Managers fear regulators would not spot ‘another Mid staffs’

Chief executives were asked how confident they were that care failings like those that occurred at Mid Staffordshire Foundation Trust – where death rates between 2005 and 2009 were higher than expected – would be detected.

The survey – carried out by Nursing Times’ sister title HSJ and law firm Capsticks – revealed that 44% of the 63 respondents were either “not confident” or “not at all confident”.

The results come as acute trusts plan to take out £2.35bn in costs this financial year and roughly half of them still need to gain foundation trust status.

The survey results showed regional variation when it came to confidence that another Mid Staffordshire-style care scandal would be detected.

Trusts in the NHS North of England strategic health authority cluster area had significantly less faith in governance systems and regulators than other parts of the country.

Janet Davies, director of nursing and service delivery at the Royal College of Nursing, described the survey results as “really worrying”.

“The chief executives are going through this [FT application] process, but clearly don’t think they are picking up the key issues,” she told Nursing Times. “They either don’t have faith in their own abilities or they don’t have faith in the abilities of their colleagues.

She said the RCN had always had concerns about the FT application process, saying it can focus boards on “finance to the detriment of quality of care.

“Even with the quality measures coming in [to the process] it’s still easy for them to take their eyes off the ball,” she warned.

Jeremy Taylor, chief executive of National Voices, the umbrella group for health voluntary organisations, said: “It’s not obvious that any of the key drivers for Mid Staffs have been tackled in the new system.

“We still have trusts going for foundation status, weak mechanisms for patient and public voice, a pressured system trying to deal with high demand and a CQC trying to find its feet.”

Judith Smith, head of policy at think tank the Nuffield Trust, said: “Given the major organisational change taking place at present there has to be the possibility of trusts falling through the cracks of organisational scrutiny.”

Robert Francis QC’s public inquiry into Mid Staffordshire is expected to report in October.

Dr Smith added: “The Francis inquiry has focused explicitly on the supervision, regulation and commissioning of NHS organisations and will surely have very challenging things to say about the perils of over-complicated management arrangements, frequent restructuring and the associated loss of organisational memory.”

Responding to the survey findings, a CQC spokesman said the organisation was “confident that it has systems in place to identify such failures”.

A Department of Health spokeswoman said the national quality board – a committee of senior managers and clinicians – would shortly publish a report on collaboration across the NHS “with a view to preventing, identifying and responding to incidents quickly”.