By continuing to use the site you agree to our Privacy & Cookies policy

Your browser seems to have cookies disabled. For the best experience of this website, please enable cookies in your browser.

Close

Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Close

OPINION

Dean Royles: 'The horrors of Mid Staffs need a system-wide response'

With the publication of the Francis report looming, Dean Royles looks at what it may mean for the NHS

If 2012 was the year of the Health and Social Care Act, 2013 seems likely to be the year of the Francis report.

It will let us take a long, hard look in the mirror.

A lot of extraordinary, unconditional care is given in the NHS and staff often show enormous bravery. I have often taken the view that the considerable amount of great care can somehow compensate for occasional poor care, while recognising the individual distress that this causes.

However, this argument is no longer good enough.

In some areas, we are seeing an erosion in public confidence, with distressing stories about seriously ill patients asking not to be taken to certain wards and fears over the Liverpool Care Pathway. Comments about the “normalisation of cruelty” have made me take a long hard look at myself, my views and my values.

How do we, as employers of 1.2 million staff, convince the public that we are just as passionate about high-quality care as they are, that our commitment to good care is what gets us up in the morning and that we don’t just consider the balance sheet?


There is a lot of speculation about the Francis report. There is a widely held view that it will lead to a tsunami of change. Could it be coming at the worst time or the best time? Will huge financial challenges in the NHS prevent its recommendations from being implemented effectively, or will they provide the impetus for significant cultural change?

Regulators, professional bodies and other organisations will sense they have a part to play. It’s going to be significant for the HR function, which is often seen as the curator of organisational values - values that can both deliver exceptional care or fail patients.



All of us in the NHS will need to show that we are as determined as the health secretary will no doubt say he is to restore public confidence. Anything less will be a disservice to patients and the public.



Will the report recommend the regulation of managers? Would this apply to all managers, including registered professionals - or just board directors? Would it be voluntary or mandatory?

There has also been a lot of speculation from professional bodies about the regulation of healthcare assistants and minimum staffing ratios. Other organisations, including NHS Employers, have taken a cautious stance. Would minimum staffing ratios signal a staffing ceiling rather than a floor? What would this mean for the professional role of the ward manager, who is often best placed to judge the right mix of staff? Would regulating HCAs improve safety and dignity, or just allow a sanction after failure? Would it be better if instead of regulation we invested in developing standards, ensured access to training, provided good supervision and recruited and appraised staff against core values?


Any new approach should focus on early identification and support to keep patients and services safe, rather than identify poor performance after a tragedy. That will always be too little, too late.

It is essential that staff should be able to raise concerns but the NHS staff survey shows that around half of employees have no confidence action will be taken if they do so. We must put this right. Acting quickly and comprehensively on this has to be a top priority. Training, culture, leadership and policies will all play a part.



I - like many others - am speculating and taking a long, hard look in the mirror. We need a government and system-wide response to Francis and the horrors of Mid Staffordshire that will get us beyond the flurry of press coverage to sustainable solutions. These need to unite clinicians and managers in a common aim to provide the best-quality care, when care and compassion are what matter most. That’s what I hope the legacy of Francis will be.

Dean Royles is director of NHS Employers

Do you want to keep up to date with the latest from the Francis Report into the Mid Staffordshire Foundation Trust? Visit our tailored Francis Report channel with the latest rolling news and analysis

Readers' comments (31)

  • michael stone

    'Would it be better if instead of regulation we invested in developing standards, ensured access to training, provided good supervision and recruited and appraised staff against core values??

    Any new approach should focus on early identification and support to keep patients and services safe, rather than identify poor performance after a tragedy. That will always be too little, too late.

    It is essential that staff should be able to raise concerns but the NHS staff survey shows that around half of employees have no confidence action will be taken if they do so. We must put this right. Acting quickly and comprehensively on this has to be a top priority. Training, culture, leadership and policies will all play a part.'

