How do you change the culture of an organisation – particularly one as large as the NHS? That was one of the key questions posed by the Francis Inquiry into the appalling failings at Mid Staffordshire Hospital. Today we set out part of the answer.
The overriding message of the Francis report was the need for a culture change across the NHS to make sure that patients always come first. That change will take time, leadership, and engagement from staff. But the measures announced today set the tone, and signal what I hope will be the start of a transformation. They provide a clear signal that patient care is always the top priority.
This morning we announced a new statutory duty of candour on health and care providers to inform people if they believe treatment or care has caused death or serious injury and to provide an explanation. This is another Liberal Democrat manifesto commitment delivered (p44: “require hospitals to be open about mistakes, and always tell patients if something has gone wrong”) after successive Labour Health Secretaries ignored the issue.
The management at Mid Staffs ignored complaints and put corporate self-interest, and the relentless pursuit of foundation trust status, above all else – above the lives and welfare of patients. It has taken years of campaigning by those affected by the scandal – not least by Julie Bailey, whose mother died at the hospital – to get answers. That is simply not right. If you or a loved one suffers because of failings by a hospital or care provider, you have a right to know about it. You should not have to battle to establish the truth about what happened. With today’s announcement, you won’t have to – hospitals and care providers will have a legal duty to tell you.
The NHS contains thousands of dedicated staff delivering excellent care every day. However, it is crucial that all staff, at every level, feel able to speak out when things go wrong – and that they do so. A culture of fear reigned at Mid Staffs. A crucial part of our response, then, is making sure that staff feel able to speak out and voice their concerns.
We have already strengthened protections for whistleblowers in the updated NHS Constitution. At the same time, “gagging clauses” that seek to limit legitimate disclosure of problems with patient safety and care on staff leaving a hospital, which have been used too often in the past, will no longer be allowed. Instead, all severance agreements must now include an explicit statement making clear that “nothing within the agreement prevents the parties from making a protected disclosure in the public interest”. This is a clear signal to the system that we will not tolerate attempts to hide problems.
Our response is not just about transparency. We are taking other steps to improve patient safety, review the complaints process and strengthen the inspection regime. We are introducing measures to ensure that anyone working in a care setting is properly trained (shockingly, this is not already a clear enough requirement) and raising the status of care as a profession. I have been determined to secure this commitment to minimum training standards for all.
But transparency matters. Sunlight, they say, is the best disinfectant. My vision is of an NHS which is honest and upfront with patients – that does everything it can to prevent anything going wrong, but that holds its hands up if it does.
You can read more about the rest of our response to Francis here. There is more work to do. You cannot transform an organisation overnight. But you can put the foundations in place.
* 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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8 Comments
Two things – when did the ‘culture of fear’ at Midstaffs begin, or has there always been one? And two, how much openness/transparency can we expect from commercial providers involved in health provision at Midstaffs?
I believe the private companies taking over services do not have to reveal any performance data or similar, due to commercial confidentiality.
“The management at Mid Staffs ignored complaints and put corporate self-interest, and the relentless pursuit of foundation trust status, above all else”
This is just a microcosm of the true malaise. The politicians and particularly the NHS central and Regional chiefs deliberately created a system over about a decade which (a) insulated the political heads of the service from any traceable responsibility at all and (b) removed from the core performance indices virtually any reference to the state of the actual product. it was as if the output of Coca Cola was being judged by the shape of the bottles, the colour of the liqor, the design of the crates and the marketing campaign without any concern as to the fact that the stuff in the bottles tasted like bilgewater.
The Care Quality Commission was deliberately set up as a useless body, deliberately overloaded, deliberately structured in a manner which made it inaccessible to people with concerns in any area and devoid of people with any local knowledge. Labour (who had championed CHCs when they had been threatened by the Tories previously) demolished Community Health Councils after THREE battles with Parliament NOT because they were inefficient but because with individual exceptions they had become individually and collectively by and large too efficient at monitoring precisely what was going on at the coal face of local NHS services. They created, instead, the faceless ‘purchasers’ and PCTs, notionally ‘local’ but containing people who in many cases had no local links to monitoring services and no support. THESE PEOPLE WANTED TO BE DECEIVED.
After my mother died we had two formal complaints about the Countess of Chester hospital. This is a hospital which has all its awards displayed in the entrance. First they lost her wedding ring, second they called the family to a discharge meeting which was actually a move to private nursing care not a return to home. Their PALS service replied saying they would review their procedures but luckily I have no family members who will need the hospital. If an award winning hospital can fail like this I would not want to be in a failing one.
When I compare local authority transparency with NHS, it’s like chalk & cheese, especially with regard to senior salaries. It’s about time that this was changed. I suggest that then the public view of the NHS will be given some perspective, and the value of the NHS will become better understood.
Norman, same as simon.Also, although you have apparently got the section 75 rules, amended, somewhat, legal opinion has said that the rules do not go far enough and all services will still have to be thrown open to outsourcing and legal tender.How could you not notice that the Tories were trying to change the rules at the last minute and how satisfied are you that the amended rules that you have written, are adequate ?
Why has this report been published now on the eve of the NHS changes coming in and why is the media getting worked up about benefit tourism, now ? I feel that timings are being manipulated and that the real danger is the privatisation of the NHS, which people do not want and which will cost the liberal Democrats, dearly.
My own impression is that the party had been comprehensively bamboozled and outflanked by the Tories, asleep on the job at the beginning and naive, the leader not having read the bill.
I am afraid that it shows a leadership divorced from many of the grassroots and a party which has shown itself to be unfit and unready to govern.By nodding though such changes in our health and welfare systems, you have allowed a rightwing agenda which even Thatcher would not have dared to bring in.It is a real tragedy for this country.
The self-destructive crisis in our party springs from swallowing market-economics delusions a decade ago. Time we squeezed the Orange Book till the pips squeak?
I guess that Tony Dawson may be exaggerating a little bit, but I think he is basically correct. Does not everyone working in the NHS have a contract? Does it say that their duty is to look after patients? The top layers of management at South Staffs should have been sacked, as they clearly were not doing their jobs. Managers must have the authority and the responsibility to manage and the rest will take care of itself. I do go on about McDonalds’ but if their managers were running the NHS at least the basic care would be second to none – just see the result when they trained the volunteers at the Olympics.