Was Stafford General Hospital the Potter’s Bar of NHS reform? Maxine Vaccine considers the lessons of a healthcare disaster for the future.
The testimonies of the Mid Staffordshire public enquiry make bleak reading. From 2005 to 2008, a hospital trust struggling to meet the financial targets demanded for Foundation Trust status and going through an organisational upheaval lost its grip on patient safety, cleanliness and basic care.
Bullying management forced out clinicians who opposed neglect of patients, resulting in an apathetic hospital where filth and suffering were considered the norm, where serious diseases went undiagnosed for months, and where meeting patients’ needs for hygiene and dignity was left to visiting family members.
Over a thousand preventable deaths are thought to have occurred. After years of campaigning by the families of the dead, a public enquiry took place in late 2009. Its final conclusions will be published in October 2012.
David Cameron and Andrew Lansley attended the Mid Staffs enquiry and declared that it proved the failure of Labour’s ‘target culture’. By encouraging bureaucratic control of the NHS, placing emphasis on process management rather than outcomes, and failing to make hospital trusts stand up to private sector competition, the Government had created a healthcare Chernobyl. The solution, they declared, was the ‘liberation’ of the NHS from targets, bureaucracy and protectionism.
The scandal caused the wheels to come off New Labour’s NHS ‘modernisation’ programme. Forcing hospital trusts to meet stringent FT criteria under the pressure of external deadlines, letting financial management override clinical expertise, and running hospitals as businesses all suddenly seemed like not such good ideas. The market reforms devised by Alan Milburn significantly lost momentum under Alan Johnson, the Health Secretary who faced public horror as the Mid Staffs public enquiry unfolded.
Under the Coalition, Milburn has found a new political home. Foundation Trusts are once again the only game in town for NHS acute care. The primary engine of quality in acute care is now differential commissioning: CCGs will send their patients to the better hospitals, so the worse ones will go out of business. The only thing that might cause a good hospital (in clinical terms) to go out of business is if it fails to meet its financial targets – in other words, if it fails as a company.
Has Lansley learned the lessons of Mid Staffs? One could argue that his NHS Outcomes Framework, which replaces process targets with clinically defined patient outcome targets, is a positive legacy of that shameful era. But to have full confidence that the outcomes will be reliably achieved, you also have to believe that the ‘hidden hand’ of the market will keep patients safe from harm.
Or one could argue that, like the Potter’s Bar disaster, Stafford General Hospital proved that the free market and public services don’t mix. There was another public enquiry that showed cost-cutting and ‘productivity’ culture to be responsible for neglect of safety, leading to preventable suffering and death on an industrial scale.
Sir David Nicholson has warned that the Francis Report on the Mid Staffs enquiry is likely to clash with current NHS policy. In particular, it is expected to recommend that the DH take back ill-managed hospitals from FT control and restore them to the NHS – a policy that the Health and Social Care Act has rendered literally meaningless. Robert Francis may also say that Monitor and the CQC should be merged to place quality at the heart of regulation – but Monitor is now purely an economic regulator.
Writing in the Nursing Times, Peter Nolan commented: “The final Mid Staffs report will emphasise that the delivery of healthcare is driven and determined by politics, yet policy makers are prone to discuss healthcare in abstract terms such as efficiency, accessibility, choice and quality without specifying exactly what these mean in practice.”
What they mean in practice will determine whether the new NHS delivers better patient outcomes and patient safety – or merely proves that Foundation Trusts, as vehicles for the delivery of acute care, have no foundation and no trust.
Maxine’s views are not necessarily those of Pharmaceutical Field.