The response to Mid Staffordshire: So do we now all agree on what ‘care’ means?

The scale of the task in changing the culture on wards explains the fervour of this document

Share

The government response to the terrible failings of the Mid Staffordshire hospital system is a remarkable document.

It may even become a classic state paper. It is certainly an unusual one. Busy media organisations duly reported the various corrective measures that were announced in its wake – among them the appointment of a chief inspector of hospitals, the barring of bad managers from further senior jobs and a new system for rating hospitals.

They didn’t have time or space to say anything about the evangelical language. The key to its style is the observation that working in health and care is “inherently emotionally demanding”. Likewise, the document implicitly calls for an emotional response. It stresses the “core humanitarian values” of the NHS.

The tone is set early on with the comment that what happened at the Mid Staffordshire NHS Trust was the development of a toxic culture that fostered the “normalisation of cruelty”, an unlikely phrase in a government document, yet a fair description of what many patients endured. The public inquiry, chaired by Robert Francis QC, revealed what the family of a 96-year-old patient discovered: “There were people walking past. Mum was in bed with the cot sides up and she hadn’t got a stitch of clothing on. I mean, she would have been horrified. She was completely naked ... covered in faeces ... It would have been there a long time, it wasn’t new.”

As a consequence, Jeremy Hunt, the Secretary of State for Health, writes in his forward that “every individual, every team and every organisation needs to reflect with openness and humility about how they use the lessons from what happened ”. This evocation of humility is not common in Whitehall. Then if you turn to the end of the document you find that even the staff of the Department of Health itself must “model the same caring values and behaviours that we seek to foster across the wider system”. Within four years, every civil servant in the department will have “sustained and meaningful experience of the frontline”. And this is all of a piece with the new requirement that every student who seeks NHS funding for a nursing degree should first serve up to a year as a healthcare assistant in order to promote frontline caring experience and values.

One way to analyse the full scope of the Government’s response is to use a distinction common in international affairs between coercive force and soft power. The measures announced yesterday, such as rigorous hospital inspections, were the former. This hard power is designed to stop the development of any Mid Staffordshire tendencies in the making. But much of the document is also concerned with soft power. The reason is that what is being attempted is changing the culture of an organisation that employs more than a million people in England alone and is now 65 years old. The scale of this task explains the religious fervour of the document.

The decision that the “common values and cultural attributes that we seek to foster across the NHS should be set out in the NHS Constitution” is an example of soft power. More striking still is the inclusion of a “statement of common purpose” by 14 leaders of the service along with an invitation to organisations in the system “to join us in signing up”. The Permanent Secretary at the Department of Health and the chairs of the Care Quality Commission, the General Medical Council, the NHS Commissioning Board, the NHS Confederation and NHS Employers, and the Nursing and Midwifery Council are some of the signatories. Curiously the name of Sir David Nicholson, chief executive of the NHS, is missing.

Among the pledges contained in the statement of common purpose, a number exemplify the humility called for by Mr Hunt. “We apologise to every individual affected by this deeply disturbing and tragic failing in a service that means so much to us all… We will listen most carefully to those whose voices are weakest and find it hardest to speak for themselves.” And finally this extraordinary promise: “Changing ourselves, our behaviour, individually and institutionally, is difficult, but we pledge to do so.”

The authors realise that their document is not going to change cultures in wards. “What matters is whether teams are inspired to own and live the values set out in the Constitution.” Own and live the values! There follow a number of measures to help this process.

A wealth of evidence shows that the key to providing safe, effective and compassionate care is supporting and valuing staff. In other words the rule is: look after your staff well and they will look after the patients well. At the same time the response argues that leaders need time to lead, and staff need time to care, unconstrained by a culture of bureaucratic compliance with national regulations. These are wise thoughts. The cruelty of Mid Staffordshire was the result of setting a multitude of targets for staff and then chasing them to achieve them.

Treat staff well and give them time – that should produce the sympathetic care that helps patients to recover or at least endure their final illness peacefully.  The authors of this document have grasped both these things. That is why this response is so remarkable.

a.whittamsmith@independent.co.uk

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES
iJobs Job Widget
iJobs General

Recruitment Genius: Sales Executive or Senior Sales Executive - B2B Exhibitions

£18000 - £30000 per annum: Recruitment Genius: A Sales Executive or Senior Sal...

