Last month saw the publication by the government of ‘Hard Truths – the Journey to Putting Patients First’, representing the culmination of many years’ enquiry into the care provided by the NHS generally and in particular the Mid Staffordshire NHS Foundation Trust.
This was the government’s formal response to the enquiry’s final report (known as the Francis report) which was published in February 2013 and dealt with the poor standards of care at Mid Stafford Foundation Trust and looked into the question of why problems which eventually came to light in 2009 were not identified sooner.
The enquiry had looked into high mortality rates and examples of appalling treatment at the hospital between 2005 and 2008, with some estimates in the media suggesting between 400 and 1200 people might have died unnecessarily.
Common themes included: call bells going unanswered, and patients left lying in their own urine/excrement or with food and drink out of reach. Patient falls were also reported to have been concealed from relatives.
The report highlighted what was described as a ‘bullying culture’ at the Trust and it was said that senior management were unwilling to face up to the scale of problems there, but were focused upon maintaining Foundation Trust status rather than quality of care.
In the first of his two reports, Robert Francis QC had concluded that:-
“Patients were routinely neglected by a Trust which was preoccupied with cost cutting, targets and processes, which lost sight of its fundamental responsibility to provide safe care”
Mr Francis concluded that a legal “duty of candour” should be placed on NHS Trusts and their individual staff meaning they should be legally obliged to disclose incidents causing harm and could be prosecuted for failing to do so.
Following the report an independent review on complaint handling in the NHS was ordered.
The report by Anne Clwyd, a Labour MP who described having first hand experience of the problems faced by NHS treatment of her late husband, concluded that it should be made easier for families to raise their concerns about hospital treatment and that hospitals should consider putting a pen and paper by every bed and also ensuring that patients knew who to report concerns to.
In its final response to the 290 plus recommendations the government announced its intention to introduce:-
Hospital safety websites, which are presently being trialled in London and North East England and are said to be styled after Trip Advisor;Patient safety Tsars;A duty of candour, which will be restricted to provider organisations and would not extend to individuals.
It has been reported that to curtail the suggested duty of candour in such a way would exempt an estimated 75 – 80,000 incidents of ‘moderate’ harm – defined as being anything from which a patient recovers – every year.
Peter Watts, Chief Executive of Action Vs Medical Accidents was quoted as saying:
“Honesty is the bedrock of any worthwhile complaints system and a prerequisite of a patient safety culture. It should not be conditional. The government’s plan would in effect legalise cover-ups of all but the most severe incidents of harm….”
Andy Burnham, the Shadow Health Secretary, said the NHS had “an unfortunate tendency to push complainants away and pull down the shutters… the NHS should use complaints positively as part of the drive to improve care”. He supported calls for a duty of candour as recommended by Robert Francis QC.
Arguably, the greatest omission made by the government, however, is its failure to offer support to NHS staff.
Mr Francis’s recommendations for the registration of untrained healthcare assistants, protection for whistle blowers who put their jobs on the line and the setting of minimum levels for adequate staffing all appear to have been overlooked by the government.
Most NHS staff do an excellent job, but if someone does their job badly and a patient receives poor care the complaints system currently appears to be set up to silence the criticism.
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