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NHS care overhaul measures don't go far enough, say patient groups NHS care overhaul measures don't go far enough, say patient groups
(6 months later)
Failing hospitals will be named and shamed and NHS managers responsible for failures will be barred from working in the health service under government plans to ensure a Mid Staffs-style care scandal never happens again – but the health secretary's proposals were nevertheless criticised by patient groups for not going far enough.Failing hospitals will be named and shamed and NHS managers responsible for failures will be barred from working in the health service under government plans to ensure a Mid Staffs-style care scandal never happens again – but the health secretary's proposals were nevertheless criticised by patient groups for not going far enough.
Jeremy Hunt said on Tuesday he was laying the foundations for a culture "of zero harm and compassionate care" – but doubts surfaced over his failure to endorse post-Mid Staffs recommendations over minimum staffing levels in hospitals and whether NHS organisations would respond to a "duty of candour" to tell the truth when things go wrong.Jeremy Hunt said on Tuesday he was laying the foundations for a culture "of zero harm and compassionate care" – but doubts surfaced over his failure to endorse post-Mid Staffs recommendations over minimum staffing levels in hospitals and whether NHS organisations would respond to a "duty of candour" to tell the truth when things go wrong.
The cabinet minister was responding to Robert Francis QC's report last month on the failings at Stafford hospital, part of the Mid Staffordshire NHS foundation trust, in 2005-2009, which contributed to the deaths of between 400 and 1,200 patients, mostly elderly.The cabinet minister was responding to Robert Francis QC's report last month on the failings at Stafford hospital, part of the Mid Staffordshire NHS foundation trust, in 2005-2009, which contributed to the deaths of between 400 and 1,200 patients, mostly elderly.
The health secretary told MPs there had been "unacceptable and, in some cases, inhumane treatment" at Stafford, where there had been "a betrayal of the worst kind" of patients, their families and "the vast majority of NHS staff who do everything in their power to give their patients the high quality, compassionate care they deserve."The health secretary told MPs there had been "unacceptable and, in some cases, inhumane treatment" at Stafford, where there had been "a betrayal of the worst kind" of patients, their families and "the vast majority of NHS staff who do everything in their power to give their patients the high quality, compassionate care they deserve."
Dr Peter Carter, chief executive of the Royal College of Nursing said that Hunt was wrong not to insist on specific levels of minimum staffing as recommended by Francis. He said greater numbers of staff result in better healthcare: "Simply leaving the setting of staffing levels to local discretion clearly isn't working and the time has come for mandatory, legally enforceable safe staffing levels."Dr Peter Carter, chief executive of the Royal College of Nursing said that Hunt was wrong not to insist on specific levels of minimum staffing as recommended by Francis. He said greater numbers of staff result in better healthcare: "Simply leaving the setting of staffing levels to local discretion clearly isn't working and the time has come for mandatory, legally enforceable safe staffing levels."
Action against Medical Accidents (Avma), which has campaigned for years for a duty of candour, was concerned ministers had apparently not been convinced by the recommendation from Francis that individual NHS employees should be made liable for mistakes – and urged the Department of Health not to discount it.Action against Medical Accidents (Avma), which has campaigned for years for a duty of candour, was concerned ministers had apparently not been convinced by the recommendation from Francis that individual NHS employees should be made liable for mistakes – and urged the Department of Health not to discount it.
But the department's 82-page response to Francis's 290 recommendations warned that there was a risk of "unintentionally create[ing] a culture of fear. This in turn could prevent lessons being learned and could make services less safe".But the department's 82-page response to Francis's 290 recommendations warned that there was a risk of "unintentionally create[ing] a culture of fear. This in turn could prevent lessons being learned and could make services less safe".
Peter Walsh, the chief executive of Avma, said Hunt's statement was "vague" – but welcomed the statutory duty on NHS organisations to tell the truth when patients have been harmed or killed as tougher measures would "help change the culture of cover-up and denial that has been eating away at the NHS like a cancer" and be "the biggest advance in patient safety and patients' rights in the history of the NHS.Peter Walsh, the chief executive of Avma, said Hunt's statement was "vague" – but welcomed the statutory duty on NHS organisations to tell the truth when patients have been harmed or killed as tougher measures would "help change the culture of cover-up and denial that has been eating away at the NHS like a cancer" and be "the biggest advance in patient safety and patients' rights in the history of the NHS.
