The scandal surrounding the events at Mid Staffordshire NHS Trust – in which as many as 1,200 patients unnecessarily died – was perhaps the low point in the long history of the British National Health Service. A terrible catalogue of neglect was laid bare: patients lying untended in their own excrement, or left so thirsty they were forced to drink the water from flower vases. Hardly less shocking was the realisation that these were only the most extreme examples of a pattern of poor standards across the NHS.
When the Francis inquiry reported in February, after a 31-month investigation into the Mid Staffordshire scandal, critics queried the decision not to name and shame guilty individuals. But the decision was made for a reason. Robert Francis QC avoided making scapegoats of callous or careless individuals so as not to distract from the real problem – systemic flaws requiring fundamental changes across the health service. Indeed, his report made no fewer than 290 recommendations in its attempt to address the culture of corporate self-interest, meeting targets and controlling costs which too often takes precedence over patients’ needs.
Yesterday, it was the Government’s turn. In setting out his response, the Health Secretary went some way to tackling the issues identified by Mr Francis. Jeremy Hunt set out plans for a beefed-up, Ofsted-style, Chief Inspector of Hospitals; for an end to confidentiality clauses which silenced whistleblowers; for a legal “duty of candour” for hospital boards; and for the slashing of bureaucratic box-ticking for nurses. All such measures are to be welcomed – although it beggars belief that many of them were not always the norm.
One such is surely Mr Francis’s recommendation that trainee nurses spend at least three months undertaking the basic caring tasks – cleaning, bathing and feeding patients – that are part and parcel of their profession. In fact, the Government has – rightly – extended the period to a year.
Annual refresher courses for nurses, as for doctors, are also to be applauded. But it would also have been helpful to have made special provision for training in the care of older people with complex multiple conditions, given the large proportion of our hospital population accounted for by such patients.
The report also identified problems at the NHS’s higher levels, with the hospital management and boards that set the policies that shaped staff behaviour. Again, the Government has taken a step in the right direction, introducing a system which will bar those senior NHS managers and non-executive directors who have proved themselves unfit to be trusted with patients’ health and well-being.
Even taken together, however, the impact of these changes will be limited so long as key parts of the NHS are so inefficiently staffed. Labour’s health spokesman, Andy Burnham, yesterday blamed cuts in the number of nurses for falling standards of care. There is certainly an issue with quality in the NHS. A recent watchdog report concluded that a staggering 27 per cent of hospitals and care homes are failing to meet minimum standards. But staffing numbers do not tell the whole story. The question is one of efficient organisation, rather than the length of the roster. And simply hiring more nurses will not, by itself, end a culture which treated patients and their families with such contempt that, in the words of one grieving relative, cruelty was normalised.
It is attitudes, then, as much as systems, that must change if patients are not to be left so appallingly neglected as they were in Mid Staffordshire. The measures outlined yesterday are just the start.