hospitals in Barrow, Kendal and Lancaster, told staff it faced a “serious financial challenge”. (Mar 2013)

Royal Lancaster Infirmary faces A&E closure threatA Lancashire hospital’s A&E unit has a month to improve or risk closure, says the CQC. The threat emerged after a surprise inspection by CQC at Royal Lancaster Infirmary found a corridor full of patients with just one nurse on duty.(2012)

North Lancashire couple hand over big health petitionMavis and David holmes of Bolton le sands, presented a uk petition with more than 400,000 signatures against privatisation of the NHS to David Morris MP (2011)

A public campaign to save the Royal Lancaster Infirmary has also been set up.

Reasons for public concernissues

Under investigation •CQC asked Royal Derby Hospital [1] to take action as it was

judged to be dealing with compaints poorly.

•Monitor point to a high risk of failure around the finance and governance of several local hospital trusts, with Derby Hospitals scoring 2/red and Burton Hospitals scoring 1/red, where 1 = high risk of failure. Of Derby Hospitals, Monitor says, “The financial risk rating for this foundation trust was amended from 3 to 2 in August 2013 due to a deterioration in financial position at Q1 2013/14”.

•See also the details for the nearby Sherwood Forest hospitals, including King’s Mill [2], under the Sherwood constituency.

Recent high profile issuesLack of staff at Royal Derby Hospital contributed to baby deathPoor staffing levels at the hospital were a contributory factor in a baby’s death, a report found. Amy Wray’s daughter Georgina was stillborn at Royal Derby Hospital in March 2012. An investigation into Georgina’s death said staffing levels on the labour ward were “below minimal levels” at the time, the labour ward was “busy” and communication between staff was “poor”. (Sep 2013)

King’s Mill Hospital ‘prioritised money over care’The hospital where women with breast cancer were given faulty test results prioritised money over patient care, a report said. The CQC inspected King’s Mill after test errors meant some women did not receive appropriate care. It reported poor communication and management, outdated equipment and said “finance appeared to take priority.”(Apr 2013)

King’s Mill Hospital admits breast cancer test errorsMonitor found concerns over “faulty tissues tests” from patients at King’s Mill Hospital. Managers admitted this meant about half the patients would not have received the most appropriate care. 79 women were recalled with regard to breast tissue biopsies between 2004 and 2010. (Oct 2012)

A local campaign group has been set up in South Derbyshire to campaign aginst the privatisation of the NHS.

Reasons for public concernissues

Under investigation•United Lincolnshire Hospitals Trust has been placed

under special measures for poor performance and a high mortality rate.

•The Care Quality Commission (CQC) criticised Lincoln County Hospital and Boston Pilgrim Hospital for low staffing levels and lack of training.

•Nearby North Lincolnshire and Goole Hospitals Trust have also been placed under special measures for poor performance and a high mortality rate.

High profile issues (2013) Call for Lincolnshire trust board’s resignationA Lincolnshire councillor has called for the entire board of the United Lincolnshire Hospitals NHS trust to resign in the wake of the Keogh report into high death rates.

Lincolnshire hospitals: Low staffing levels and poor trainingThe Care Quality Commission (CQC) criticised Lincoln County Hospital and Boston Pilgrim Hospital for low staffing levels and lack of training.

Northern Lincolnshire and Goole Trust boss gets £25k rise.The chief executive of a hospital trust which was put in special measures after a review of high mortality rates has been given a 15% pay rise.

Reasons for public concernissues

Under investigation•The Royal Sussex County Hospital failing four out of five

criteria when last assessed by the CQC.

•Princess Royal Hospital, West Sussex is one of seventeen NHS hospitals that have dangerously low staffing levels, according to rulings by the official safety watchdog, CQC

High profile issues (2013)Brighton and Sussex NHS ‘worst for A&E 12-hour waits’Brighton and Sussex University Hospitals NHS trust has been named as the worst in England for patients waiting more than 12 hours to be admitted to A&E. The trust has A&E departments at the Princess Royal Hospital in Haywards Heath and the Royal Sussex County Hospital in Brighton.

Nurses describe “worst working week of their lives”Nurses at the Royal Sussex County Hospital in Brighton have raised concerns they are no longer able to properly care for patients because of overcrowding and understaffing.

“Major incident” declared as Sussex hospitals hit crisis pointUnrelenting pressure on two Sussex hospitals forced bosses to declare a “major incident”. Non-urgent operations were cancelled and patients were turned away at the Royal Sussex County Hospital, Brighton, and the Princess Royal Hospital.

Brighton and Sussex NHS Trust faces £30 million of cutsNew chief executive says he cannot rule out job cuts as he tries to reach the government target for savings.

NHS campaigners challenge “creeping privatisation” NHS supporters demonstrated in Brighton to raise awareness of their concerns after Specsavers was awarded the contract to provide NHS hearing aid services earlier this year, previously run by the local NHS Trust, and campaigners fear this move is the beginning of a slippery slope as NHS trusts begin to lose other services to private companies.

A substantial event with bands and speeches used the 65th anniversary of the NHS to spread public awareness about the impact of NHS changes

Reasons for public concernissues