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Stafford Hospital: NHS must 'fundamentally change' Stafford Hospital: Hiding mistakes 'should be criminal offence'
(35 minutes later)
By Nick Triggle Health correspondent, BBC NewsBy Nick Triggle Health correspondent, BBC News
There needs to be a "fundamental change" in the culture of the NHS to ensure patients are cared for properly, a public inquiry says. NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.
The conclusion by the Francis inquiry comes after a £13m investigation into the Stafford Hospital scandal. Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.
Previous investigations have already established in harrowing detail the abuse and neglect that contributed to the deaths of hundreds of patients. The inquiry chairman, Robert Francis QC, said "fundamental change" was needed to prevent the public losing confidence in the NHS.
This inquiry said the failings went from the top to the bottom of the NHS. The prime minister David Cameron apologised to the families of patients.
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. He said he was "truly sorry" for what happened at Stafford Hospital, which was "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency.
Mr Cameron announced that a new post of chief inspector of hospitals would be created in the autumn.
The report made 290 recommendations aimed at ensuring patients are put first.
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
The inquiry concluded the failings at the hospital went form the top to the bottom of the NHS.
Previous investigations have already established in harrowing detail the abuse and neglect from 2005 to 2008. This inquiry looked at why the system did not prevent the problems or at the very lest detect them earlier.
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.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.
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 local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough.
Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.
'Remote''Remote'
The Department of Health was also criticised for being too "remote" and embarking on "counterproductive" reorganisations.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.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.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.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.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."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."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.""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.In a letter to Health Secretary Jeremy Hunt accompanying his report, Mr Francis said there needed to be a "fundamental change" in culture.
Target drivenTarget 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.
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.
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. Katherine Murphy, the chief executive of The Patients Association, said the report was a "watershed moment" for the health service.
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. She said: "It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.
"It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability."
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.