On 14 January 2022, the world became a little less magical following the passing of a soulmate, an incredible mother of three and a friend loved by so many. Hilary Gibson.
Hilary brought laughter into the lives of everyone she met and in recent years, proudly worked for Addenbrookes Stroke department as a medical secretary, a position she loved. She took the words of a former Addenbrookes CEO “proceed until apprehended” to heart and dedicated her time to going that extra mile to ensure patients got the treatment they needed and the medical staff the support they required. The end result was she was loved by colleagues and patients alike as shown by the volume of sympathy messages and cards we have received.
We will be establishing a charity in Hilary’s name to continue her legacy of helping others with a focus on diseases that eventually led to Hilary’s death. We are exploring plans to do this through education and raising awareness and working with Addenbrookes to understand how her worsening condition was missed so that we may focus on those areas that are most needed. We also hope to work in liaison with other charities such as The UK Sepsis Trust and CUTIC (Chronic Urinary Tract Infection Campaign) to change the attitude towards these two serious diseases which sadly did not get the attention of the medical staff at Addenbrookes their gravity deserves.
Please help us as we establish The Hilary Gibson Zero Foundation and continue Hilary’s work in making the lives of others better, when it could have been so easy for her to turn her back on people in need. Our company, Appsherpas, has kickstarted the fund and are changing their company articles to donate 10% of future profits on an annual basis.
Posted: 3 October 2022 10:12
I have been advised by the Cambridgeshire Coroners Office that both Addenbrookes Hospital and Royal Papworth Hospital legal departments have been invited to the Inquest Review on October 11th, 2022 as Interested Parties.
The Inquest Review is to provide all parties the opportunity to raise questions and obtain answers to the events that led to an individuals death. I hope to get answers to the many questions raised in my submission document to the Coroners Office and gain an understanding on why events I recognise as unacceptable are allowed to proceed without review. Or for that matter whether what I recognise as unacceptable, are indeed acceptable practice and help me understand why my view is wrong.
This exercise has never been about blame or vengeance. merely to understand whether what appears from my experience to be poor common practices are indeed best practices and whether improvements can be made to prevent unavoidable deaths in the NHS. Hilary is gone. Nothing will change that but I believe it to be unacceptable for me to ignore what I believe to be failings in the NHS and stand quietly by while others suffer the same outcome. Unlike the Coroners Office, it is not my duty to investigate events to prevent further deaths but by not standing to ask inconvenient questions I would be condoning future failings.
Thank you to all those that have provided support, both for the charity but also for the kindness shown to me and my family since Hilary’s death. Donations for the charity are still being taken by Peasgood and Skeates as shown above and we hope to get the charity finalised following the outcome of the Inquest Review and can start putting into action plans where we hope to help achieve what we believe everyone should desire and that is reduce avoidable deaths in the NHS to Zero.
Graeme
Posted: 1 September 2022 23:47
Today I submitted a 23 page document to the coroner’s office expression the concerns we shared with Addenbrookes during Hilary’s period of care until her death. 23 pages listing the questions we raised during Hilary’s treatment. 23 pages of questions we have been asking PALs since Hilary’s untimely death. Questions that have not been answered by the PALs report which took 6 months to compile.
I have asked PALs two questions since the report’s publication.
- what have they learnt from this expensive exercise. Expensive as I assume a report taking six months to produce must have been expensive.
- can I meet the head of PALs to help me understand why they feel the report is appropriate based upon the questions that have been asked. Perhaps more importantly, to help me understand whether I have an incorrect view on the remit of PALs and therefore being unfair to the organisation.
Both questions have been ignored.
Shortly after Hilary’s death on the 14 January 2022 I was offered a consultation with a member of the medical team to understand what had happened during Hilary’s last week under Addenbrookes care. This was dependant upon a case review so the medic would have as much knowledge as possible. Having heard nothing for a couple of weeks after the review date I contacted PALs only to be told that the consultation has been withdrawn and would not be possible until after the production of the PALs report on Hilary’s care.
Fast forward six months and the report is published. I requested the meeting but PALs would not agree to a meeting. Asking instead I provide my questions in writing.
