Cameron favours accountability and transparency as response to Stafford Hospital scandal

By Harry Phibbs
^{Follow Harry on Twitter}

David Cameron reported to Parliament today on the findings of the Francis Report on how the scandalous neglect of patients at Staffordshire Hospital between 2005 and 2009 was able to occur.

Mr Cameron said:

The Inquiry finds that the appalling suffering at Mid-Staffordshire hospital was primarily caused by a “serious failure” on the part of the Trust Board which…

…failed to listen to patients and staff…

…and “failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities.”

But the Inquiry finds that the failure went far wider.

The Primary Care Trust assumed others were taking responsibility and so made little attempt to collect proper information on the quality of care.

The Strategic Health Authority was “far too remote from the patients it was there to serve, and it failed to be sufficiently sensitive to signs that patients might be at risk.”

Regulators, including Monitor and the then Healthcare Commission, failed to protect patients from substandard care.

Too many doctors “kept their heads down” instead of speaking out when things went wrong.

The Royal College of Nursing was “ineffective both as a professional representative organisation and as a trade union.”…

…and the Department of Health too remote from the reality of the services they oversee.

The way Robert Francis chronicles the evidence of systemic failure means we can not say with confidence that failings of care are limited to one hospital.

Mr Cameron identified from the report three failings - not just failings with this individual hospital but with the wider NHS culture. 

First "a pre-occupation with a narrow set of top-down targets" which excluded listening to what patients, their relatives, and many staff were saying.

Second, "there was an attitude that patient care was always someone else’s problem. In short, no-one was accountable."

Third, "defensiveness and complacency".   Concerns was ignored - "managers were suppressing inconvenient facts in favour of looking for comfort in positive information."

What is going to be done about it? One proposal is for hospitals to have the equivalent of Ofsted inspections.

Mr Cameron said:

In our schools we have a very clear system of deciding whether a school has the right culture – and whether it is succeeding or failing.

It’s a system based on the judgement of independent experts, who walk the corridors of the school and analyse more than just the statistics.

The public know which schools near them are outstanding and which are failing.

They have a right to know the same about our hospitals.

We need a hospital inspections regime that doesn’t just look at numerical targets but examines the quality of care and makes an open, public and explicit judgement.

So I have asked the Care Quality Commission to create a new post – a Chief Inspector of Hospitals to take personal responsibility for this task.

I want the new inspections regime to start this autumn.

Priority for inspections will be where large number of patients have expressed concerns:

We need the words of patients and front line staff to ring through the Boardrooms of hospitals and frankly beyond, into the regulators and Department of Health itself.

So from this year every patient, every carer, every member of staff will be given the opportunity to say whether they would recommend their hospital to their friends or family.

These will be published and the Board will be held to account for their response.

Put simply, where a significant proportion of patients or staff raise serious concerns about what is happening in a hospital…

…immediate inspection will result and suspension of the hospital board may well follow.

The report shows there was an abundance of regulation:

There were and are a plethora of agencies, scrutiny groups, commissioners, regulators and professional bodies, all of whom might have been expected by patients and the public to detect
and do something effective to remedy non-compliance with acceptable standards of care. For years that did not occur...

It adds:

Healthcare is not an activity short of systems intended to maintain and improve standards, regulate the conduct of staff, and report and scrutinise performance. Continuous efforts have been made to refine and improve the way these work. Yet none of them, from local groups to the national regulators, from local councillors to the Secretary of State, appreciated the scale of the deficiencies at Stafford and, therefore, over a period of years did anything effective to stop them.

So, for example, members of the Stafford Borough Council Overview and Scrutiny Committee would read reports. It would be minuted that the reports had been "noted." Reports would be seen and noted by the Staffordshire County Council Overview and Scrutiny Committee.  Reports would be seen and noted by the Staffordshire County Council Health Scrutiny Committee.

Councillors may have read the reports carefully. They may have asked lots of questions about them. But none of the reports would have mentioned patients being so thirsty they drank from dirty flower vases or being left to lie in urine for days.

Real transparency and accountability is needed to deliver patient power.