Mid Staffs report demands NHS cultural revolution

News, views and analysis

Mid Staffs report demands NHS cultural revolution

6 February 2013

The BMA has vowed to help build a new NHS culture following the ‘appalling and unnecessary’ events at Mid Staffordshire NHS Foundation Trust.

The report of the public inquiry into failings at the trust, published today, calls for a cultural change in the NHS following the ‘truly shocking’ experiences of hundreds of patients treated there between 2005 and 2009.

Inquiry chair Robert Francis QC said: ‘This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.’

He said the changes needed did not require a root-and-branch reorganisation of the NHS, rather than an overhaul of its culture to promote openness, transparency and candour.

Mr Francis said: ‘We need a patient-centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership, caring, compassionate nursing, and useful and accurate information about services.’

Cooperation essential

BMA council chair Mark Porter said he had been profoundly disturbed and saddened to hear again of the series of failings at the trust that led to such tragedy for so many patients and their families.

He said: ‘It is not enough to say that lessons must be learnt. It is essential that we all — politicians, NHS organisations, doctors, managers, nurses, and patient groups — work together to develop a different kind of health service where the system will not tolerate poor quality of care.

‘We must urgently develop a new culture. Everyone working in the health service must play their part, and be allowed to play their part, in practising zero tolerance to poor and dangerous care.’

Mr Francis made 290 recommendations after examining the commissioning, supervisory and regulatory bodies responsible for monitoring the trust.

He summarised his recommendations into five main areas including:

NHS standards and patient safety:

A list of standards of patient safety, effectiveness of treatment and basic care are needed. Non-compliance with these standards by organisations and individuals leading to serious injury or death of a patient should be a criminal offence
The National Institute of Health and Clinical Excellence should develop measures on the suitability and competence of staff and the culture of organisations in addition to its clinical outcome measures. Measures should include minimum staff numbers as well as skills mixes, and should be developed in association with professional bodies
The CQC (Care Quality Commission) and Monitor should merge regulatory functions. The CQC should be responsible for hospital inspectors who monitor compliance with these standards
The NHS Commissioning Board and clinical commissioning groups should devise ‘enhanced quality standards’ to drive improvements in the NHS.

Culture and transparency:

A culture of ‘openness, transparency and candour’ should be fostered in the NHS, and a deliberate obstruction of this duty should be made a criminal offence
Gagging clauses should be banned from NHS contracts.

Training standards:

Named clinicians should be responsible for the welfare and care of each patient in hospital
Postgraduate deaneries, commissioners, the GMC, the CQC and Monitor should share information on patient-safety concerns
The GMC should set out standard requirements for routine visits for LETBs (local education and training boards)
Medical students should be asked by placement providers to give feedback on compliance with patient safety standards. The GMC should amend undergraduate standards to ensure this happens
Health Education England should have a medically qualified director of medical education, and LETBs should have a medically qualified director responsible for postgraduate medical education.

Leadership:

Strong and patient-centred leadership is required
An NHS leadership staff college for common training of leaders is needed to implement a common culture
There should be a registration scheme to ensure ‘fit and proper’ individuals can be directors of NHS organisations
Leaders should be held to account on the core values of the NHS constitution.

Compliance with standards:

All professionals, individually and collectively, should be measured on their compliance with fundamental standards
NHS boards should make public their trusts’ compliance with standards
A ‘wilful or reckless’ false statement on safety or standards should be a criminal offence
GPs should take on a ‘monitoring role’ of all patients referred to acute hospital or other specialist services. They should also have internal systems on patterns of concern and knowledge of standards of service across providers to help ‘patient choice’.

Every organisation concerned with implementing the report’s recommendations should give a regular and public update on its progress in those areas. The Commons health select committee should review their progress.

The health select committee today announced an inquiry into the report, and Mr Francis will appear before MPs to give evidence on Tuesday.

Prime minister David Cameron announced that the CQC would appoint a chief inspector of hospitals as part of its response to the recommendations. He added that the government would study the recommendations closely and respond in full next month.