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20.11.13

Mid Staffs failings ‘must not be allowed to happen again’

The government’s response to the Francis review has been widely welcomed by the NHS, with organisations acknowledging the importance of more accessible safety information, greater accountability, and the introduction of a new duty of candour.

Some welcomed the more flexible approach to minimum staffing levels, while the royal colleges have pointed out that inadequate numbers of trained staff can be a key factor in the very failures the NHS is working to avoid.

Non-mandatory regulation of healthcare assistants (HCAs) is also a sticking point, with some agreeing that the Care Certificate is a good first step, but raising concerns over the consequences this could have on quality of care.

NHS Confederation policy director Dr Johnny Marshall welcomed the response, saying it sent a “clear message” to NHS leaders to continue patient safety improvements and moves to a more transparent and open culture.

The announcement on staffing levels will give reassurance to patients and carers, he said, and argued that “crude national ratios” would risk “hitting the target, but missing the point”. Local flexibility is essential to get the right mix of staff to meet patient needs.

Measures on accountability, and the introduction of a duty of candour was “absolutely supported”, and added that it was important that it set at an appropriate threshold.

Dr Marshall said: “We have always argued that this duty should apply to organisations rather than individuals because threatening individuals with legal action is not the right way to encourage them to speak out about failings. We are therefore pleased to see the distinction between the professional duty on individuals and the statutory duty on provider organisations.”

On leadership, he accepted that poor managers should “face the consequences” if they are not up to the job, but added that the NHS must also work to highlight good leaders. “We must avoid any increase in the 'blame game' which Robert Francis warned against,” he cautioned.

But Peter Bradley, editor of the British Journal of Healthcare Assistants (BJHCA), described the failure to regulate HCAs as ‘a missed opportunity’.

He said: “Regulation need not be bureaucratic or expensive, but the arguments in favour of regulating doctors and nurses apply to support staff too, the staff who, under supervision, provide frontline, intimate care to vulnerable people. We urge the Government to look again at this question, and soon.”

Dean Royles, chief executive of NHS Employers, said the different parts of the NHS must work together to deliver the improvements set out in the government’s response.

The report provides “a platform” he said, for the NHS to move forward, and reiterated that the duty of candour on organisations and not individuals will “help to promote and encourage the creation of a world beating transparent, open culture”.

Royles also agreed that national minimum staffing levels “cannot capture the complex way care is provided on wards and in homes, in clinics and in the community” and welcomed the flexible, local approach set out.

He said: “It is right we drive out wilful neglect, but we also need to emphasise that great care comes from staff working in a supportive environment where they feel valued and engaged. This rather than fear is what we need to drive improvements.”

Dr Alistair Douglas, president of the Society for Acute Medicine (SAM) welcomed the focus on a culture of patient safety, and added that the formal Care Certificate for HCAs was “of great interest”.

Professor Terence Stephenson, chairman of the Academy of Medical Royal Colleges (AoMRC) said he appreciated the detailed level of deliberation in the report. The academy is undertaking work to meet recommendation 236, to have an accountable clinician named over every hospital bed, and expects to produce guidance by next spring.

Prof Stephenson welcomed the emphasis on transparency and the publication of more information, and agreed that the duty of candour for individual clinicians is “a matter of professional regulatory responsibility rather than statutory duty”.

He said: “Doctors and medical Royal Colleges recognise the failings at Mid-Staffordshire must not be allowed to happen again. The Government’s response provides the framework for medical Royal Colleges individually and the Academy of Medical Royal Colleges collectively to continue the work already under way to help ensure this is the case.”

NMC chief executive and registrar Jackie Smith said: “We particularly welcome the commitment to legislate at the earliest opportunity to provide all healthcare regulators with a modern and efficient legal framework.”

The emphasis on professional candour was also welcomed, and Smith said they will be working with other regulators to prepare guidance on this.

NHS Clinical Commissioners interim president Michael Dixon said: “The old system which allowed an outrage such as Mid-Staffs to happen must be consigned history. Blind obedience to the centre cannot deliver patient safety; indeed it will deliver a culture that ensures bullying, lying and gaming of targets.”

Giving power to local clinicians and communities is “the only way” to ensure patient safety and quality, he added.

But the NHSCC was concerned that “a new edifice is being constructed that risk making similar mistakes to ones made before”. Dixon warned that regulation “regulators cannot guarantee quality” and emphasised that change depended on local leaders and staff, to ensure appropriate care is provided “the first time around”.

On complaints data, Steve Kell, NHSCC leadership co-chair and chair of Bassetlaw CCG said information must be aligned with that data being collected by CCGs. “More problems are likely to emerge” as a result of greater transparency and investigation, he added.

Niall Dickson, chief executive of the General Medical Council (GMC), called for the NHS to “step up” to the challenge of the Francis report and welcomed the move towards greater consistency between regulators.

He said: “We must strengthen the link between our guidance and doctors’ practice on the frontline, the words on the page and actions on the ward.”

Cathy Warwick, chief executive of the Royal College of Midwives (RCM), said it was a “robust and comprehensive” response and said a maternity service with the right number of staff, with the right skills, would lead to “an even safer and better NHS”.

Sir Richard Thompson, president of the Royal College of Physicians (RCP), said: “It is encouraging that the response emphasises the setting and monitoring of quality standards in healthcare.”

Dr Peter Carter, chief executive & general secretary of the RCN, welcomed the recognition of how important safe staffing levels are on hospital wards and said: “This measure could have the single biggest impact on improving care in the NHS today.”

Greater transparency on staff numbers will help to ensure patients across the country can access good care, he said, and called the Care Certificate for HCAs “an important first step”. Mandatory regulation would be the most effective way of protecting patients, Dr Carter added.

The RCN questioned whether a new law to hold clinicians who willfully neglect patients to account was actually requires, stating “remedies already exist to tackle staff who are guilty of harming patients”.

It was important to look at the whole system around care failures, rather than solely the actions of an individual clinician, Dr Carter said, and highlighted the consequences of inadequate staffing levels “which all too often result in poor care”.

Tell us what you think – have your say below, or email us directly at opinion@nationalhealthexecutive.com

Image c. David Jones/PA Archive/Press Association Images

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