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Inquiry reports on Stafford Hospital deaths scandal Stafford Hospital: NHS must 'fundamentally change'
(about 3 hours later)
By Nick Triggle Health correspondent, BBC NewsBy Nick Triggle Health correspondent, BBC News
The public inquiry into the failings at Stafford Hospital - one of the biggest scandals in the history of the NHS - will publish its conclusions later. There needs to be a "fundamental change" in the culture of the NHS to ensure patients are cared for properly, a public inquiry says.
Previous investigations have already established in harrowing detail the abuse and neglect that contributed to hundreds of deaths from 2005 to 2008. The conclusion by the Francis inquiry comes after a £13m investigation into the Stafford Hospital scandal.
This inquiry has looked at why regulators and senior NHS managers failed to pick up what was happening. Previous investigations have already established in harrowing detail the abuse and neglect that contributed to the deaths of hundreds of patients.
Between November 2010 and December 2011 more than 160 witnesses gave evidence. This inquiry said the failings went from the top to the bottom of the NHS.
The inquiry, chaired by Robert Francis QC, is the fifth major investigation into the scandal. The 1,781-page report catalogued missed opportunities at every turn between 2005 and 2008 - and said the findings still had relevance today four years after they first came to light in a 2009 report by the Healthcare Commission.
A full public inquiry had been promised in opposition by the Tories and soon after becoming Prime Minister, David Cameron announced its launch. While it is well-known the trust management ignored patients' complaints, local GPs and MPs also failed to speak up for them, the inquiry said.
Chief inspector The local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough.
The report will be laid before Parliament on Wednesday morning, and Mr Cameron will deliver a statement to the House of Commons following Prime Minister's Questions. Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.
One of the measures the government is expected to announce is the creation of a chief inspector of hospitals post. 'Remote'
The Department of Health was also criticised for being too "remote" and embarking on "counterproductive" reorganisations.
The report said the failings created a culture where the patient was not put first.
But the inquiry - chaired by Robert Francis QC - said the change needed did not require further reform.
Instead, it urged everyone from "porters and cleaners to the secretary of state" to work together to shift the culture.
In particular, it recommended:
  • The merger of the regulation of care into one body - two are currently involved
  • Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
  • Hiding information about poor care to become a criminal offence
  • A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
  • An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors
Mr Francis said: "This is a story of appalling and unnecessary suffering of hundreds of people.
"They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.
"I have today made 290 recommendations designed to change this culture and make sure that patients come first.
"We need a patient-centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership, caring compassionate nursing, and useful and accurate information about services."
In a letter to Health Secretary Jeremy Hunt accompanying his report, Mr Francis said there needed to be a "fundamental change" in culture.
Target driven
The "appalling" levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.The "appalling" levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.
They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.
Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.
Cases have also been documented of patients left crying out for help because they did not get pain relief and food and drinks being left out of reach.Cases have also been documented of patients left crying out for help because they did not get pain relief and food and drinks being left out of reach.
Some staff have said they tried to raise the alarm but were silenced by senior managers.Some staff have said they tried to raise the alarm but were silenced by senior managers.
Helene Donnelly, who worked as an A&E nurse at the hospital, said: "It went right to the top. People didn't want to know and that is why things got so extreme."Helene Donnelly, who worked as an A&E nurse at the hospital, said: "It went right to the top. People didn't want to know and that is why things got so extreme."
Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment.Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment.
NHS Confederation chief executive Mike Farrar said: "The culture of that organisation was not geared up to put patients' needs right at the heart of it; there was almost an institutionalised blindness to what mattered."
He added: "The risk, I think, today, is that we look to external things like better regulation or more inspection, to try to solve what effectively is a problem that can really be only solved by having a culture in every hospital where every member of staff is geared up to try and provide the best possible care for patients."
While the Francis inquiry has solely focused on what happened at Stafford Hospital, there is mounting concern in the wider NHS about basic standards of care.While the Francis inquiry has solely focused on what happened at Stafford Hospital, there is mounting concern in the wider NHS about basic standards of care.
Recent reports by the Patients Association and Care Quality Commission have both raised the issue.Recent reports by the Patients Association and Care Quality Commission have both raised the issue.
Ministers have already started responding. At the start of the year prime minister David Cameron said he wanted to make improving care one of his top priorities for 2013. He is due to make a statement on the latest report later.
At the start of the year href="http://www.bbc.co.uk/news/health-20898401" >Mr Cameron said he wanted to make improving care one of his top priorities for 2013. Mr Cameron pointed to the money being made available for training, particularly around dementia, the extra ward rounds being introduced in hospitals and the roll-out of the new "family and friends" test patient survey as evidence of this.
He pointed to the money being made available for training, particularly around dementia, the extra ward rounds being introduced in hospitals and the roll-out of the new "family and friends" test patient survey as evidence of this.
'Eyes and ears'
Chris Hopson, chief executive of the Foundation Trust Network, said: "Hopefully the report will help the NHS get to the nub of why poor care continues in spite of persistent attempts by trusts to resolve this complex problem."
Jeremy Taylor, chief executive of National Voices, an umbrella organisation of patient groups, said the solution lay in strengthening the patient voice.
"No matter how good, regulators and inspectors cannot be everywhere at once," he said.
"Patients, families and staff are the eyes and ears of the health service. We must ensure that they are in a position to speak out and be listened to."
BBC West Midlands special investigation, The Hospital That Didn't Care, on BBC One at 10.35pm on Wednesday 6 February.BBC West Midlands special investigation, The Hospital That Didn't Care, on BBC One at 10.35pm on Wednesday 6 February.
Were you affected by the events at Stafford Hospital? You can send us your experiences using the form below.Were you affected by the events at Stafford Hospital? You can send us your experiences using the form below.