The following piece has been written for Guardian Health Care Network You will find it here http://www.guardian.co.uk/healthcare-network/2011/sep/08/mid-staffordshire-nhs-learn-diana-smith.
Should we treat Mid Staffordshire as a pretty average trust which hit a bad patch without seeing any warning signs?
Stephen Moss, the chairman of Mid Staffordshire foundation trust, worries that the NHS has not learned from what happened at Stafford Hospital. In June, he asked a session of 120 hospital managers if they had read the key reports. Only 20% indicated they had. http://www.expressandstar.com/news/2011/08/31/nhs-turning-blind-eye-to-stafford-hospital-scandal-says-boss/
Why is the interest so low? Here are some possible reasons:
1. The media coverage of Stafford shows us something so extreme that it clearly has nothing to do with any ordinary hospital;
2. Within the NHS there are major doubts about the Healthcare Commission investigation and specifically about the leaked 'excess death figures' that dominated the press coverage. Given these doubts the report may not be top of the required reading list.
3. Robert Francis' independent report is a remarkable piece of work offering deep insights into the workings of the hospital and the sobering perceptions of patients, but it is 800 pages long and it was dismissed by both the protest group and health secretary Andrew Lansley, both of who wanted a public inquiry. Senior NHS staff may therefore have been uncertain of its importance.
I would strongly suggest that NHS managers should take interest because Stafford is to all appearances such an ordinary hospital. The press coverage of the public inquiry - which started again this week - may focus on the three minutes of a day when a witness appears to say something dramatic, but this is selected from six hours of nothing very remarkable.
We have heard from many people who get on with their jobs in the face of frustrations shared by service providers everywhere. We saw staff, managers, regulators, councillors, governors, GPs and politicians who all shared the same experience. No one had any warnings that there was a problem until the press stories began, at which point everyone was overwhelmed.
What does this mean? I think there are two equally worrying propositions. Either there were problems on a truly appalling scale but none of our regulation systems could see them, or this was a pretty normal hospital going through occasional bad patches. If the latter is the case, then the scandal which has toppled the management, caused massive loss of public confidence, forced dozens of people out of their jobs and cost well over £10m so far of tax payers money may be effectively based on the failure of the hospital complaints system.
It is worth remembering that the events that led to the inquiry began with one very determined and very unhappy relative. How well would your hospital deal with that? If I were an NHS chief executive I would be asking myself the following questions:
- How do we know how good our basic nursing care is?
- Do we have systems to help us learn from mistakes?
- Are my staff actively supporting people visiting sick relatives?
- What help do we offer to people who are suffering a difficult bereavement process?
- Does the complaints system work for the patients and their families? Do we give good support to staff who are handling difficult complaints?
- Are there advocacy services which will support angry patients or relatives to conduct an effective dialogue with us?
- Is the Links/HealthWatch system in our area working?
- Does our community see our service as open, transparent and responsive?
- Do local politicians know enough to ask the right questions?
- If we had an implacable complainant would we be able to convince regulators, the press, the public and politicians that our hospital is doing a good job even in the face of hostile questions?
Whatever it was that went wrong at Mid Staffordshire occurred at a time of cut backs, staff reductions, structural re-organisations and political turbulence. The specific mix of circumstances that produced Stafford is unique, http://pressreform.blogspot.com/2011/04/what-forms-our-perception-of-stafford.html but other hospital scandals will occur. The question is, when and where? Studying Stafford Hospital may help to ensure that it is not your hospital.
Diana Smith @mulberrybush runs community website Stafford Direct where she writes on local issues(http://stafforddirect.ning.com/),
blogs about media reform and Stafford Hospital http://www.pressreform.blogspot.com/
and comments on Guardian.co.uk as Wildsloe (http://www.guardian.co.uk/discussion/user/wildsloe)
