The inside track on the Mid Staffordshire NHS Foundation Trust Public Inquiry: Five questions for Bevan Brittan’s adviser to the CQC

In a follow-up to our recent alert on the report of the Mid Staffordshire NHS Foundation Trust Inquiry, Julian Hoskins discusses the practical impact of the report on workforce issues, in a Q&A with Carlton Sadler - the Bevan Brittan Senior Associate who led the team advising one of the core participants in the Inquiry, the Care Quality Commission.

The publication of the Mid Staffordshire Inquiry report on 6 February 2013 heralded the conclusion of possibly the largest ever public inquiry into the regulation of healthcare in this country - and its conclusions and recommendations are relevant for all those dealing with workforce issues in the health and social care sector. 

What was the Mid Staffordshire FT Public Inquiry investigating?

Following the Healthcare Commission’s investigation which had first identified appalling standards of care in certain parts of Stafford Hospital, Robert Francis QC carried out his first inquiry, which reported in 2010, focussing on events at the Trust.  The purpose of this latest Inquiry, however, was to examine how those events went undetected for so long, looking at the conduct of not just those within the Trust but the full range of patient involvement, commissioning, oversight and regulatory bodies interacting with the Trust.  The aim is to identify lessons for all these players in the system to ensure failing hospitals are identified much sooner.

What was your role in the Mid Staffordshire Inquiry?

I was instructed to act for the Care Quality Commission, who appeared as one of the core participants in the Inquiry.  My role was to assist with the preparation of evidence for the Inquiry i.e. prepare witness statements, assist in the drafting of opening and closing submissions, review and advise on the evidence of other witnesses, attend the oral hearings, and to attend and support our client around the publication of the report on 6 February 2013.

What were the key findings of the Inquiry in respect of workforce matters?

Workforce concerns were a key theme in the Inquiry and permeated many aspects of the report. 

Key findings were that:

• there was a general lack of engagement of employees across the workforce, from Board level to ward staff
• training was inadequate
• staffing levels and skills mixes were inadequate
• there was an institutional culture that put the business of the system ahead of care for patients
• poor standards were tolerated and not addressed through appraisal and disciplinary proceedings
• whistle blowing was not encouraged.

What were the key recommendations of the Inquiry in respect of workforce matters?

This is difficult to summarise, given the importance of workforce concerns in the Inquiry, but I’ll try to get this down to some bullet points:

• First off, the need for improved transparency, openness and candour was a key general recommendation.  This recommendation had a wide scope, and includes the need for staff to have more confidence to raise concerns as whistle blowers.  The report goes further than this, though, and recommends that the reporting of incidents of concern relevant to patient safety needs,  not only to be encouraged, but insisted upon (recommendation 12).  As anticipated, the report calls for the NHS Constitution to be amended with regard to openness, transparency and candour.  One of the most striking aspects of the report was its recommendation that a statutory ‘Duty of Candour’ be introduced, going further than the current whistle blowing regime; recommendation 183 is that directors and healthcare professionals should not only report concerns about care or treatment causing death or serious injury, but must do so, or face criminal sanctions.  Furthermore, the report recommends that employment contracts and settlement agreements should be reviewed and revised, so that employees are not restricted in making bona fide disclosures in respect of matters of public interest relating to patient safety.
• The need to strengthen nursing standards is also important.  The Inquiry called for nursing to be given a stronger voice and recommended that nursing standards be revised to include a renewed emphasis on compassion, care and commitment to patients.  As widely anticipated, the report also calls for the regulation and registration of Healthcare Support Workers.
• The need for improved performance management.  The Inquiry’s report recommends that measures formulated by the National Institute for Health and Clinical Excellence should include measures not only of clinical outcome, but also of the suitability and competence of staff.  From a practical point of view, disciplinary procedures may need to be reviewed, to take account of the Inquiry’s recommendation that disciplinary proceedings may go ahead even if there are pending Fitness to Practice proceedings going on in parallel.
•  As was widely reported in the press, no one senior individual was blamed for the failings at the Mid Staffordshire hospital; but the culture of the organisation was roundly criticised.  The report recommends that there is an overhaul of the culture of healthcare organisations, where ‘balancing the books’ is not given priority over patient safety.  An NHS Leadership College is recommended and it is also recommended that a Code of Ethics and Conduct for Senior Managers be implemented, with senior managers who breach the code being ineligible for the role.
• Finally, staffing levels and skills mix were addressed in the Inquiry’s report.  The report also recommends that NICE should develop evidence-based tools for establishing what each service is likely to require in terms of minimum staffing levels and that the NHSLA introduces a requirement for observance with such levels.

What practical steps should those working in healthcare HR take now that the report has been published?

All healthcare organisations – whether in the NHS or otherwise, and whether in the public or private sector, will need to enter into a period of reflection on the Inquiry’s findings and absorb Robert Francis’ recommendations. This will take some time – the report runs to over 1500 pages and contains some 290 recommendations.  It remains to be seen which of the report’s recommendations the Government will endorse and this will not be announced until early March 2013.

However, while some of the recommendations (for example the proposed statutory duty of candour) will require government support and legislation to take effect, there are many recommendations addressed directly to healthcare organisations themselves, in relation to their systems, policies and procedures. Implementation is therefore a task for all organisations to consider and Robert Francis was very clear in his report that this not a time for those working in healthcare management to sit on their hands until they are told what they should be doing. 

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If you would like any help or guidance on the matters set out above, or have any further questions in relation to the workforce aspects of the Robert Francis report, please do contact Julian Hoskins at Bevan Brittan LLP. 

To assist with understanding and implementation of the Robert Francis Report, we are running a series of seminars at our offices in Bristol, Birmingham and London – these are now fully booked but please do check our events page on our website for details of any forthcoming events on this topic.