    As I've commented before, I feel sure a major problem is that 'te culture' of the NHS seems to be that:

    1) If anything is 'significant or serious' it has to written down somewhere;

    2) If it isn't written down, or going to be written down, it isn't serious - and will not be taken seriously.

    The consequence of this, all too often, is that if you raise an issue 'below the level of a formal complaint', nobody pays much attention, because it isn't a formal complaint.

    If you formally complain, everyone tends to become 'very deensive', and instead of objectively looking at the possible problem, people are much more concerned with makings ure any blame will end up on someoen else.

    That is what has got to be changed - it has got to become possible, to 'think fairly hard about' concerns, without turning things into formal complaints and slowing the process down to 'fill-in this form, hold that formal meeting, record this, fill-in that, write to .... ' etc !

    I've just posted some initial thoughts, about a sort of network of 'Cultural Champions', in another discussion.

    Unsuitable or offensive?

  • Royals is well aware that the Mid Staffs disaster was rooted in despicably poor "management".

    All that mattered at Mid Staffs was achieving "Foundation" status patients did not matter and in fact where a nuisance. As a result many died of "management failure"

    Nursing staff were deliberately reduced by 100s, nursing skill mix was decimated by the employment of (cheap) care assistants. Warning signs were ignored and Whistle blowers bullied and hounded out of their jobs.

    Mr Royals is fully aware of the "macho" management style which has been widely adopted as a "productive" model !

    Royals supports the "consortia" who are actively engaged the attempt to destroy clinical staffs terms and conditions of service !

    The NHS "culture" of rewarding the failure of senior managers is well known and documented. Basically two forms of reward --1) Negotiate a settlement amounting to £0000s +large pension entitlement walk away to be re-employed in the NHS as a "Consultant" a few weeks later OR 2) Be promoted away from the trouble preferably to a better paying post !
    Mr Royals and his colleagues should be afraid it is alleged that attempts have already been made to have the Francis report watered down. Criticism of management is said to snake all the way from trusts to Whitehall

    I sincerely hope Mr Francis recommends an end to the NHS management system which is focussed on bonus payments and salary increases whilst the plebs suffer pay freezes.

    A system of open, transparent management is badly needed within which failure is rewarded with dismissal without the benefit of a "golden goodbye" and a promise of re-employment.

    Unsuitable or offensive?

  • I fully agree with Jenny, lets stop pretending that this is about Nurses and Doctors and admit this is about a culture where Chief Execs and their lackeys can make or break a Hospital. They have far too much power, if they choose to ignore clinical staff concerns and patients best interest they can do so without any fear of reprisals.

    It's time for the Government to make it clear that Hospital managers are accountable for their actions and the buck stops at the top - some hope!

    Unsuitable or offensive?

  • HEY Royles !!

    Yet more evidence emerges of currupt, inept and grossly incompetent "management!

    ALL the folowing have recieved "Warnings" from the CQC ----

    Scarborough Hospital; Milton Keynes Hospital; Royal Cornwall Hospital; Walton Centre NHS Foundation Trust in Liverpool; Queen’s Hospital, Romford; Stamford & Rutland Hospital; Southampton General Hospital; Croydon University Hospital; Bodmin Hospital, Cornwall; Northampton General Hospital; St Peter’s Hospital, Maldon; Queen Mary’s Hospital, London; Chase Farm Hospital, London; Westmorland General Hospital; Pilgrim Hospital, Leicestershire; St Anne’s House, East Sussex; and Princess Royal Hospital, West Sussex.

    The warnings concern the deliberate and cynical attempts by "Management" to provide services with insufficient staff!

    These "Managers" who's actions place patients at risk must be publicly named, shamed and removed, without compensation, from the NHS.

    Unsuitable or offensive?

  • Jenny Jones - where did you get your info from? I would be interested in reading it.

    Unsuitable or offensive?

  • there was an article on this in yesterday's telegraph online but articles have also appeared on the incompetency of the the CQC - all very confusing!

    there is also one on Hunt on the shortage of nurses!

