Robert Francis QC’s much-awaited report on the care provided under the auspices of the Mid-Staffordshire NHS Foundation Trust is published and laid before Parliament today.  But while most people will be aware, at least passingly, of the scandal at Stafford Hospital in which up to 500 patients are said to have died due to poor care.  But what are the specifics?


What Happened?

It’s difficult to summarise such a massive scandal – but what can be said is that between 2005 and 2008, there were between 400 and 1,200 more deaths than might have been statistically expected.  Moreover, the general standard of cleanliness and care at Stafford Hospital was very, very poor – the chairs in the A&E waiting area were crusted with dried blood, children’s playmats were stained, there were puddles of urine and cigarette butts left on the floor; patients were left crying out for assistance.  Patients were left without assistance, forced in some cases to drink water from vases or left in soiled sheets.  One woman – who had a broken arm – was given no assistance in feeding herself.

This was, shockingly, only noticed after Terry Deighton, a retired government adviser, was invited by the patients’ forum at the hospital to review whether or not there might be an additional risk of infection if a new telephone system were installed.  He presented a three-page report on the hospital’s A&E department to the hospital’s Patient and Public Involvement in Health Forum which was then sat on by those running the Forum.  Frustrated, Mr Deighton turned to his local newspaper, who reported on the “squalid” conditions at the hospital immediately.

This prompted an investigation by the Healthcare Commission, one of the bodies which preceded the current Care Quality Commission.  The report, published in 2009, was very critical of the way in which the hospital, and the trust which had responsibility for the hospital (Mid-Staffordshire NHS Foundation Trust) were run.

An independent inquiry was held soon after, and the report was published in 2010.  A further public inquiry has recently concluded, and the resulting report has been published today.

Some reports indicate that the Mid-Staffordshire Trust has paid over £1 million in medical negligence compensation so far.

Who’s Led the Inquiry?

Both the independent Inquiry and the public Inquiry were led by Robert Francis QC.  The first inquiry focused primarily on the individual patients’ stories, and the way in which care at Stafford Hospital fell short of the expected standard.  The latest inquiry has focused more on the managerial side of things, looking at what monitoring systems were in place and how the condition of the hospital was allowed to get so bad.

What are the Findings?

The report is quite damning in some areas, and unexpectedly easy-going in others.  For example, while a number of the individuals involved in management at Stafford Hospital at various levels have been named, they have not been singled out for particular criticism.

The focus of the report has, instead, been on the processes which allowed the situation to come about.  The report states that there was a culture which prioritised “the system’s business – not that of patients”; assumptions that quality monitoring was always the responsibility of another party or department; consistent failure to heed warning signs and an institutional tendency to give too much weight to positive feedback as opposed to negative, among other things.  Mr Francis has also warned that he is “…unlikely to have confidence that another Stafford does not exist, in the absence of being convincingly persuaded that sufficient change has taken place”

What’s the likely Impact?

This is much harder to assess.  The report makes some 290 recommendations which aim to refocus the culture of the NHS on patient care.  Some specific recommendations include, among others:

  • A statutory “duty of candour” for staff
  • That it should be a criminal offence to conceal information related to poor care;
  • That senior NHS staff who breach the NHS code of conduct be disqualified;
  • That there be “zero tolerance” for poor care;
  • That Monitor (which is the NHS’s economic regulator) and the Care Quality Commission (the care regulator) be merged into a single body.

How many of the recommendations will be implemented remains to be seen – we do know that the Prime Minister has already announced the creation of the post of Chief Inspector of Hospitals.  The Government will be making a full response to the report in the next month.  However, somewhat worryingly, the Government has shown – in the wake of the Leveson Inquiry – that it is quite willing to disregard the recommendations of even the most high-profile and emotionally-charged Inquiries.  The Government may take the view that as the Health & Social Care Act 2012 has been passed into law while the Inquiry was underway, many of the Inquiry Report’s recommendations are now obsolete.  For example, the Government has previously refused calls for a duty of candour to be introduced, considering that amendments to the NHS Constitution were sufficient.

But whether there is change or not on an official level, there will almost certainly be a greater public consciousness of the duty of care which is expected of clinical practitioners, both in and outside of the NHS.  Further, staff at hospitals and care homes will hopefully be more alert to the possibility that any deficiency in the service they provide might eventually be dragged into the light of day by the press.

What Does this mean for You?

You are entitled, in any setting, be it a hospital, at your GP’s practice, at a care home or receiving care in your own home, to a high standard of care, irrespective of whether the care is provided privately or via the NHS.

If you are receiving poor care and you don’t speak out, you’re not just doing yourself an injustice – as at Stafford Hospital, inaction can and does create a situation which is potentially fatal for dozens, possibly even hundreds of people.  If you’re unsure, or feel nervous about speaking out against poor care, call our clinical negligence team – we’re here any time to help you.

If you’d like to find out more about the medical negligence claims process, or if you’d like to see how a clinical negligence solicitor can help you with your case.

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  1. Its pure rubbish to tell Patients who are ill -having operations, recovering from Ops. and in need -in varying degree’s that “they are ones that have the responsibility of Speaking out about poor levels of Care” . They may need scans, X rays extra treatment, follow ups, physiotherapy, help in some degree or other that they want value and dont want to predjudice…
    What if the hospital then refuses to treat them next time- what if their Dr gets to find out they’ve complained ? What if… when they really need some help the Dr will not help them ? There are huge risks for the old, the ill the needy… and those… without much power at all to take on their local Hospital managers. The vast Majority of old folks just will not do it- they haven’t the courage to fight, they have not the courage to assert their rights at all- some of them many do so… but to place the burden on the already Ill and needy is pure rubbish- you should think about /look at the social psychology of those that are ill….Its not the same as those those that are fit and healthy and doing normal things…its quite different.

  2. buteykomikeM says:

    1. Need for the equivalent of “Freedom of Information Act” , “Security of Complaints Act” facility to have a complaint against any large organisation anonymous to public personal details held bt complaints ombudsman.
    2. Need for a patient “buddy” to protect vulnerable patients against abuse or neglect, a service given by voluntary bodies.
    3. A surgical removal of inefficient & wasteful administration tumours in the NHS & breakdown of the NHS megalith into truly manageable sized units with clear responsibilities.
    4. The widespread use of a notice in every clinic, hospital, surgery rather like the “No smoking” sign that would say “Remember, the secret of patient care is caring for the patient” (From Dr Francis W Peabody 1927.

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