The NHS will get a new inspectorate and a legal duty of candour will be imposed on hospitals and potentially NHS staff, in tough new measures designed to stop another Mid Staffs from happening again.
Speaking to the House of Commons yesterday, the health secretary Jeremy Hunt (pictured) said that “terrible things” happened at Mid Staffs and the Staffordshire hospital, where 400 to 1,200 extra deaths were recorded between 2005 and 2008 due to poor care and negligence.
Hunt said that at Mid Staffs the system “failed” and did not protect patients from “inhumane” treatment. To stop this from happening again, he has announced new measures to protect patients and add more legal responsibility for care onto hospitals and trusts.
These measures include a new inspectorate for the NHS, which will be set up under the Quality Care Commission. With this, every NHS Trust will get a single rating, and Hunt says that patient experience will “be at the heart of this”.
Hospitals will also be measured on a department-by-department basis and there must be a culture of zero harm in the NHS. “That does not mean there will be no mistakes. But it does mean that harm will be treated as totally unacceptable. A review of how this could be established is underway,” he adds.
Hunt says a new statutory duty of legal candour will be introduced for providers registered under the CQC, and could include hospitals, GPs and other hospital staff. The health secretary said further details on this aspect of the plans would require 'careful consideration'. It was widely believed before the publication of the report that just institutions such as hospitals and trusts - and not individuals or staff - would be given this new duty, but it seems there is still room for manoeuvre on this point.
“I want Mid Staffs to be not a byword for failure, but a catalyst for change,” he said.
These announcements are all in response to the Francis report, one of five reports into the Mid Staffs and Staffordshire hospital scandal, which made 290 recommendations to the government in February, including:
• Causing death or harm to a patient should be a criminal offence
• A “duty of candour” should be imposed on NHS staff
• Everyone having hands-on care of a patient should be properly trained and registered.
• Senior NHS staff who breach the code of conduct should be disqualified
• Scandal cannot be dealt with by sacking scapegoats and reorganising NHS.
Hunt said that Robert Francis QC produced a “seminal report that will, I believe, mark a turning point in the history of the NHS”.
Too posh to wash?
Hunt has also accepted Francis’s call for people going into nursing to have to have hands-on experience of helping to feed and wash patients.
This will be a pilot programme that will see nurses working for up to a year as a healthcare assistant as a prerequisite for receiving funding for their degree.
Commenting on the government’s proposals, David Welbourn, visiting Professor in the practice of health systems management at Cass Business School, said: “There is no doubt that the NHS’s emphasis on compassion is very high profile, but there is a question mark in my mind about whether focusing on trainee nurses is a smoke screen – it will be four years before this policy will have any effect.
“The more pressing question is what are we doing about those already in post? Leaders need to be more aware of what is happening on a day-to-day basis - spending more time both setting the tone and culture of what is expected, spending time with staff nurses, increasing time coaching and observing. They need to recognise that the job of caring is emotionally and physically draining.
“Leaders need to support and equip staff to deal with these pressures, and the current environment of fear and blame hinders rather than helps. A statutory duty of candour and a threat of criminal action does nothing other than add to the fear and mistrust, when what is required is to build greater trust and genuine openness.
“Hearing what Jeremy Hunt has just said, we should welcome his comment that what went wrong at Mid Staffs was not typical of the NHS, and that in responding to it, the system must not crush the decency of most people in the NHS.”
Nicholson debate continues
During the Commons debate after the report was announced Bill Cash, a Conservative MP, raised the elephant in the room of Sir David Nicholson, the chief executive of the NHS and a manager in the Mid Staff Trust region during the scandal.
Cash said that Sir David “should resign” his post because of his role in Mid Staffs - Hunt said, however, that he “does not agree with Cash on this point”, meaning the coalition government is still backing the NHS chief, at least for now.
