Over the course of four years at Mid Staffordshire hospital, hundreds of patients suffered from appalling neglect and mistreatment. Relatives that voiced concerns were ignored; staff that tried to speak up were silenced. It was a shocking betrayal of trust of patients and their families.
Yesterday Robert Francis QC published his report into the Mid Staffordshire NHS Foundation Trust. The public inquiry lasted more than two years, heard over 250 witness statements, considered over one million pages of documentary evidence, and has produced a report nearly two thousand pages long. It makes 290 separate recommendations.
The story of Mid Staffs, the report says, is one of “terrible and unnecessary suffering of hundreds of people who were failed by a system which ignored the warning signs of poor care and put corporate self interest and cost control ahead of patients and their safety.” The overriding message is the need for a culture change across the NHS to make sure that patients always come first.
This is a message that the Government has heard. It is one that we are acting on. Achieving culture change across the system is something that will take time, effort and commitment from all involved in the NHS – not just Government but also commissioners, providers and regulators as well as frontline professionals and senior managers.
Yesterday we announced:
• Steps to strengthen the Care Quality Commission and appointing a new Chief Inspector of Hospitals to improve quality in hospitals
• A review of hospitals with high mortality rates so that urgent action can be taken on any Trust where serious concerns are identified
• Introducing minimum training standards for healthcare assistants to ensure staff can provide safe, effective and compassionate care
• A ‘zero harm’ patient safety review led by international expert Don Berwick
• A review of how complaints are handled
These come on top of a number of other steps we are taking to strengthen patients’ voice and to encourage openness and transparency, such as introducing the Friends and Family test, creating a contractual duty of candour, and giving more support for whistleblowers.
As a Liberal Democrat Minister at the Department of Health I am determined to build on these steps to ensure that patient care is the fundamental priority of every part of the system.
The Lib Dem manifesto included a commitment to require hospitals to be open about mistakes, and always tell patients if something has gone wrong. This is something I argued for when we were in opposition, and it is something I will push for within Government. I am also clear that there should be no more rewards for failure – despite the shocking failures of care that occurred at Mid Staffs, the Chief Executive Martin Yeates left with a large compensation pay off.
We know this is an important moment. I think that staff right across the NHS, the Care Quality Commission and other bodies recognise that too. The Government will consider all the report’s recommendations carefully and give a more detailed response next month – but doing what is necessary to promote and embed a culture of care across the whole system is our priority.
* Norman Lamb is MP for North Norfolk and was Liberal Democrat Minister of State at the Department of Health until May 2015. He now chairs the Science and Technology Select Committee
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5 Comments
In schools, the board of governors are legally liable for the actions of their school.
Are board members of an NHS trust legally liable in the same way? If not, why not?
What is happening in some parts of the NHS is dreadful beyond words. Unfortunately the solutions being proposed by politicians are the wrong ones.
We DON’T need more laws. If a car manufacturer knowingly sold over a period of years cars with defective brakes that caused the deaths of many hundreds of people and compounded the problem by actively preventing people raising the alarm, I’m pretty sure that the HSE would have something to say. That’s HSE as in HEALTH and SAFETY by the way. I can’t reach a friend who is an expert in such matters at the moment but I would expect the directors of such a car company to face charges of criminal negligence.
Then there is the nonsense of a “contractual duty of candour”. From the post, “Relatives that voiced concerns were ignored; staff that tried to speak up were silenced.” Lack of ‘candour’ wasn’t the problem; it was lack of willingness to listen and a perverse ordering or priorities which put targets before patients. From an earlier BBC report, “One [doctor] gave an example of being asked to leave a heart attack patient being given life-saving treatment. Nurses reported leaving meetings in tears after being told their jobs were at risk after breaching the target.” The diagnosis of a problem with lacking candour is so far wide of the mark I can only see it as wilfully so. If the culture of fear continues it would put staff in an impossible position.
http://news.bbc.co.uk/1/hi/health/7948943.stm
What the government should do quickly (i.e. by the end of this week) is forbid NHS Trusts spending money on legal costs to gag whistleblowers and on settlements with them containing confidentiality clauses. The government should also direct NHS Trusts that have silenced past whistleblowers with confidentiality clauses to unilaterally (and immediately) cancel such clauses enabling these whistleblowers to speak out at last. We need to turn over these rocks and expose the nasties lurking underneath. There is absolutely no public interest in protecting the guilty or negligent and no taxpayers’ money should be spent in doing so.
Equally, appointing yet more regulators is NOT the answer to anything. Each one represents yet another cook ‘helping’ with the broth yet, as we have seen, the result is a total failure (and a very expensive failure at that). Why does anyone suppose that more of a failed strategy will suddenly start working? For the same reason appointing an ‘international expert’ is not a good idea. (BTW Is this the man who helped with Obamacare – a shameful sell out to the privatised medical insurance sector? Is there another dark agenda here?)
