Staffordshire NHS Foundation Trust.

Most of the UK media has reported on the Francis inquiry into significant failures in care at the Mid Staffordshire NHS Foundation Trust.
The report suggests a raft of radical changes to help improve patient safety. These include proposals to make serious but avoidable medical mistakes a criminal offence.
The Healthcare Commission (the hospital regulator at the time) first raised concerns about the trust in 2007, after determining it had unusually high death rates.
These concerns led to a series of reports, undertaken by different bodies, which all found widespread evidence of significant failures in care, including:

• patients being left in soiled bedding
• patients not given ready access to food and water
• chronic staff shortages
• failure in the leadership of the hospital
• a culture in which staff members who had concerns about failures in care were discouraged from speaking out

This current inquiry was commissioned in 2010 to investigate wider issues that may have contributed towards these serious problems. The inquiry, carried out by the barrister Robert Francis QC, was asked to come up with recommendations which could help prevent similar failings from happening in the future.
The findings of the inquiry have now been published.

What is a public inquiry?

Public inquiries are wide-ranging investigations commanded by the government to look at very serious issues, particularly where there have been numerous deaths.

Due to their scale and level of detail, they are not often carried out. The most recent health-related public inquiry was the 2005 Shipman Inquiry into the case of Hyde GP Harold Shipman who was imprisoned for murdering 15 patients.

What were the main findings of the inquiry?

The findings of the inquiry can fairly be described as damning. It highlights what amounts to a ‘perfect storm’ of systematic failures of care at multiple levels, including:

• a ‘Somebody Else's Problem’ attitude among hospital staff – perceived problems were too often assumed to be the responsibility of others
• an institutional culture that cared more about the needs of the hospital staff than the patients
• an unacceptable willingness to tolerate poor standards of patient care
• a failure to accept and respond to legitimate complaints
• a failure of different teams within the hospital, as well as in the wider community, to communicate and share their concerns
• a failure of leadership – in particular, financial changes needed to achieve Foundation Trust status were seen, by the inquiry, to take precedence over patient care

Mr Francis concludes that, ‘The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed. This does not require a root and branch reorganisation – the system has had many of those – but it requires changes which can largely be implemented within the system that has now been created by the new reforms.’

What recommendations does the inquiry make?

The inquiry makes a total of 290 individual recommendations. These include:

• causing harm or death to a patient due to avoidable failures in care should be a dealt with as a criminal offence (rather than a regulatory or civil matter)
• NHS staff, including doctors and nurses, should have a legal ‘duty of candour’ – so they are obliged to be honest, open and truthful in all their dealings with patients and the public
• a single regulator of both quality of care and financial matters should be created
• non-disclosure agreements (‘gagging orders’) – where NHS staff agree not to discuss certain matters – should be banned
• there should be a ‘fit and proper’ test for hospital directors, similar to those set for football club directors
• a clear line of leadership needs to be established, so it is always clear who is ultimately ‘in charge’ when it comes to a particular patient
• uniforms and titles of healthcare support workers should be clearly distinguished from those of registered nurses

What happens next?

The final report of the public inquiry has now been published, and the government has said it will respond to the recommendations of the inquiry in March 2013. Changes required by earlier reports into the failings at Mid Staffs are already underway.
The Prime Minister David Cameron has said that “quality of care” should be on a par with “quality of treatment”.
He said: “We have set this out explicitly in the Mandate to the NHS Commissioning Board, together with a new vision for compassionate nursing.
“We have introduced a tough new programme for tracking and eliminating falls, pressure sores and hospital infections.
“And we have demanded nursing rounds every hour, in every ward of every hospital.”
Edited by NHS Choices. Follow Behind the Headlines on twitter.

Links to the headlines

Stafford Hospital: Hiding mistakes 'should be criminal offence'. BBC News, February 6 2013
Mid Staffordshire NHS trust inquiry report published. The Guardian, February 6 2013
David Cameron apologises for Mid Staffs scandal after damning report. The Daily Telegraph, February 6 2013
Medical staff must face criminal charges for failures, says care scandal report. The Independent, February 6 2013

Further reading

Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry Executive summary (PDF, 839Kb). Published