healthcare update - issue 11
Lessons from Mid-Staffordshire
On 24 February 2010, Robert Francis QC published his inquiry
report into the care and treatment provided by Mid-Staffordshire
NHS Foundation Trust. The inquiry followed numerous complaints
about the standard of care at the Trust and an investigation by the
Healthcare Commission in March 2009.
The report identifies serious systematic deficiencies at the
Trust between 2005 and 2009 and makes 18 recommendations. Whilst
the majority of these recommendations focus on identified
shortcomings at the Trust, it is clearly intended that all health
care providers should heed the lessons learnt and there is a
specific recommendation that all NHS and Foundation Trusts review
their own standards, governance and performance in light of the
report.
So, what key lessons are identified in the report?
Trust boards
The inquiry report makes it clear that Trust Boards are expected
to challenge and engage with key issues. Whilst it is recognised
that on the whole, Trust Board members are responsible for
strategic rather than operational matters, directors will in some
circumstances, be expected to ‘roll up their sleeves and see for
themselves what is actually happening’ - for example, where there
are developing governance structures in place.
In a similar vein, it is vital that boards engage with the
public and that Trusts conduct their own internal assessments
rather than relying on external assessments which may not, in fact,
reflect the actual experiences of patients and staff. It is clear
from the experience at Stafford that bench marks, comparative
ratings and Foundation status do not, in themselves, bring to light
serious and systemic failures and the inquiry report makes it clear
that directors should be focused on outcomes rather than
systems.
The report also identifies a lack of public accountability for
senior managers. As a result, it recommends a review of the
arrangements for the training, appointment, supervision and
accountability of executive and non-executive directors and we can
expect to see uniform professional standards being created for such
roles. These standards will probably be enforced by an independent
body (perhaps part of the CQC) with powers of disciplinary
sanction.
Complaints procedures and incident reports
The report highlights the need for information about things
which are going wrong in a Trust to be fed up to the board promptly
and in sufficient detail for the directors to take appropriate
remedial action. Key to achieving this is an effective complaints
procedure and it is vital that complaints are thoroughly
investigated and responded to promptly. The outcome of the
investigations together with any action plan should be communicated
to the complainant and front line staff in the services affected.
The substance of complaints should also be reported to the Board so
that any trends can be identified and investigated
appropriately.
Trust links
The inquiry report considers that as treatments become more
sophisticated and care more specialised, there is a good case for
hospitals to focus on what they can do well and for arrangements to
be made for other services to be provided elsewhere, or in
co-operation with other facilities that have the necessary skills.
Trusts should therefore review the services offered and consider
how they might be strengthened by links with neighbouring
Trusts.
The future
It remains to be seen how far the ripples caused by the Inquiry
recommendations will spread. However, the report is a timely
reminder for all who work within the NHS that people must always
come before numbers. It also presents an opportunity for those who
design and implement policy for the NHS both at a strategic and
local level to devise a system whereby patients and their
experiences are recognised alongside statistics, benchmarks and
action plans.
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The content of this update is provided for the purposes of general
interest and information. It contains only brief summaries of
aspects of the subject matter and does not provide comprehensive
statements of the law. It does not constitute legal advice and does
not provide a substitute for it.