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Mid Staffordshire NHS Enquiry

The Mid Staffordshire report was published in February 2010 following a Department of Health commissioned enquiry led by Robert Francis GC. The actual report comes to 400 pages. The main points are summarised here.Concerns about the standards of care and mortality rates at the Mid Staffordshire Hospital were raised between 2005 and 2008. An initial investigation by the Health Care Commission (now known as the Care Quality Commission) identified a raised emergency mortality rate at the Trust. A second, more thorough, investigation was carried out between March and October 2008. It is estimated that between 500-1200 extra people died in the 3 year period (2005-2008) when compared to normal NHS mortality figures. The Mid Staffordshire NHS Trust was a Foundation Trust at the time, which raised some concerns from Monitor (the Foundation Trust Regulator).

 

The Trust was severely criticised and the Chief Executive, Martin Yeates was suspended and the Trust’s Chairman, Toni Brisby, resigned.


 

 

The inquiry identified serious concerns around the basic provision of patient care including:

  • Safety
  • Basic hygiene
  • Pressure area care
  • Nutrition/hydration of patients
  • Infection control
  • Diagnosis and treatment
  • Discharge arrangements
  • Patient dignity and record keeping

A cultural problem within the Trust was also indentified, including:

  • Staff bullying
  • Poor staff attitude
  • Too much focus on achieving targets
  • Poor distant management structure
  • Low staff morale

This was compounded by several issues with management including:

  • The geographical configuration of the wards
  • Implementation of staff cuts and financial pressures
  • Lack of formal governance arrangements
  • Lack of clinical leadership
  • Poor audit structure
  • The internal scrutiny of mortality statistics
  • Poor response to incident reporting
  • Retrospective risk management structure after the event
  • Poor focus on outcome measures and data

There were several recommendations made in this report which includes:

  1. Patients’ needs should be put first above all
  2. For the Secretary of State to make a decision to “de-authorise” Mid Staffordshire NHS Trust of its Foundation status
  3. The Trust should form links with other trusts to promote clinical and managerial excellence
  4. Training of all medical staff should be reviewed with help from the appropriate regulatory bodies (GMC, NMC, Royal Colleges, nursing schools etc.)
  5. Attention to the audit process should be encouraged, especially to outcome data
  6. More attention to complaints and incident reporting processes
  7. A full review of Trust policy, procedures and practice
  8. Encourage the support of staff who raise clinical concerns and forge an open and honest environment to work
  9. The Secretary of State should, with Monitor, set minimum requirements for training, appointment and accountability of senior management positions (executive and non executive positions)
  10.  A complete review of the management structure at the Mid Staffordshire NHS Trust
  11. The use of standardised hospital mortality rates should be published online so to encourage the national benchmarking by health care staff and patients of all NHS trusts
  12. All NHS trusts should review their governance and management structures in light of this report

 

 

 

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