Robert Francis QC’s long-awaited final report into the Mid Staffordshire NHS Foundation Trust scandal has now been published, highlighting the appalling suffering of many patients.
Reflecting on the Trust’s failings, Robert Francis QC commented that the Trust “did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention.” It also failed to tackle “an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities.” This failure, he asserted, was in part “the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking Foundation Trust status”, which was at the cost of delivering acceptable standards of care. He further criticised the agencies, scrutiny groups, commissioners, regulators and professional bodies that failed to detect and remedy non-compliance with acceptable standards of care, commenting: “A system which ought to have picked up and dealt with a deficiency of this scale failed in its primary duty to protect patients and maintain confidence in the healthcare system.” Calling for a ‘fundamental culture change’ in the NHS, the report makes 290 recommendations designed to create a common patient-centred culture across the NHS. Organised around four key themes, the recommendations cover: a structure of fundamental standards and measures of compliance; openness, transparency and candour throughout the system underpinned by statute; improved support for compassionate, caring and committed nursing; and stronger healthcare leadership. Recommendations on ensuring ‘openness, transparency and candour’ included:
• A statutory duty to be truthful to patients where harm has or may have been caused.
• Staff to be obliged by statute to make their employers aware of incidents in which harm has been or may have been caused to a patient.
• Trusts have to be open and honest in their quality accounts describing their faults as well as their successes.
• The deliberate obstruction of the performance of these duties and the deliberate deception of patients and the public should be a criminal offence.
• It should be a criminal offence for the directors of Trusts to give deliberately misleading information to the public and the regulators.
Robert Francis QC stated that the reporting of concerns regarding patient safety, or compliance with fundamental standards, should ‘not only be encouraged but insisted upon’. Staff should also be entitled to receive feedback in relation to any report they make, including information about any action taken or reasons for not acting. There should also be improved support for compassionate, caring and committed nursing:
• Entrants to the nursing profession should be assessed for their aptitude to deliver and lead proper care, and their ability to commit themselves to the welfare of patients.
• Training standards must be created to ensure that qualified nurses are competent to deliver compassionate care.
• Nurses also need a stronger voice, including representation in organisational leadership.
As an immediate first step in responding to the report, the NHS Commissioning Board Medical Director, Sir Bruce Keogh, announced that he is to conduct an investigation into a number of hospitals that have been outliers on mortality. NHS Commissioning Board Chief Executive Sir David Nicholson, further commented: “It is important that we, in the NHS, reflect soberly and sensitively on what happened at the Mid Staffordshire NHS Foundation Trust and decide what action the NHS needs to take to ensure this never happens again.”
