'The Inquiry has been examining the commissioning, supervisory and regulatory bodies in the monitoring of Mid Staffordshire hospital between January 2005 and March 2009. It has been considering why the serious problems at the Trust were not identified and acted on sooner, and identifying important lessons to be learnt for the future of patient care. It builds on Mr Francis’s earlier report, published in 2010 after the earlier independent inquiry on the failings in the Mid Staffordshire NHS Foundation Trust between 2005 and 2009. The Inquiry identifies a story of terrible and unnecessary suffering of hundreds of people who were failed by a system which ignored the warning signs of poor care and put corporate self interest and cost control ahead of patients and their safety.' (Link to earlier inquiry added).
Mr Francis made 290 recommendations designed to change this culture and make sure patients come first by creating a common patient centred culture across the NHS. An interesting question is: how did health care professionals and NHS managers ever come to lose a 'patient centred culture?' I am not certain of the answer or answers to that but suspect that various financial and other targets imposed by successive governments have much to do with it. Large entities like the NHS operate within the climate created by governments. There seems to be one certainty. The culture will not change in the way Mr Francis (and the general public) would wish unless there is a change of senior management within the NHS..
Responsibility:
Despite the numerous failings identified by Mr Francis, it seems that nobody in the NHS is carrying any personal responsibility. For example, Sir David Nicholson continues to cling to his post - Daily Mail 16th February 2013. (For information about Sir David see Department of Health and his wikepedia entry).
It is reported that the Police are considering the Francis report - Staffordshire Hospital scandal: Police to review evidence (BBC 15th February 2013). In principle, where deaths have occurred NHS Trusts could be charged with Corporate Manslaughter - (Corporate Manslaughter and Corporate Homicide Act 2007). (For more on this offence see CPS website). NHS Trusts are 'corporate bodies' - NHS and Community Care Act 1990 s.5.
Some of the legal issues which might arise are identified in an article by solicitor Andrew Bennett appearing on Evershed's website - Eversheds, Solicitors 15th June 2010
Whistleblowing:
Another emerging feature in all this relates to so-called 'whistleblowers' who. it appears, have been 'forced' to sign 'gagging clauses' to prevent them revealing their concerns. The following links give some idea of the problem: NHS whistleblowers are being gagged, says consultant paediatrician (Guardian 13th December 2011); The NHS whistleblower and the £500,000 'supergag' (Bureau of Investigative Journalism 29th June 2012); Whistleblowers: gagged by those in power, admired by the public (Guardian 19th October 2012); Leveson and a gag on whistleblowers (Daily Mail 14th February 2013) and Gagging NHS whistleblowers will threaten lives (The Times 15th February 2013).
Current legislation relating to 'whistleblowing' is the Public Interest Disclosure Act 1998 which inserted Part IV A into the Employment Act 1996. Protection is offered to 'workers' (as defined by the Act) in relation to 'protected disclosures.' It appears that some form of review of this legislation is to take place - The Guardian 15th February 2013. Section 43J of the Employment Act 1996 appears to be particularly relevant to 'gagging' clauses:
Contractual duties of confidentiality.
(1) Any provision in an agreement to which this section applies is void in so far as it purports to preclude the worker from making a protected disclosure.
(2) This section applies to any agreement between a worker and his employer (whether a worker’s contract or not), including an agreement to refrain from instituting or continuing any proceedings under this Act or any proceedings for breach of contract.
My knowledge of employment law is not extensive enough to be able to say how this section is being 'dodged' but 'dodging' appears to be commonplace. If money has been paid under a contractual term which turns out to be void then the question arises as to whether the money can be recovered. When they arise, such problems can be productive of complex litigation.
See also Stevebarclay.net - Why public interest disclosure is not working for NHS whistleblowers
UK Human Rights blog - Mid Staffs Inquiry Report: Human rights abuses need human rights solutions - Sanchita Hosali
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I believe there are two factors that have played a major part in the débâcle of Mid Staffs NHS trust and more broadly troubling the working world in general.
ReplyDeleteThese is (1) the general increase of highly paid senior managers who are centered purely on management with very little knowledge or understanding of what is being produced and how, plus reluctance to take any responsibility for issues raised.
And (2) the rise the "professional" who leaves school attends university and starts a job in his/her early 20s with absolutely no understanding of the nuts and bolts of the industry/profession that they have joined. Leading to the general demise of skills and knowledge gained through "on the job" learning.
I experienced item 1 when working for a British multinational company as a professional engineer in the late 80s when my new "commercially aware" line manger introduced us to something called Total Quality Management (TQM). It had absolutely nothing to do with what we did but more to do with record keeping. It came with its own bizarre lexicon, with which my line manager sought to obfusticate aned disguise his inability to understand engineering problems. "if its and engineering problem then its your job to resolve, if its management its my job" was his simplistic approach.
A good example of item 2 is the current practice of training nurses in universities rather than the old "on the job" type training. It seems that some nurses that are university trained are lacking in basic care skills.
The privatisation of Railtrack resulted in an essentially engineering organisation being run by a board with no professional engineers on it. The chairman, Gerald Corbett, was previously a director of Woolworths and today is chairman of Betfair. The result was inevitable with great loss of life and nobody really held to account. Not unlike Mid Staffs