    Unsuitable or offensive?

  • Anonymous | 13-Jan-2013 11:15 am

    Sorry I should have posted my source!

    If you look in the on line health section of todays Telegraph you will find the detail.

    Unsuitable or offensive?

  • tinkerbell

    i once completed an incident form stating the staffing levels were 'dangerously low' many years ago.

    I was called to the managers for a meeting.

    They wanted to discuss my 'inflammatory' use of the word 'dangerous'. Other than that the wording was approved. Nothing came of it.

    What a farce!

    So what is to become of hunts pseudo concerns of 'dangerously low staffing levels' Is any action going to be taken?

    What is to become of the Francis report, i would love to think that all these reports aren't just lip service, that something good will happen and action will be taken, but i think there is a very dusty shelf somewhere, a room 101, where they are all stacked up mile high.

    Voicing concerns is one thing, actioning them is another. If you have it within your power to change something for the better then do it please. It's what we DO that counts.

    Unsuitable or offensive?

  • tinkerbell | 13-Jan-2013 12:36 pm

    did you do a cost/benefit analysis on that meeting?

    Unsuitable or offensive?

  • tinkerbell

    Anonymous | 13-Jan-2013 12:39 pm

    sorry as the only nurse in charge had to get back out and nurse the people but did continue to fill out incident forms and use the words 'dangerously low staffing levels' and encourage all my colleagues to do the same.

    Unsuitable or offensive?

  • tinkerbell | 13-Jan-2013 12:45 pm

    very important, because money saved on all these frequent meetings, excessive consumption of coffee beans, extra electricity for the machine and lighting plus staff time involved and all of unnecessary administration and paperwork, not forgetting the photocopying (a costly process) and , taking a senior nurse off the ward, etc. could save an awful lot of money for more nurses salaries!


    you could also take into the calculation the time it took you to get to the meeting, the time you spent there, the time to get back to your ward and the time it took for you to return to full concentration on your job. multiply that by everybody in your organisation in similar circumstances, and the rest speaks for itself.

    How many do you have wandering the corridors going to and from meetings every day and possibly engaged in idle chat on the way! That represents an awful lot of money!

    Unsuitable or offensive?

  • tinkerbell

    Anonymous | 13-Jan-2013 12:58 pm

    Agree. Hoever any meeting i attend doesn't last very long as far as i'm concerned. If it goes on for longer than an hour i make my excuses and leave because nothing is being achieved, mostly.

    I was at a meeting the other day where i excused myself by saying i felt awfully tired and thought i might fall asleep. Nobody batted an eyelid as i got up and left. I genuinely felt i could stay no longer. Stangely as soon as i was out of the meeting my energy levels lifted.

    I lose interest rapidly and have a tendency to fall asleep in meetings that are not actually achieving anything as it works as some kind of hypnotic on me.

    Unsuitable or offensive?

  • tinkerbell | 13-Jan-2013 1:20 pm

    from Anonymous | 13-Jan-2013 12:58 pm

    I admire your honesty!

    I think the problem is that even the best managers are forced to engage in these silly tactics because power comes from the top. possibly this is explains why many of them in their turn attempt to wield their power over anyone below them in the administrative/managerial hierarchy because they are powerless to change the system so indulge instead in some very silly and seemingly senseless behaviours.

    Unsuitable or offensive?

  • tinkerbell

    perhaps it would help if in these 'meetings' there were a 'bullshit barometer'. You have so much time allotted to make your point and if it is starting to sound like 'waffle' a bullshit alarm sounds, or like in some programme on TV you get ejected from your seat when someone pulls the lever.

    Like Sir Jerry Robinson said in one of the chief execs meetings when he went into the NHS to try and help out and make it more efficient, 'i'm sorry to have to say this but this is all sounds like 'bullshit'. He left a drained, defeated man.

    Those who are talking 'sense' should be allowed to go out and ACTION their ideas.

