Jeremy Hunt MP has recently made a statement to Parliament setting out the Government’s response to the recommendations made by the Robert Francis’ Report, compiled following the failings in care at Stafford Hospital.
Mr Hunt did not respond to each of the 290 recommendations set out in the Report, he instead announced the ‘key elements’ of the Government’s response. He suggested that these key elements fell within five areas: Preventing problems by putting the needs of the patient first, Detecting problems early, Taking action promptly, Ensuring robust accountability and Leadership.
Putting the needs of the patient first
Mr Hunt stated that a new regulatory model will be set up, under the guidance of an independent Chief Inspector of Hospitals, and this regulator will be responsible for carrying out assessments on hospitals’ overall performance, patient dignity and respect, the safety of services, responsiveness, clinical standards and governance.
It is envisaged that these assessments will based on the Ofsted scheme used in schools (i.e. hospitals will be given an outstanding, good, requiring improvement or poor rating) and, because patient experience will be at the heart of these assessments, high standards of patient care will be of upmost importance.
It is also suggested that these assessments will not just be carried out on the NHS Trust as a whole, but on the hospital’s performance in each speciality or department.
This will ensure that patients have access to information regarding a hospital’s performance as a whole and for the specific department that deals with their treatment.
Detecting problems quickly
A new statutory duty of candour is going to be placed upon NHS boards to be honest and open about mistakes.
This new duty is something that the charity AvMA (Actions against Medical Accidents) has been relentlessly campaigning for. Peter Walsh at AvMA recently stated that, ‘For over 60 years the NHS has done no more than pay lip service to the fundamental principle that if something goes wrong and a patient is harmed the health service should be open and honest about it. It's a cancer, if you like, that has been eating away at the NHS, it creates a culture of cover up and denial, which permits and tolerates bullying and intimidation of whistleblowers, as well as dishonesty with patients’.
It is yet to be seen how far this duty will go and what the sanctions will be for failing to comply with its provisions. However, any change that promotes honesty and openness with patients is to be welcomed and will hopefully go a long way to improving doctor-patient communication and trust.
Dealing with problems quickly
Mr Hunt has suggested that no hospital will be rated as good or outstanding (in the new assessments scheme) if fundamental standards are breached. He stated that Trusts will be given strict deadlines to rectify any breaches and, if they fail to do this, they will be put into a failure regime which could ultimately lead to special administration and the automatic suspension of the board.
Again, it is yet to be seen how strict these deadlines will be. I would suggest that the Government is not going to want to have hospital boards suspended one after the other for failing to rectify ongoing breaches, as this will cause difficulties and inconsistencies in the day-to-day running of the hospital.
Accountability for wrongdoers
Mr Hunt has suggested that the Government will be looking at new legal sanctions at a corporate level for organisations that wilfully generate misleading information or withhold information they are required to provide.
The Government are also going to consult on a barring scheme to prevent managers found guilty of gross misconduct finding a job in another part of the system.
In addition, the Government has asked other professional regulators (GMC and Nursing and Midwifery Council) to tighten their procedures for breaches of professional standards.
It appears that this area is very theoretical at present and that no actual sanctions have been considered.
Mr Hunt suggested the aim of this key area was to ensure that NHS staff are properly led and motivated. The main crux of the changes in this area are focused on changes in training for nurses.
Mr Hunt stated that he wanted nurses to spend up to a year working as a healthcare assistant, prior to undertaking their degree, so that they get experience providing basic care. He stated that, ‘Frontline, hands-on caring experience and values need to be equal with academic training’ and that ‘These measures are about recruiting all staff with the right values and giving them the training they need to do their job properly, so that patients are treated with compassion’.
A Code of Conduct and minimum training standards will also be introduced for healthcare assistants.
I would suggest that the Government appears to be making all of the right noises about putting a package of measures together to safeguard patients’ safety and improve the quality of care provided by the NHS. We will have to wait to see whether these measures will be effective.
In the meantime, one issue the Government has not addressed is staffing levels within hospitals. It appears to me that a lot of the issues at Stafford Hospital were due to nurses or hospital staff being too busy to provide adequate care.
With further cuts in NHS budgets likely in the future, how long will it be before corporate considerations once again take precedence over patients’ care and safety?
By clinical negligence solicitor Carla Twist