Jumping the Gun

This week sees the much-delayed publication of the public inquiry report into disastrous care at Mid Staffordshire NHS Foundation Trust between January 2005 and March 2009. The Eye will consider the findings in the next issue, but whatever Robert Francis QC recommends, it’s 3 years too late. The lessons from Mid Staffs were needed to inform Andrew Lansley before he launched into his vast, untested reforms in 2010. Reorganizations on this scale are invariably dangerous for patients, as was Labour’s desire to make every hospital a self-governing Foundation Trust. Mid Staffs should never have been forced down that route. It was too small and simply not up to the task, just as child heart surgery in Bristol was not fit for purpose twenty years ago. Both sacrificed lives to balance the books.

Bristol happened on the Tory watch but, as with Mid Staffs, it took a change of government to order a public inquiry. This took so long, it post-dated Labour’s NHS Plan and so none of its 198 recommendations were included. The chance to rebuild the NHS around transparency, humanity and safety was lost, despite all the extra funding.  It’ll be depressing to see how many of the recommendations in Sir Ian Kennedy’s 12 year-old report are repeated by Francis.

The culture of fear, blame and bullying in the NHS is as prevalent now as ever, and you’d need a career death-wish to blow the whistle on unsafe care (see Shoot the Messenger). Part of the responsibility lies with NHS chief executive Sir David Nicholson and his command and control team, whose talent for sticking to budget, keeping waiting lists down and hitting politically driven targets is matched with an ability to ‘manage’ bad news and suppress dissent. Nicholson, doubtless wary that Francis may criticise him, has come out fighting with interviews in the Health Service Journal and the Independent saying why he should stay on as chief executive of the NHS Commissioning Board (a post he walked into unopposed, aided by the delays in investigating Mid Staffs). The on-line responses on the HSJ site were near unanimous that Nicholson should go, a view held by Ken Lownds and Julie Bailey of Cure the NHS. But Nicholson is no George Entwistle and is unlikely to go unless Francis decides he was willfully blind to the deaths at Mid Staffs, rather than just asleep at the wheel.

The Coalition has the power to reject every one of Francis’ recommendations, but Labour has the luxury of reflecting on the findings before releasing its plans for further reform. Alas, Andy Burnham has jumped the gun and unleashed Labour’s proposals ahead of Francis. This seems nonsensical, until you remember it was Burnham who approved the proposal for Mid Staffs to become a Foundation Trust in 2007 based on just four lines of civil service advice. He then pointed the finger at the regulatory bodies (Monitor and the Healthcare Commission) for not scrutinising the proposal properly and spotting the appalling care, conveniently ignoring that Labour set the regulators up, decided their remit and budget, and appointed their leaders.

Unsurprisingly, Burnham resisted a public inquiry into Mid Staffs in 2009 as being ‘too distracting to managers’, just as Tory health secretary Stephen Dorrell resisted a public inquiry into the Bristol heart scandal that showed how the department of health and medical establishment knew babies were dying but refused to act. Both inquiries were delayed long enough for the findings to be dismissed as ‘historical’. In reality, they’re anything but. Child heart surgery still hasn’t been safely reorganized 21 years after the Eye broke Bristol and the horrors of appalling care of the most vulnerable patients are still too common across the NHS. There are no easy solutions in such a prolonged funding crisis, but the bullying, fear and absurd imperative to deny harm and deliver only good news to Downing Street must end.

Health secretary Jeremy Hunt now has to digest not just Mid Staffs, but reports on the reorganizations of child heart surgery – which should save lives –  and hospital mergers in south London – which almost certainly won’t. The excellent Lewisham hospital is collateral damage in a war it did not start, its services under threat not to improve quality but to bail out a bankrupt neighbour. There is no evidence that forced reconfigurations to save money ever succeed, and every chance of sacrificing more lives to try to balance the books. Let’s hope the lessons of Mid Staffs don’t fail at the first hurdle.