It is time to usher in a culture of real accountability and an admission of responsibility from managers and clinicians and staff within the National Health Service when things go wrong.
This follows the highly critical report published this week into the care provided by Mid Staffordshire NHS Foundation Trust. The Inquiry Chairman, Robert Francis QC, concluded that patients were routinely neglected by a Trust that was preoccupied with cost cutting, targets and processes and which lost sight of its fundamental responsibility to provide safe care. The report can be seen here. It has been widely reported in the press and media and is considered to be probably the worst scandal regarding patient care to have affected the NHS since its inception.
Reading this report and its contents I was shocked and appalled that patients could be treated in such an inhumane and uncaring manner. I personally worked Stafford Hospital in 1987 in the oral surgery department and found it to be a wonderful place to work. That is why I find the contents of this report particularly painful. It is reported that as many as 1,200 patients are feared to have died from neglect at Mid Staffordshire NHS Trust between 2005 and 2008 with thousands of others subject to ‘inhumane’ and ‘degrading’ treatment.
What worries me on reading this report is the fact that there is no accountability or responsibility. There is no mention of names of personnel involved. Although the report has some 290 recommendations there is no mention of Sir David Nicholson, who got promoted and is now the current head of the NHS but who was previously at the strategic health authority responsible for Stafford and Cannock Chase hospitals at the time that these appalling events took place.
I find it incredible that Cynthia Bower who was head of the West Midlands Strategic Health Authority (SHA) which was responsible for overseeing the trust at Stafford at the time of this scandal was promoted to head the Care Quality Commission (CQC) the body which is responsible for inspecting health care facilities such as care homes, hospitals and dental practices. While disgraceful and reprehensible medical practice was going on under her watch at the SHA which she was either unaware of or ignored, she then gets promoted to head a regulatory body that seeks to ensure clinical quality and patient safety. You could not actually make this up it is so shambolic. Martin Yeates who was the chief executive of the Mid Staffordshire Trust resigned in 2009 and left with more than £400,000. He gave no evidence to the Francis inquiry as he was reported to be too ill to be cross-examined over the scandal at a public inquiry. I am utterly astounded that he now has a job as chief executive of a health charity, Impact Alcohol and Addiction Services, which hold contracts with the NHS. When managers who have let the public down so badly get promoted then it gives the impression that within the NHS there are strong rewards for failure. This culture has to change. The culture of the NHS for these senior managers seems to be that it is one long rotating conveyor belt – if you get thrown off at one point you can simply hop back on elsewhere and carry on as if nothing ever happened.
It is of course possible as the report does to blame ‘the system’ or talk about the need for a ‘fundamental culture change’ at the Trust, or putting ‘patients, not numbers’ first, and a ‘zero tolerance’ approach to breaches of care. However without holding people to account over these gross and negligent failings closure cannot be achieved. Not one member of staff has been disciplined or struck off following this scandal. More than 80 medical staff have been accused of failings at the hospital since the scandal was exposed in March 2009. It is reported that the General Medical Council (GMC) stated that of 42 doctors who have been investigated by the GMC – four face public hearings in the next few months and four more are still under investigation. The remainder have just received warning letters or had their cases dismissed. The Nursing and Midwifery Council report that 41 nurses had been investigated. Ten are awaiting public hearings, and one is subject to an interim suspension. Two nurses who have had public hearings escaped sanction despite being found guilty of misconduct.
The Francis report highlighted a culture of failed management where poor medical practice was ignored and patient complaints and concerns were either dismissed or ignored. This was all against a background of target driven spending cuts. Within the current NHS dental system we are working in a target driven culture where we have to hit targets for treatment or face financial penalties all within a progressively reducing spending envelope. Processes rather than care are at the forefront. This mentality has to change. It worries me for the future of NHS dentistry that targets are what we are required to achieve given the events at Stafford.
At Langley Dental Practice I am proud to encourage an open and honest culture amongst all my staff where they should feel able to come forward without fear or favour. All staff at Langley Dental Practice undergo a system of annual appraisals and objective setting. These objectives tie in with the short medium and long term aims of the business. We are all aware that within the NHS we are working in financially difficult times where value for money is vitally important. However we must remember that our primary duty is to care and look after our patients to the best of our ability. This is something that was forgotten at Stafford from the frontline right up to senior management. At Langley Dental Practice we instill a culture of duty of care to patients into all our staff from day one. Quality and high standard starts from the grass roots at the front line. Here at Langley Dental Practice we have been members of the British Dental Association Good Practice Scheme since 2011 and last year we had a positive inspection report from the Care Quality Commission (CQC). We are also an approved training practice by the North West Deanery for new dental graduates. We are always prepared that our practice could be inspected at any time so we do our best to maintain our standards day in and day out.
It is simply not enough just to blame the system and the culture. Ultimately that system has people working in it and those people have to take responsibility for their actions. If mistakes are made and mistakes will be made then they must hold their hands up and try and rectify those errors. However when there are major inherent failings and poor medical practice then it is not enough to look at systems, processes and culture. At the frontline people have to take responsibility for their actions, higher up the chain management and the Department of Health need to remember that patients come before profits and at a national level the regulatory bodies need to win public confidence and trust by acting decisively and removing those individuals from the field of medical practice so that they cannot harm patients ever again.
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