The latest report on Stafford Hospital is the most revealing yet. Why? Because it lifts the lid on the management culture at the trust.
You could be forgiven for switching off at the mention of another report into Mid Staffordshire NHS Foundation Trust - there’s been a few over the past year. But there are still some important lessons the Department of Health has yet to learn.
The independent inquiry paints a truly disturbing picture. In A&E, the emergency assessment unit and a number of the wards there were some serious and repeated failures in care. Vulnerable patients were neglected. Mistakes happened but because of weak governance issues weren’t addressed and the organisation didn’t learn.
The report suggests that the hospital’s management focused on costs and targets at the expense of quality. Demoralised, understaffed teams just kept their heads down and got on with it.
Why didn’t more of them speak up? This is the question the GMC would like answered. This week, Niall Dickson, chief executive of the GMC, said: “The report does raise questions about how doctors and other professionals respond when they see poor quality care. Our guidance, Good Medical Practice, which is the foundation of good care and medical professionalism makes it absolutely clear that all doctors must make the care of their patient their first concern.
“If any doctor has reason to think that patient safety is, or may be, seriously compromised then they must take steps to put the matter right. If doctors have concerns that a member of the team may not be fit to practise they must take appropriate steps without delay. This includes raising concerns locally and, if there are still concerns about the safety of patients they should inform the relevant regulatory body.”
Do doctors really need reminding of this? Probably not. I’d take a guess that doctors in the units involved at Mid Staffs were well aware of their responsibilities but knew that if they put their heads above the parapet there might be a huge personal cost.
As the inquiry has found, the doctors were dealing with a fearsome management culture described as secretive and bullying. Don’t get me wrong, if doctors were complicit in poor care they deserve to be investigated by the GMC as some are now being.
But, who would willingly become a whistleblower in the NHS? We’ve supposedly had protective legislation since 1998 and yet doctors continue to be drummed out of trusts for raising concerns.
Look at Kim Holt and Ramon Niekrash for recent examples. There are plenty of others.
Maybe that’s where the GMC’s attention should be. We should also be concentrating on the senior managers - they set the priorities and the level of resource to deliver them. Why is there no regulator that can bring managers to book individually? For me they’re more responsible than an under trained and over worked nurse.
I also believe that patient groups have a strong case in calling for a full public inquiry. There are some bigger issues here. None of the reports have so far resolved the wider systemic failings that allow an underperforming hospital to be highly rated and awarded foundation status. None of the reviews have included a wider discussion on targets and their ability to distort clinical priorities.
Andy Burnham has said “this was ultimately a local failure”. He needs it to be seen as an isolated case because there’s an election around the corner. While it’s doubtful so many problems will present again within one trust, many other hospitals are going to under intense pressure in the next few years and it doesn’t strike me that we’ve adequately dealt with the root causes of this dysfunction.
Tags: Mid Staffordshire, Whistleblowing
I’m sorry but we do have to stand up to senior management if we see serious failings whatever the risk. And, to be fair, most managers will listen and help sort the problems out.
You’d like to think so wouldn’t you Mark? I suspect Kim Holt would tell you that it ‘aint necessarily so (certainly not at GOSH)
There are all sorts of compromises being made to cut costs that are not in the patient’s best interest but are dressed up as such by managers. Emergency surgery has been stopped in my hospital and unstable bleeding patients in need of surgery are sent in an ambulance from the A and E to the sister hospital. Recently a ruptured ectopic almost died in the ambulance in transit. I wonder how many patients will actually have to die before the managers will bite the bullet and close A and E or reopen emergency surgery at night here because they just aren’t listening at the moment. What else can i do to prevent a predictable death when Darzi and the Royal College of Surgeons sanction this sort of arrangement?
In 2002 when my own Trust had a spot of bother with CHI (Commission for Health Improvement - one of the many precursors of CQC) we were slated for “split site working. That is the A&E was in the city center with orthopaedics, while the main specialities were 4 miles away on the city edge.
It is interesting that this is exactly the model currently being proposed for London and other places such as described above.
I accept that it takes courage to whistleblow - but, if ‘going through the usual channels’, does not produce results, it is our duty (to our patients) to do so. Of course, single blowers can easily be picked off. There is an old saying “United we stand, divided we fall” - so bring back the Medical Staff Committee! Modern management knows that they can get away with it by using the tactic of “Divide and rule”. Time to regroup?