HomeMay 2013There, but for the grace of God!

There, but for the grace of God!

Denis Doherty looks at some of the conclusions of the Stafford Hospital inquiry and asks if this type of scandal could occur in Ireland.

Staffordshire is a landlocked county in the West Midlands Region of England. Stafford is one of the towns in the area known as the potteries. Stafford Hospital is a medium size, 300 bed, general hospital. It is the larger of two hospitals that make up the Mid Staffordshire Foundation Trust.

Denis Doherty
Denis Doherty

Not the sort of hospital that attracts a global reputation.  But, Stafford Hospital is now internationally known, for all the wrong reasons.

In 2007, concerns were raised about the Trust’s mortality rate as compared with other similar trusts. The highly critical report of an investigation into the complaints gave rise to a public outcry led by patients and relatives. That resulted in an independent inquiry; the report of that inquiry contained damning criticism of the Trust and led to a public inquiry conducted by Robert Francis Q.C. who also conducted the independent inquiry.

‘Between 2005 and 2008 conditions of appalling care were able to flourish at the hospital serving Stafford and its surrounding area.’

The inquiry into the hospital found that ‘between 2005 and 2008 conditions of appalling care were able to flourish at the hospital serving Stafford and its surrounding area’. Ironically, during this period the hospital succeeded in obtaining Foundation Trust status. In doing so it had to satisfy what were portrayed as exacting criteria.

The report of the inquiry is as readable as it is shocking. Mr. Francis describes it as ‘a story of unnecessary suffering of hundreds of people.’ I have selected the following quotations from the report as ones that are likely to be of particular interest to managers.

The inquiry was charged with investigating the deficiencies in the system which allowed the events of Mid Staffordshire to pass unnoticed or without effective reaction for so long.’

‘The Trust’s culture was one of self promotion rather than critical analysis and openness.’

‘Trust management had no culture of listening to patients.’

‘The Trust was operating in an environment in which its leadership was expected to focus on financial issues, and there is little doubt that this is what it did. Sadly, it paid insufficient attention to the risks in relation to the quality of service delivery this entailed.”

‘The Board of the time must collectively bear responsibility for allowing the mismatch between the resources allocated and the needs of the services to be delivered to persist without protest or warning of the consequences.’

‘It should be patients – not numbers – that count.’

‘There was unacceptable delay in addressing the issue of shortage of skilled nursing staff.’

‘Any system should be capable of caring and delivering an acceptable level of care to each patient treated, but this report shows this cannot be assumed to be happening.’

‘Poor corporate and clinical governance.’

‘The Trust’s culture was one of self promotion rather than critical analysis and openness.’

The negative aspects of culture in the system were identified as including:

  • A lack of openness and criticism
  • A lack of consideration for patients
  • Defensiveness
  • Looking inwards not outwards
  • Secrecy
  • Misplaced assumptions about the judgements and actions of others
  • An acceptance of poor standards
  • A failure to put the patients first in everything that is done

Commissioners, Regulatory Bodies, Professional Bodies all of whom might be expected by patients and public to do something effective to remedy non-compliance with acceptable standards of care. For years that did not occur and even after the first investigation patients were left at risk.’

‘Accreditation schemes for managers promoted by the staff college should be considered.’

Could a Stafford Hospital type scandal occur here? The report posed that question in relation to other hospitals in England and answered it as follows – ‘Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated or that the risk of recurrence was so low that major preventive measures would be disproportionate. The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.’

Food for thought!

The report of the Mid Staffordshire Public Inquiry was published in February 2013. In April 2013, Monitor – the Independent Regulator of Foundation Trusts in England – appointed Joint Trust Special Administrators to oversee the running of the Mid Staffordshire hospitals.