Individual hospital wards will be rated by patients and negligent managers blacklisted from working in the NHS as part of sweeping reforms to prevent another Mid-Staffordshire style scandal, the Government has announced.
Under plans unveiled by the Health Secretary Jeremy Hunt hospitals will be given Ofsted style ratings from next year – while patient satisfaction ratings for individual wards and units will also be published.
In addition the Government has signalled that it expects hospitals to employ more nurses to improve patient care and will tighten up the training and monitoring of healthcare assistants.
But it stepped back from plans to require a legal “duty of candour” for all NHS employees to expose wrong-doing saying it was concerned it could perversely lead to a new “culture of fear” in the organisation.
The Francis Inquiry into the lessons to be learnt from Mid Staffordshire also called for a new regulatory system for the NHS's army of healthcare assistants. But Mr Hunt only announced a code of practice and minimum training standards for the support staff, saying that a regulatory system could create a “bureaucratic quagmire”.
Hundreds of patients are thought to have died needlessly at Stafford Hospital between 2005 and 2009 after they were “routinely neglected”, given the wrong medication and left without food or water for days on end.
The Francis Inquiry into the scandal made 290 sweeping recommendations for healthcare regulators, providers and the Government.
Announcing its response yesterday Mr Hunt said the Government would:
• Appoint a new Chief Inspector of Hospitals who would be able to name and shame poorly performing trusts. Trusts that do not deliver adequate care to patients could be put into a “failure regime” and possibly into administration.
• Award hospitals Ofsted-style ratings including “outstanding”, “good“, “requiring improvement” or “poor”. Hospitals judged not to be providing compassionate care will be unable to achieve a “good” rating even if their medical outcomes are excellent.
• Move towards a system where all NHS staff are paid according to their current performance rather than time served.
• Ensure all nurses spend up to a year working as healthcare assistants as part of the degree courses.
Department of Health sources said under the new regime patients will be able to see not just how individual hospitals are performing but how well units within those hospitals do.
From next month all patients who visit A&E or who spend time on an acute ward will be asked to rate their care within 48 hours of discharge.
The feedback is expected to be published so other patients will be able to see how hospital services are rated before they have an operation.
In addition hospital managers who manipulate statistics or try and cover up cases of poor care will be “struck off” and banned from any future role in healthcare.
The Government is expected to set out details of how the new managerial barring scheme will work within the next few days.
Sources suggested that it might include managers at below board level but stressed that no final decision had yet been taken.
They added that it was being designed to ensure that there was a clear mechanism to ensure that failing managers did not get “shunted around the system”.
“In the past you’ve had managers who fabricated hospital waiting time figures turn up at a health authority or a primary care trust and there was nothing anyone could do to stop it.
“This is about bringing in a system to ensure that managers are held account for their failings and don’t just move around the NHS without any consequence.”
Mr Hunt conceded that as a result of the changes announced the NHS may have to recruit hundreds of extra nurses.
“I wouldn’t be surprised if many more nurses are employed,” Mr Hunt said.
Until now health chiefs have said that the reduction in nursing numbers was not affecting patient care.
But the campaign group set up in the wake of the Stafford Hospital scandal said the reforms did not go far enough.
Julie Bailey, head of Cure The NHS said the leadership and the “command and control type management” of the organisation had to change.
She told the BBC: “I sat through every day of that public inquiry, all the bodies failed, all the bodies had to apologise, and I really don't think that's been addressed in this statement.
“How many more reviews do we need to tell us the one thing that needs to change is the culture that needs to change? The very top, the people that rule the NHS, the leadership, that's what needs to change, and it works all the way down to the front line.”
Others also criticised the decision not to introduce a system of regulation for healthcare workers.
Jeremy Hughes, chief executive of the Alzheimer's Society said: “Real professional standards and registration for healthcare assistants does not constitute a box-ticking exercise and to suggest as such is a deeply disappointing compromise of patient safety for cost or convenience.”
The independent think tank the King's Fund also warned that the value of Ofsted-style ratings in hospitals was very limited.
“The value of aggregated ratings for hospitals is highly questionable,” said Chris Ham, its chief executive.
“These are complex organisations with different services and specialisms that may vary in quality so an overall rating can hide significant failings within a trust.”