Mid Staffs scandal: 10 years on, inquiry chair worries NHS staff too scared to speak up

Exclusive: Next month marks 10 years since the first official report by Sir Robert Francis into the poor care at the trust

Shaun Lintern
Health Correspondent
Wednesday 15 January 2020 01:12 GMT
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Sir Robert says some safety risks highlighted a decade ago remain unresolved
Sir Robert says some safety risks highlighted a decade ago remain unresolved

Ten years on from the Mid Staffordshire NHS trust scandal, the man who led the inquiry into one of the worst care disasters in the service’s history has said he remains worried about the safety of patients and a culture that leaves staff too frightened to speak up.

Sir Robert Francis QC said some safety risks highlighted a decade ago remain unresolved and he threw his weight behind calls for senior managers in the NHS to be regulated.

The barrister said he believed the NHS was safer now than a decade ago but added he worried whether actions taken since the disaster had made a real difference.

“What keeps me awake at night is not so much has anyone implemented recommendation 189 or not, but more whether the collectivity of what has happened since has actually resulted in things being better for patients and staff,” he told The Independent.

“Where I am disappointed there hasn’t been more progress, is in the support given to NHS staff. And we see the evidence for that in all the problems we now have in retention, recruitment and working conditions. A lot of what I was recommending was actually about making life easier for staff to do the job they would want to do.”

He added: “Something that really distresses me is people who say ‘I couldn’t possibly have said that’ in relation to something somebody else has done, and what they mean is ‘I wouldn’t have dared say that’. And I just find that very distressing.

“We do need to get away from this situation where people in responsible positions feel they can’t say what they genuinely think is good for an organisation in whatever setting they’re in.”

Sir Robert published his first report on the NHS trust which ran Stafford Hospital in February 2010. Three years later he unveiled a landmark public inquiry report into the wider system failure not only of the NHS but of all its regulatory bodies, politicians and the then Labour government.

He called for a widespread culture change in the NHS to put patients first.

Stafford Hospital was the scene of unprecedented abuse and the neglect of hundreds of vulnerable patients with many left in their own faeces and urine, unable to eat or drink and often suffering falls or going without vital medication.

The hospital’s A&E department was described as being “immune to the sound of pain” while the trust’s surgery department was labelled “inadequate, unsafe and at times frankly dangerous” in an official report.

The story of Mid Staffs was one of poor management, bullying of staff, cuts to nursing staff levels to save money and a near obsessive focus by senior managers on meeting government targets.

The scandal was only exposed thanks to a small band of campaigning families who formed a group, called Cure the NHS, to demand improvements in patient safety.

It was their efforts which directly led to the investigation carried out by Sir Robert.

Asked what his assessment was today Sir Robert, who was knighted for services to healthcare and patients in 2014, said: “The last 10 years have been marked by huge pressures on the system, in terms of the demands made of it and I have been concerned at times as to whether there was a danger of Mid Staffs repeating itself because of those pressures.

“In some ways it is a tribute to the system that, while some things have gone wrong, it has got through that period in the way that it has.”

The NHS is currently considering proposals to regulate senior managers, such as chief executives, after a number of examples of poor managers being moved to new roles.

Sir Robert, who recommended regulation of managers a decade ago, said it was important they were given support, training and a professional ethos but that ultimately they should be regulated. “We should not be moving people who are judged to be incompetent or unsuitable from one place to another,” he said. “I would like to see them being regulated or at least registered. We need the ability to exclude unfit people.”

He also repeated his calls for registration of the more than 400,000 healthcare assistants (HCAs) in the NHS, who deliver most of the personal care to patients.

HCAs can work on wards often after just a few weeks of training.

Asked whether the NHS was safer overall, Sir Robert said he believed it was. “While there are still instances of continuing denial, when that’s not the appropriate response, much more often than before, you’ll have an acceptance of responsibility and a commitment to do something about it,” he said. “And that’s why I say it’s safer.”

He said two major positives from his report into Mid Staffs were the implementation of a legal duty of candour, requiring organisations to be honest with families when mistakes were made, and the creation of new “freedom to speak up guardians” to respond to whistleblowing issues in each hospital.

He said these two things had “put in place a means of transparency and learning, which were not there before. And I believe have actually changed the atmosphere in many places.”

He added: “Despite all the pressures of the last 10 years, there is a consistent recognition that quality matters as much as money. You will go to very few places now where quality is not talked about at the same level as finances. It is quite remarkable that has survived despite the financial pressures in the last few years.”

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