Editorial: So much must change to ensure Mid Staffs can never be repeated

The account of NHS priorities twisted so inhumanely out of shape is chilling

Share
Related Topics

While it hardly needed a fifth inquiry to expose the appalling lack of care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009, the accounts of neglected patients, lying in excrement, drinking from flower vases, have lost none of their power to shock. Nor indeed has the staggering figure of anywhere between 400 and 1,200 people dead who might otherwise have lived. But where the report from Robert Francis QC differed from its predecessors is in its focus, not on the details of what happened, but on the hows and the whys. It is scarcely less harrowing, even so.

What Mr Francis does not do is point the finger at particular individuals, despite vociferous campaigning for heads to roll – not least that of Sir David Nicholson, the NHS chief executive who was, in 2005, a regional official with oversight of Mid Staffs. Patients and their families may, understandably, feel short-changed; but Mr Francis is right. Not because individuals cannot be responsible and should not be held to be so; rather because the system needs more fundamental change.

A herd of management scapegoats risks creating the impression that the problem is thus swiftly solved. It is not. Mr Francis’s conclusions as to the endemic, cultural failings at the NHS trust – and way beyond it – make for far more disturbing reading than would an account of a few bad apples easily flicked from the barrel.

Instead, what the QC describes is a grotesque disconnect between those running the organisation and its purported purpose, with negligent, abusive and sometimes fatal results. The culture at Mid Staffs was one where the “corporate self-interest” of meeting targets and controlling costs took precedence over patients’ needs, where successes were proclaimed and failings ignored, and where poor standards were tolerated regardless of the consequences. The picture of a hospital with its priorities twisted so inhumanely out of shape is truly chilling.

Nor, sad to say, is this only a local problem. That the grave dysfunction at Mid Staffs was allowed to continue for an astonishing four years – in the face of persistent complaints by patients, their families, and even members of staff – only underlines the extent to which every level of the system is implicated, from the hospital, to the primary care trust, to the regulator, to the Department of Health. Amid so generalised a cultural malaise, there is no reason for confidence that Mid Staffs is an isolated case. The immediate review of care at hospitals with the highest mortality rates, announced by the Prime Minister, therefore comes not a moment too soon. And any number of regulators, patient groups and NHS staff bodies have sharp questions to answer as to why complaints were not more assiduously pursued.

Faced with such systemic problems, it is appropriate that Mr Francis’s near-300 recommendations range so widely. Many appear so elementary that it is hard to believe they are not already in place – the proposal that causing death or harm to a patient should be a criminal offence, for example, or the suggestion of formalised training for healthcare assistants. Equally, it is surely shocking that it takes the failures at Mid Staffs for NHS trust boards to be held accountable for the standards of care in their hospitals – as they will now be – as well as their financial performance.

Taken together, Mr Francis’s calls for a statutory “duty of candour” requiring NHS staff to be open about mistakes, for an established code of conduct the breach of which results in managers’ disqualification, and for a louder voice for nurses are long overdue. As is the creation of a beefed-up regulator, with Ofsted-style inspections focused explicitly on care standards, overseen by a Chief Inspector of Hospitals.

Most important of all, however, is the proposition that care and compassion become the priorities in the recruitment, training and ongoing assessment of medical staff and their auxiliaries. For all that the flawed system has much to answer for, it is too easy to blame the usual suspects of under-staffing, central targets and box-ticking alone. The unpalatable fact remains that in many cases the neglect described is of so basic a nature – the placing of food out of reach, or the failure to provide a drink of water – that even the broken organisation around them cannot entirely absolve individuals for their want of sympathy. Better management, different organisational priorities and closer monitoring can do much. But the change must also come from the heart.

David Cameron told Parliament that we “can only begin to imagine the suffering endured”. Quite so. The only possible redress is to ensure that Mid Staffs can never happen again. Mr Francis’s report is only the very beginning.

React Now

Latest stories from i100
iJobs Job Widget
iJobs General

Guru Careers: Software Developer / C# Developer

£40-50K: Guru Careers: We are seeking an experienced Software / C# Developer w...

Guru Careers: Software Developer

£35 - 40k + Benefits: Guru Careers: We are seeking a Software Developer (JavaS...

SThree: Trainee Recruitment Consultant / Resourcer

£18000 - £23000 per annum + Commission: SThree: As a Trainee Recruitment Consu...

Ashdown Group: UI Developer - (UI, HTML, CSS, JavaScript, AngularJS)

£25000 - £40000 per annum: Ashdown Group: UI Developer - (UI, JavaScript, HTML...

Day In a Page

Read Next
Terry Sue-Patt as Benny in the BBC children’s soap ‘Grange Hill’  

Children's TV shows like Grange Hill used to connect us to the real world

Grace Dent
An Indian bookseller waits for customers at a roadside stall on World Book and Copyright Day in Mumbai  

Novel translation lets us know what is really happening in the world

Boyd Tonkin
Abuse - and the hell that came afterwards

Abuse - and the hell that follows

James Rhodes on the extraordinary legal battle to publish his memoir
Why we need a 'tranquility map' of England, according to campaigners

It's oh so quiet!

The case for a 'tranquility map' of England
'Timeless fashion': It may be a paradox, but the industry loves it

'Timeless fashion'

It may be a paradox, but the industry loves it
If the West needs a bridge to the 'moderates' inside Isis, maybe we could have done with Osama bin Laden staying alive after all

Could have done with Osama bin Laden staying alive?

Robert Fisk on the Fountainheads of World Evil in 2011 - and 2015
New exhibition celebrates the evolution of swimwear

Evolution of swimwear

From bathing dresses in the twenties to modern bikinis
Sun, sex and an anthropological study: One British academic's summer of hell in Magaluf

Sun, sex and an anthropological study

One academic’s summer of hell in Magaluf
From Shakespeare to Rising Damp... to Vicious

Frances de la Tour's 50-year triumph

'Rising Damp' brought De la Tour such recognition that she could be forgiven if she'd never been able to move on. But at 70, she continues to flourish - and to beguile
'That Whitsun, I was late getting away...'

Ian McMillan on the Whitsun Weddings

This weekend is Whitsun, and while the festival may no longer resonate, Larkin's best-loved poem, lives on - along with the train journey at the heart of it
Kathryn Williams explores the works and influences of Sylvia Plath in a new light

Songs from the bell jar

Kathryn Williams explores the works and influences of Sylvia Plath
How one man's day in high heels showed him that Cannes must change its 'no flats' policy

One man's day in high heels

...showed him that Cannes must change its 'flats' policy
Is a quiet crusade to reform executive pay bearing fruit?

Is a quiet crusade to reform executive pay bearing fruit?

Dominic Rossi of Fidelity says his pressure on business to control rewards is working. But why aren’t other fund managers helping?
The King David Hotel gives precious work to Palestinians - unless peace talks are on

King David Hotel: Palestinians not included

The King David is special to Jerusalem. Nick Kochan checked in and discovered it has some special arrangements, too
More people moving from Australia to New Zealand than in the other direction for first time in 24 years

End of the Aussie brain drain

More people moving from Australia to New Zealand than in the other direction for first time in 24 years
Meditation is touted as a cure for mental instability but can it actually be bad for you?

Can meditation be bad for you?

Researching a mass murder, Dr Miguel Farias discovered that, far from bringing inner peace, meditation can leave devotees in pieces
Eurovision 2015: Australians will be cheering on their first-ever entrant this Saturday

Australia's first-ever Eurovision entrant

Australia, a nation of kitsch-worshippers, has always loved the Eurovision Song Contest. Maggie Alderson says it'll fit in fine