The GMC has urged hospital doctors to speak out if they see poor quality care in the wake of an inquiry into Mid Staffordshire NHS Foundation Trust.
An independent inquiry, chaired by Robert Francis QC, said this week that the trust had become driven by targets and cost-cutting.
Last year, a Healthcare Commission investigation revealed that at least 400 more people had died at the hospital between 2005 and 2008 than would have been expected due to poor care.
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. 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.”
He added: “Doctors with management responsibility must make sure that there are systems in place through which colleagues can raise concerns about risks to patients.”
The GMC is investigating the conduct and performance of a number of doctors at Stafford Hospital following referral by the medical director.
The inquiry report claims poor care caused “unimaginable distress and suffering” for patients.
The culture of the trust was not conducive to providing good care for patients or providing a supportive working environment for staff, the report finds.
A bullying management style was outlined. “A high priority was placed on the achievement of targets, and in particular the A&E waiting time target. The pressure to meet this generated a fear, whether justified or not, that failure to meet targets could lead to the sack,” the report says.
The consultant body largely dissociated itself from management, the report says, and often adopted a fatalistic approach to management issues and plans. There was also a lack of trust in management leading to reluctance in raising concerns.
Staff morale was low and absence and sickness rates high.
The report also points to a lack of openness by the foundation trust board. It cites an incident where an attempt was made to persuade a consultant to alter an adverse report to the coroner, and questioned how candid the trust was prepared to be about things that went wrong.
Governance was weak at the foundation trust, with sub-standard clinical audit, complaints handling and incident reporting.
Appraisal and professional development were a low priority, and deficient performance was not addressed. The report says this was starkly evidenced by two Royal College of Surgeons’ reviews of the hospital’s surgical division and the dysfunction brought to light by them.
The report says: “The few instances of reports by whistleblowers of which the inquiry was made aware suggest that the trust has not offered the support and respect due to those brave enough to take this step. The handling of these cases is unlikely to encourage others to come forward, and the responses to the investigation of the concerns raised have been ineffective.”
BMA council chairman Hamish Meldrum commented: “It is particularly worrying that a culture of fear exists in some hospitals and one which prevents doctors and other health professionals from speaking out when they have concerns. In many cases doctors’ concerns are not heeded and this can inhibit their ability to take further action. We agree with the inquiry’s findings that there needs to be a much greater degree of engagement with clinicians in the management process.”
Some clinical staff were described as uncaring by patients at the inquiry, and the report heavily criticised the standards of nursing and personal care provided.
The report says: “Failure to ensure a proper level of personal cleanliness and hygiene degrades patients, aggravating the feelings of illness, disability and separation from home and familiar surroundings. A wholly unacceptable standard was tolerated on some of the trust’s wards for a significant number of patients.”
Since the original report last year, inspectors have been carrying out regular checks and say that care is now safe.
The government has resisted calls for a full public inquiry, calling it a “local failure”, despite pressure from patient groups and Conservative leader David Cameron.
Read the full report.
Read a timeline on Stafford Hospital.