    The regular meeting i attend on a monday mostly consists of some senior manager rambling on about his caseload and why he hasn't done such and such and being asked why not as the situation is now in 'crisis' mode, next mondays meeting will be a repeat performance no doubt, talk about 'groundhog day'. My deep sighs go unnoticed as the chinese water torture continues and as in the nobel peace awards for the accepting speaker i want to say
    'please stop, this is boring'.

    Unsuitable or offensive?

  • tinkerbell | 13-Jan-2013 2:16 pm

    there is a wealth of literature on how to conduct a successful meeting but I guess those who fail aren't aware that they are the very ones who would benefit from studying it.

    Unsuitable or offensive?

  • from Anonymous | 13-Jan-2013 11:56 am


    Hospital watchdog 'would not spot another Stafford’


    A senior inspector at a key NHS watchdog has resigned after warning the organisation would not be able to spot another scandal in patient care such as the one at Stafford Hospital.

    By Patrick Sawer, and Laura Donnelly7:50AM GMT 13 Jan 2013


    http://www.telegraph.co.uk/health/heal-our-hospitals/9797707/Hospital-watchdog-would-not-spot-another-Stafford.html

    Unsuitable or offensive?

  • Anonymous | 13-Jan-2013 3:52 pm

    brow beaten and bullied the good ones resign because of yet another corrupt institution, when they are the very ones who could change it. Doesn't bode well does it?

    These tired old tactics don't go away and we are left with the same problems that never get resolved and tragically the innocent are left to suffer.

    The brow beaten band together and form a new group that will not let this happen again and again as it is the only way to create positive change for the better.

    We are supposed to be represented by these inspectors, as we are by our government, but they do not represent 'US' they represent their own agenda.

    I wonder if mankind is doomed to perpetuate this behaviour because nothing seems to change because the gang mentality and bullies rule and make the honest, outspoken persons life such a misery.

    Now we need inspectors it seems to go in and inspect the CQC, where will it ever end?

    Unsuitable or offensive?

  • tinkerbell

    Anonymous | 13-Jan-2013 5:31 pm

    Anonymous | 13-Jan-2013 3:52 pm

    brow beaten and bullied the good ones resign because of yet another corrupt institution, when they are the very ones who could change it. Doesn't bode well does it?

    These tired old tactics don't go away and we are left with the same problems that never get resolved and tragically the innocent are left to suffer.

    The brow beaten band together and form a new group that will not let this happen again and again as it is the only way to create positive change for the better.

    We are supposed to be represented by these inspectors, as we are by our government, but they do not represent 'US' they represent their own agenda.

    I wonder if mankind is doomed to perpetuate this behaviour because nothing seems to change because the gang mentality and bullies rule and make the honest, outspoken persons life such a misery.

    Now we need inspectors it seems to go in and inspect the CQC, where will it ever end?

    Unsuitable or offensive?

  • I have done incidents forms re: poor staffing levels, and all I got back is they are unable to find the staff to cover.
    The other day we were short as usual, but the senior doctor was around so was the sister and it was visiting time so a lot of visitors too. One patient was waiting so long to be seen to as all the few nurses and carers were with other patients, he started shouting for help.
    The doctor went in to see the patient then quickly looked for a nurse to send her in to see to the patient. The nurse left what she was doing to see to the shouting patient, the doctor was happy that he had done his bit to help and the poor patient who could not shout was left to be seen to later.
    The ward became quiet again and to some people all was under control again.
    The wards are really in a state of a mess--with dangeously poor staffing levels.

    Unsuitable or offensive?

  • let's hope that the mid staffs report will put an end to short staffing and inadequate skill mix.

    let's hope it also leads to management and the governing bodies accepting responsibility for what is going on in 'their' hospitals every day of the week.

    Unsuitable or offensive?

View results 10 per page | 20 per page | 50 per page

Have your say

You must sign in to make a comment.

Related Jobs

Sign in to see the latest jobs relevant to you!

newsletterpromo