Part six of Peter Nolan’s series on the Mid Staffordshire Foundation Trust Public Inquiry looks at the lessons that should be learnt for the future
As we await the final report from the Mid Staffordshire Foundation Trust Public Inquiry the question I would like to explore is: What will this inquiry achieve?
It has already had some positive outcomes. During the testimonies, many relatives obtained for the first time a truthful account of the circumstances in which their loved ones died. Members of the public became much better informed about their NHS. There was satisfaction in seeing those responsible for poor services held to account. Members of the media fulfilled their obligation to inform the general public about the structure, function and malfunctioning of the NHS. Multiple legal teams sitting in huddles were able to clarify points of law relating to the NHS.
Sir David Nicholson told the inquiry that the NHS is not just one organisation, as popularly perceived, but rather a set of organisations, with different cultures and principles.
Sir Liam Donaldson declared that the most serious failing of the NHS is not putting the patient at the centre of all its activities but instead placing activities such as meeting financial targets more highly.
“Nurses in the future must not allow their professional standards to be subverted by the commands of general managers”
Sir Bruce Keogh regretted that the NHS had not yet learnt the lesson that sound clinical governance increases quality of care and saves money.
The NHS must learn to become more humble, take criticism and act on it. Every member of staff must be alert to threats to the quality of patient care.
What happened at Mid Staffs hospital between 2004 and 2009 was that it became a strategy-free zone where the board did not know what was expected of it and were cowed into silence. A power struggle consumed medical and managerial attention and the majority of nurses took refuge in apathy to avoid confronting what was happening on the wards. Nurses in the future must not allow their professional standards to be subverted by the commands of general managers.
More than half of those who gave evidence to the inquiry agreed that too many groups are involved in writing standards – the royal colleges, professional bodies, universities, patient groups, regulatory bodies, the Department of Health and the National Institute for Health and Clinical Excellence - and too few are involved in implementing them.
The final Mid Staff report will emphasise that the delivery of healthcare is driven and determined by politics, yet policy makers are prone to discuss healthcare in abstract terms such as efficiency, accessibility, choice and quality without specifying exactly what these mean in practice. The report is also likely to comment on:
- The recruitment, training and regulation of healthcare support workers, nurses and senior managers;
- Strategies for identifying and removing underperforming non-clinical managers;
- The need for professional regulatory bodies to focus far more vigorously on their “fitness to practice” function;
- The interface in trusts between regulation, local authorities and governance; between finance, quality and safety;
- The duty of candour and how to support people to exercise it – protecting whistleblowers.
The report is expected to say that too much change was introduced in a short period of time and inadequate preparation results in unfavourable outcomes. Above all, the report will confirm that the patient’s voice is still not being heard.
It would be a great disappointment to all concerned if the report did nothing more than chronicle past failings in order to appease certain people.
Many members of the public felt that a follow-up review should take place one year after the publication of the final report.
In his closing remarks, the chair of the inquiry Robert Francis QC emphasised that it is in the interests of all trusts to re-examine their practices in the light of the Mid Staffs inquiry and ensure that there are no further failures in any part of the NHS in delivering acceptable levels of care to vulnerable people.
Peter Nolan is professor of mental health nursing (emeritus)