The only viable plan is to change the culture of the NHS into a learning adaptive one and that means no more top-down reorganisation and a whole lot more bottom-up. Such a large and complex organization can only work properly if staff are allowed and encouraged to take responsibility for their part of the whole. The ‘Czars’ and ‘experts’ the government loves to trumpet simply cannot know what’s going on at the coal face. (Putin’s neo-Czarist Russia has deep-seated problems for the same reason). One way to promote this would be to introduce an annual upwards staff appraisal where staff would grade those above them under a series of headings (e.g. technical ability, bullying, fairness, overall contribution) with the results having a big input into promotion prospects. Suitably empowered, the doctors and nurses who went into medicine to make people better would do a far better job of winckling out the bad apples and holding the NHS true to its mission than any number of regulators.
The other big change needed is clear lines of authority and responsibility (they go together). It is simply not good enough to blame “systemic problems” (nowdays this is government issue Standard Operating Procedure when something goes wrong) as a smokescreen to shuffle responsibility away. Of course, it’s often true that there are systemic problems but that only means that it’s the boss who is responsible. They say a fish rots from the head and this is an exceedingly rotten fish; Sir David Nicholson must go. Immediately. And without a golden parachute.
‘Act’??? I do hope that next time Norman Lamb treads the boards he has a better script than that he was reading from on Newsnight last night. It was, without qualification, the most dire performance I have seen from any minister in over 40 years of political involvement. Once again (as with Danny Alexander in the early days) I wondered why it is Lib Dem Ministers who volunteer to face the fire of the media on all the bad news pieces. There are only three outcomes in such a scenario. Bad, worse and dire. And, as a side effect, protecting our Coalition partners from flak even when the events concerned took place under Labour!
If half a dozen people died in a hotel fire, there would be a proper investigation and, if blame were identifiable, heads would roll. But when hundreds die in an organisation paid many millions to keep people alive and well, nobody seems to be in the firing line at all. Except the hapless Norman.
Norman looked and sounded as though he wouldn’t even be familiar with the concept of decapitation: he wouldn’t even be interested in cutting toenails. It was all down to ‘culture’ y’see.
What utter tosh. Culture is defined by those at the top. It is acceded to by those in the middle (especially when whistleblowing is fearlessly weeded out) and imposed upon those at the bottom. It was a cultural thing at the FSA. It was a cultural thing in the banks which fixed the interbank lending rates, it was a cultural thing which allowed Jimmy Saville. It was a cultural thing which let that hopeless man become BBC chairman and which paid him a fortune of our money for his 56 useless days in office. It was a cultural thing which led the nuclear industry to lie about its pollution problems at Windscale. It was a cultural thing which let Phone hacking develop and continue. I am just waiting to hear someone high up say that it was a cultural thing which led to the deaths of those two brave policewomen in Manchester.
There is only one ‘cultural thing’ that’s wrong in this country. It is not new to the present two governing parties, but it has not been touched significantly by them in their 2 1/2 years either. You will find it lies at the heart of government. And at the very heart of government you will find lies. It is not just a question of whether or not government will find individuals incompetent. It is a question of whether government is even competent to find those who are – or whether it cares at all whether it does so. 🙁 Now there’s a challenge worth facing by Liberal Democrats!
I would like to say to Norman Lamb that I respect him greatly, think he is a good MP, rational, even handed, yet with his heart in the right place. I also respect him as a Minister, I believe he is capable, understands his brief, both from a LD perspective and from a Coalition perspective.
I fear, though, that he is missing one factor which always get members of the public raging whenever these sorts of scandals arise: no one is ever held responsible. If you are a manager in any institution of significance in British life, you are simply immune from dismissal, from loss of salary, pension or benefits and you will certainly never be prosecuted. It doesn’t matter how many people have died, been maimed or suffered miserably because of your actions.
The little guys might well be blamed. Rightly so, as if they allow patients in a hospital to die of neglect, they certainly can’t say they weren’t there whilst it happened. Nevertheless it is entirely disgraceful that managers, who put unbearable pressure on their staff to give higher priority to secondary matters than to the primary duties of treatment and care, should walk off without a single adverse consequence.
Ed Balls often gets a bad press. I have no reason either to believe or disbelieve many of the stories of his allegedly cutthroat style of politics, as I don’t know him personally. However, I do remember one thing about him. He sacked a manager in social services for her failings in the case of Baby P. The only politician in living memory who has ever had the courage to sack someone who was widely viewed by the public to have failed in an important post. Although, a court later found that due process had not been followed, I doubt you will find many people in the general public who didn’t applaud Ed Balls at the time, nor who today believes that he did the wrong thing.
Accountability is for the little people – if anyone is to be accountable at all. That’s how it is in Britain today.
Can a “duty of candour” and all the rest be enforced in the myriad private companies who will dominate health provision by the time of the next election?