With no possibility of meeting with any medics to discuss Hilary’s case, nor with PALs to discuss their report my only hope currently is that the coroner’s office are able to get some answers to some of the questions posed if not all.
My understanding of PALs is help patients reach the right place in the hospital to address patient concerns. In addition, they are there to investigate complaints raised by patients.
My experience however is that their main role is to suppress patient concerns and give the pretence that the hospital cares.
Graeme
Posted: 13 June 2022 17:02
Following the publication and my reading over the weekend of the book Zero, written by Jeremy Hunt MP, I have decided to rename Hilary’s charity to the Hilary Gibson Zero Foundation. Mr Hunt’s book focuses on the instances of avoidable deaths in the NHS where it claims that approximately 4% of all deaths in NHS England could be avoided and should never had happened. This relates to approximately 150 deaths a week.
It was both sad and alarming to hear of so many experiences similar to my own but also uplifting that at least these problems are recognised. Until a problem is acknowledged and understood then it can’t be fixed. The charity therefore is to be renamed the Hilary Gibson Zero Foundation as its intent is to campaign for change and where appropriated help deliver that change through education, awareness and if appropriate technology.
We wish to stand with those working to make the number of avoidable deaths in NHS England as close to zero as possible.
Graeme
Posted: 3 June 2022 12:53 ( charity name updated 13 June 17:02 )
All donations to the Hilary Gibson Zero Foundation are still in the care of Peasgood & Skeates as I regret to say that due to significant delays from Addenbrookes PALs and the Cambridgeshire Coroners service we still await the results of their investigations.
I made the decision early in the process of investigations that I would not establish the charity based upon the hypothesis I have regarding Hilary’s untimely death but allow the authorities concerned to perform the processes they state are needed. However, after the multitude of delays and the failure of people keeping to their commitments I must now take a more active involvement beyond gentle nudging. Both parties have burnt all goodwill and patience.
It has been 140 days since Hilary’s death and 106 days since her autopsy at the time of this post. We still have no date on when to expect the report being compiled by Addenbrookes to provide answers on the lack of effective care given while Hilary was in their care.
During the five month period Hilary was under the care of our GP surgery and Addenbrookes and Papworth hospitals, I witnessed a catalogue of what I believe to be ineffective activities and in my opinion totally unprofessional and unacceptable behaviours. I understand that the services are stretched by the Covid pandemic but witnessed a failure of professionalism and responsibility which is caused by poor attitude and a lack of relevant metric measurement. Both communication and process failures either failed or show a lack of effectiveness. At a minimum, I have tried to get people to help me understand why such behaviours are seen to be acceptable. I shall continue on that quests but believe I have witnessed a focus on box ticking without obvious regard to outcomes.
We communicated our concerns all through those five months in the hope that we could make a difference and nudge people to recognise what was being missed. This proved impossible. No one seemed to be listening.
All we wish to achieve for the charity is to confirm the issues we suspect led to Hilary’s early death. This is so the charity can focus its time and resources on helping others avoid the outcomes we sadly encountered.
From my current knowledge and experience walking by Hilary’s side for those five months and my experiences since, I believe that parts of Addenbrookes is broken but show no signs of wishing to understand so that they can learn from the experiences. The local population believe they have a hospital of which to be proud. So did we and so did Hilary. A hospital she was proud to work for and regarding us as being fortunate that we lived in its catchment area. Sadly a belief that I no longer hold. I salute the many that work in the NHS who strive to meet the needs of their community, however they are let down by a minority who’s attitude and professionalism let down their colleagues and appear to continue without sanction.
I am committed, through the charity, to follow the lead of Hilary who we know from the people involved – patients and medical staff alike – made a difference in the way she did her job.
Although we have not formally established the charity we have agreed trustees to help us guide the charity, and have also been exploring resources and partners to help us understand how we can deliver some of the activities we believe will be necessary. We also thank everyone who has already contributed and urge those who feel they can offer their support, either by making a contribution through the links above or sharing with me their experiences at the hands of our local NHS to help us build a picture on where we can help make a difference for the good.
In future updates we will be communicating our plans and focus and maybe reaching out to those that may wish to offer their time and support and experiences to help the Hilary Gibson Zero Foundation meet its objectives.
Graeme