A final decision on the proposal of personal accountability will not be made until later, subject to the findings of a review of patient safety in the NHS being conducted by Professor Don Berwick, a global expert in safe care who has advised President Barack Obama, who will report by July. Many medical organisations, including the British Medical Association, have expressed concern that such a move would deter staff from owning up to errors and open the NHS to a flood of new litigation.A final decision on the proposal of personal accountability will not be made until later, subject to the findings of a review of patient safety in the NHS being conducted by Professor Don Berwick, a global expert in safe care who has advised President Barack Obama, who will report by July. Many medical organisations, including the British Medical Association, have expressed concern that such a move would deter staff from owning up to errors and open the NHS to a flood of new litigation.
Many of Hunt's proposals had been carefully trailed in the past few days. Failing hospitals would be monitored with a system of performance ratings based on Ofsted's existing assessments of schools in England. Meanwhile, managers responsible for failures will be barred from working elsewhere in the health service, while clauses gagging ex-NHS staff from raising concerns publicly will be banned.Many of Hunt's proposals had been carefully trailed in the past few days. Failing hospitals would be monitored with a system of performance ratings based on Ofsted's existing assessments of schools in England. Meanwhile, managers responsible for failures will be barred from working elsewhere in the health service, while clauses gagging ex-NHS staff from raising concerns publicly will be banned.
Lisa Jordan, a medical lawyer at Irwin Mitchell, which has investigated over 50 cases of alleged negligence at Mid Staffs since 2005, said many patients would wonder why a zero-harm culture wasn't already in place. "Until ministers give their full response and put a detailed plan of action together responding to each of the 290 recommendations set out in the Francis reports, patients and their families will be left with questions unanswered as to how this could have happened in the first place and left waiting for the assurances they want that patient safety will never again be compromised to this extent," she said.Lisa Jordan, a medical lawyer at Irwin Mitchell, which has investigated over 50 cases of alleged negligence at Mid Staffs since 2005, said many patients would wonder why a zero-harm culture wasn't already in place. "Until ministers give their full response and put a detailed plan of action together responding to each of the 290 recommendations set out in the Francis reports, patients and their families will be left with questions unanswered as to how this could have happened in the first place and left waiting for the assurances they want that patient safety will never again be compromised to this extent," she said.
Welcoming the statutory duty of candour and penalties for executives who withheld important information, Jordan said questions remained "as to what will happen to less senior members of staff who are found to withhold information or cover up inexcusable mistakes".Welcoming the statutory duty of candour and penalties for executives who withheld important information, Jordan said questions remained "as to what will happen to less senior members of staff who are found to withhold information or cover up inexcusable mistakes".
Emma Jones, from the law firm Leigh Day, who represented over 120 victims of abuse at Stafford hospital in successful claims for compensation, called Hunt's measures "a small step in the right direction to keep the NHS true to its founding principles and the envy of the world." She said the duty of candour "needs to apply to individual hospital employees as well as the hospital itself. The majority of my clients complained about their treatment and care but either received a very bland or misleading response or no response at all."Emma Jones, from the law firm Leigh Day, who represented over 120 victims of abuse at Stafford hospital in successful claims for compensation, called Hunt's measures "a small step in the right direction to keep the NHS true to its founding principles and the envy of the world." She said the duty of candour "needs to apply to individual hospital employees as well as the hospital itself. The majority of my clients complained about their treatment and care but either received a very bland or misleading response or no response at all."
But the NHS Employers organisation however was lukewarm about the new obligation. Dean Royles, its chief executive, said that while such a requirement "makes sense … we need to beware the law of unintended consequences. You don't improve culture by creating a climate of fear."But the NHS Employers organisation however was lukewarm about the new obligation. Dean Royles, its chief executive, said that while such a requirement "makes sense … we need to beware the law of unintended consequences. You don't improve culture by creating a climate of fear."
Francis said that although ministers had not accepted all his 290 recommendations, "the government's statement indicates its determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives."Francis said that although ministers had not accepted all his 290 recommendations, "the government's statement indicates its determination to make positive changes to the culture of the NHS, in part by adopting some of my recommendations and in part through other initiatives."
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