Update: Failing hospitals should be closed, Francis inquiry concludes
11:56 06 February 2013
There should be a “zero tolerance” approach to poor standards of care in the NHS, the head of the inquiry into “appalling” failings at Mid Staffordshire NHS Foundation Trust said today.
Robert Francis QC said hospitals which failed to comply with a “fundamental standard” should be forced to close.
And healthcare providers should be liable for prosecution if they fail to comply with standards.
Inquiry chairman Robert Francis QC made a total of 290 sweeping recommendations for healthcare regulators, providers and the Government in his 1,782-page report.
The £11 million review of Mid Staffordshire NHS Foundation Trust looked into what went wrong at Stafford Hospital between January 2005 and March 2009 when between 400 and 1,200 more people died than would have been expected.
Mr Francis said the NHS has a series of checks and balances which should have prevented “serious systematic failure of this sort”. The system failed in its primary duty of protecting patients, he added.
There were “numerous” warning signs which should have alerted authorities to problems at the trust.
There was a failure to communicate between the plethora of regulatory agencies and “too great a degree of tolerance of poor standards”, he said.
Fundamental standards should be policed by a single regulator - the Care Quality Commission (CQC), he said.
He added that the regulator Monitor should be stripped of its powers to award trusts foundation trust status - a supposed marker of excellence in the NHS. The regulator awarded the trust the status in 2008 - at the height of its troubles.
Mr Francis said “appalling” conditions suffered by patients at the trust, which runs the hospital, were primarily caused by “serious failure” on the part of the trust board.
The trust failed to tackle an “insidious negative culture” including a tolerance of poor care standards. They also failed to appreciate the enormity of the situation, he said.
The trust’s culture was one of “self-promotion rather than critical analysis and openness”, the report states.
Managers had “no culture” for listening to patients.
And as a result of poor leadership and staffing policies a “completely inadequate” standard of nursing was offered on some wards at Stafford Hospital.
In the scathing report he attacked local health authorities and the trust board but he refused to blame any individual for failures at the trust.
He said there should be an increased culture of compassion and caring in nursing and recommended that there should also be a legal obligation for healthcare providers and medics to observe a “duty of candour”.
Mr Francis said: “We need to ensure fundamental standards are enforceable by law – and the criminal law in the most serious of cases. Senior managers should be made accountable, patients need to be protected from poor nursing standards and all staff should be empowered to be open and transparent when it comes to the well- being of the people in the care.”
“The NHS can provide great care and the system and the people in it should make sure that happens everywhere. The recommendations I am making today represent not the end but the beginning of a journey towards a healthier culture in the NHS where patients are the first and foremost consideration of the system and all those who work in it. It is the individual duty of every organisation and individual within the service to read this report and begin working on its recommendations today.”
See Thursday’s EDP for local reaction to the inquiry.