The conclusions of Professor Sir Bruce Keogh’s review make for alarming reading.
None of the 14 hospitals with high death rates were granted anything approaching a clean bill of health, and 11 of them have been placed in “special measures” for fundamental breaches of care. Inadequately maintained operating theatres, poor governance and unacceptable nursing are just a few of the problems needing remedies.
After the appalling revelations of the Francis report earlier this year, such failures – and the unnecessary deaths that result – are no longer the shock that they should be. Nor, indeed, should we be surprised by Sir Bruce’s evidence that the problems at Mid Staffordshire NHS Foundation Trust were not a one-off. It was never likely that the injurious culture, the target-chasing lack of compassion and the suppression of whistleblowers were restricted to a single location.
Much needs to be done to stop the rot. That so many underperforming institutions were signed off by the Care Quality Commission is a damning indictment of the regulatory regime. The introduction of newly rigorous assessments and the appointment of a Chief Inspector of Hospitals – as recommended by Robert Francis – are, therefore, the right priority. Measures to hold trust boards accountable for clinical standards, to encourage troubled staff to speak out, and to stamp out the egregious practice of failed managers being re-employed elsewhere in the NHS, are also welcome.
The reforms resulting from Sir Bruce’s review are equally necessary. With so many hospital management teams found to be ignorant of what was happening on their wards, leadership-quality assessments cannot start too soon. Creating partnerships between failing trusts and high-performing counterparts will also help.
Two concerns remain. The first is that a debate which should be about the quality of care is rapidly descending into dead-end political point-scoring. Having held back at the time of the Francis report, the Government is now explicitly blaming its predecessor. There are also accusations of cover-up: at best, the CQC was encouraged not to reach difficult conclusions; at worst, evidence of problems, even deaths, was ignored.
Such claims have, perhaps understandably, provoked outrage from the Opposition – and from former Health Secretary Andy Burnham in particular. In return, he accuses Jeremy Hunt, the current incumbent, of spin and scaremongering. In fact, the situation has deteriorated since 2010, Mr Burnham says, pointing the finger at Coalition budget cuts.
With so much fur flying, the substantive issue – which is to establish the extent of health service ills, find workable solutions and restore the confidence of both public and staff – is in danger of being obscured.
Nor is this merely a matter of distraction, although over-politicised vitriol will hardly help create a new culture of openness in the NHS. An even greater worry is that politicians are backing themselves into corners from which they cannot do all that they need to. The most obvious example is around staff numbers: Sir Bruce notes several cases of under-staffing and the Francis report called for minimum levels. Yet if Mr Hunt sticks to his script that these are historic issues, so critical an issue will remain unresolved.
The second risk is broader. Yesterday’s revelations are indisputably disturbing. And, in the face of major financial and demographic challenges, there is much to do. It is as well to remember, though, that the vast majority of NHS hospitals perform well and the vast majority of NHS staff are very much all they should be. Forget that, and we may imperil what works in the health service even as we attempt to fix what does not.