Mid Staffordshire scandal highlights regulators' failings: The Francis report on what went wrong at the trust has been put back – let's hope the QC is not under pressure to water down his inquiry
The Francis report on the Mid Staffordshire scandal was due to be published on 15 October. I was hoping that that would be a terrible day of judgment, on a par with the independent report on the Hillsborough disaster, or Leveson's forthcoming findings of his inquiry into the behaviour of the press.
I hoped that guilt would be apportioned, not just on the managers of the hospital, but on the hospital consultants, who failed to blow the whistle, and the BMA and the royal colleges, who averted their eyes and did not punish members for not blowing the whistle. And where were Pals and the local Link, who are supposed to safeguard the patients' interests?
Then there were the regulators, the Care Quality Commission, whose remit is exactly to stop scandals like Mid Staffordshire happening, and Monitor, the financial regulator, through whose hoops the board was trying to jump, to achieve foundation trust status. Nor did the Department of Health realise what was going wrong. Finally, local press and MPs only picked up on the scandal when many had already died.
It was a total regulatory failure. All are to blame. Nobody has anywhere to hide.
The only difference between Hillsborough and Mid Staffs is that Hillsborough happened 23 years ago, whereas Mid Staffs was only four years. I also wonder whether other mini-Mid Staffs scandals are happening somewhere in the country as I write this. Mid Staffs may be just the tip of an iceberg.
However, last month, we heard that Robert Francis had deferred the publication of his report until early January. The reason he gave was that he needed "to complete a number of formal processes, to ensure any conclusions and recommendations I produce are fair and constructive. Pulling this together into the final report is a complex and sensitive process."
It is all too easy to imagine a scenario in which a damning report, which would destroy all confidence in the NHS, was shown to horrified Department of Health officials and massive pressure placed on Francis.
Just a week before Francis made his decision to delay the report, I listened to a panel of regulatory gurus, at a Westminster health forum seminar, who seemed to have been struck by a sense of doom. If Francis was about to condemn the regulators, it could damage them and the government, as the cornerstones of the new Health and Social Care Act.
And yet, these bodies, including also the General Medical Council, the National Institute for Health and Clinical Excellence (Nice), Monitor and the CQC, are taking on new responsibilities – probably, in these days of financial cutbacks – without commensurate increases in funding. For example, CQC is spreading its wings to oversee GPs and dentists, the embryology authority and the human tissues authority; Monitor is to cover all providers, private as well as public. Nice is moving from just defining medical standards, into standards for social care and public health. Will they have the skills and resources? Can we expect patchy regulation in the next few years, while the existing regulators learn the new ropes?
Anna Dixon of the King's Fund put regulators firmly in their place. She views regulation as the patients' last line of defence. The frontline are carers, clinicians and whistleblowers. They must sound the alarm. And trust boards and clinicians must learn to listen to them and to the voice of the patients. Niall Dickson of the GMC described Mid Staffs as a catastrophe of clinical governance, and that the only real regulators at Mid Staffs were the patients themselves.
One speaker at the forum hit the nail on the head: the trouble with Mid Staffs was the culture of fear. It deterred everybody, nurses, doctors, junior managers from speaking out. How many other NHS institutions still have the culture of fear? One thing is for certain: regulators are not the people to change an organisation's culture.
We have to hope that the report will be as robust as it should be, otherwise, what hope have we of an NHS which serves patients? Guardian Professional.
The Francis report on the Mid Staffordshire scandal was due to be published on 15 October. I was hoping that that would be a terrible day of judgment, on a par with the independent report on the Hillsborough disaster, or Leveson's forthcoming findings of his inquiry into the behaviour of the press.
I hoped that guilt would be apportioned, not just on the managers of the hospital, but on the hospital consultants, who failed to blow the whistle, and the BMA and the royal colleges, who averted their eyes and did not punish members for not blowing the whistle. And where were Pals and the local Link, who are supposed to safeguard the patients' interests?
Then there were the regulators, the Care Quality Commission, whose remit is exactly to stop scandals like Mid Staffordshire happening, and Monitor, the financial regulator, through whose hoops the board was trying to jump, to achieve foundation trust status. Nor did the Department of Health realise what was going wrong. Finally, local press and MPs only picked up on the scandal when many had already died.
It was a total regulatory failure. All are to blame. Nobody has anywhere to hide.
The only difference between Hillsborough and Mid Staffs is that Hillsborough happened 23 years ago, whereas Mid Staffs was only four years. I also wonder whether other mini-Mid Staffs scandals are happening somewhere in the country as I write this. Mid Staffs may be just the tip of an iceberg.
However, last month, we heard that Robert Francis had deferred the publication of his report until early January. The reason he gave was that he needed "to complete a number of formal processes, to ensure any conclusions and recommendations I produce are fair and constructive. Pulling this together into the final report is a complex and sensitive process."
It is all too easy to imagine a scenario in which a damning report, which would destroy all confidence in the NHS, was shown to horrified Department of Health officials and massive pressure placed on Francis.
Just a week before Francis made his decision to delay the report, I listened to a panel of regulatory gurus, at a Westminster health forum seminar, who seemed to have been struck by a sense of doom. If Francis was about to condemn the regulators, it could damage them and the government, as the cornerstones of the new Health and Social Care Act.
And yet, these bodies, including also the General Medical Council, the National Institute for Health and Clinical Excellence (Nice), Monitor and the CQC, are taking on new responsibilities – probably, in these days of financial cutbacks – without commensurate increases in funding. For example, CQC is spreading its wings to oversee GPs and dentists, the embryology authority and the human tissues authority; Monitor is to cover all providers, private as well as public. Nice is moving from just defining medical standards, into standards for social care and public health. Will they have the skills and resources? Can we expect patchy regulation in the next few years, while the existing regulators learn the new ropes?
Anna Dixon of the King's Fund put regulators firmly in their place. She views regulation as the patients' last line of defence. The frontline are carers, clinicians and whistleblowers. They must sound the alarm. And trust boards and clinicians must learn to listen to them and to the voice of the patients. Niall Dickson of the GMC described Mid Staffs as a catastrophe of clinical governance, and that the only real regulators at Mid Staffs were the patients themselves.
One speaker at the forum hit the nail on the head: the trouble with Mid Staffs was the culture of fear. It deterred everybody, nurses, doctors, junior managers from speaking out. How many other NHS institutions still have the culture of fear? One thing is for certain: regulators are not the people to change an organisation's culture.
We have to hope that the report will be as robust as it should be, otherwise, what hope have we of an NHS which serves patients? Guardian Professional.
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