Recruitment Genius: Head of Support Services

£40000 - £55000 per annum: Recruitment Genius: This is an exciting opportunity...

Recruitment Genius: Warehouse Team Leader

£22000 per annum: Recruitment Genius: This industry leading company produces h...

Recruitment Genius: Business Development Manager / Sales - OTE £40,000

£20000 - £40000 per annum: Recruitment Genius: This IT provider for the educat...

Day In a Page

Read Next
 

Errors & Omissions: the strange case of the errant royal pronoun

Guy Keleny
Flowers and candles are placed at the site where a refrigerated truck with decomposing bodies was found by an Austrian motorway  

EU migrant crisis: The 71 people found dead in a lorry should have reached sanctuary

Charlotte Mcdonald-Gibson
The Silk Roads that trace civilisation: Long before the West rose to power, Asian pathways were connecting peoples and places

The Silk Roads that trace civilisation

Long before the West rose to power, Asian pathways were connecting peoples and places
House of Lords: Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled

The honours that shame Britain

Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled
When it comes to street harassment, we need to talk about race

'When it comes to street harassment, we need to talk about race'

Why are black men living the stereotypes and why are we letting them get away with it?
International Tap Festival: Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic

International Tap Festival comes to the UK

Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic
War with Isis: Is Turkey's buffer zone in Syria a matter of self-defence – or just anti-Kurd?

Turkey's buffer zone in Syria: self-defence – or just anti-Kurd?

Ankara accused of exacerbating racial division by allowing Turkmen minority to cross the border
Doris Lessing: Acclaimed novelist was kept under MI5 observation for 18 years, newly released papers show

'A subversive brothel keeper and Communist'

Acclaimed novelist Doris Lessing was kept under MI5 observation for 18 years, newly released papers show
Big Blue Live: BBC's Springwatch offshoot swaps back gardens for California's Monterey Bay

BBC heads to the Californian coast

The Big Blue Live crew is preparing for the first of three episodes on Sunday night, filming from boats, planes and an aquarium studio
Austin Bidwell: The Victorian fraudster who shook the Bank of England with the most daring forgery the world had known

Victorian fraudster who shook the Bank of England

Conman Austin Bidwell. was a heartless cad who carried out the most daring forgery the world had known
Car hacking scandal: Security designed to stop thieves hot-wiring almost every modern motor has been cracked

Car hacking scandal

Security designed to stop thieves hot-wiring almost every modern motor has been cracked
10 best placemats

Take your seat: 10 best placemats

Protect your table and dine in style with a bold new accessory
Ashes 2015: Alastair Cook not the only one to be caught in The Oval mindwarp

Cook not the only one to be caught in The Oval mindwarp

Aussie skipper Michael Clarke was lured into believing that what we witnessed at Edgbaston and Trent Bridge would continue in London, says Kevin Garside
Can Rafael Benitez get the best out of Gareth Bale at Real Madrid?

Can Benitez get the best out of Bale?

Back at the club he watched as a boy, the pressure is on Benitez to find a winning blend from Real's multiple talents. As La Liga begins, Pete Jenson asks if it will be enough to stop Barcelona
Athletics World Championships 2015: Beijing witnesses new stage in the Jessica Ennis-Hill and Katarina Johnson-Thompson heptathlon rivalry

Beijing witnesses new stage in the Jess and Kat rivalry

The last time the two British heptathletes competed, Ennis-Hill was on the way to Olympic gold and Johnson-Thompson was just a promising teenager. But a lot has happened in the following three years
Jeremy Corbyn: Joining a shrewd operator desperate for power as he visits the North East

Jeremy Corbyn interview: A shrewd operator desperate for power

His radical anti-austerity agenda has caught the imagination of the left and politically disaffected and set a staid Labour leadership election alight
Isis executes Palmyra antiquities chief: Defender of ancient city's past was killed for protecting its future

Isis executes Palmyra antiquities chief

Robert Fisk on the defender of the ancient city's past who was killed for protecting its future