Emma Jones on who is to blame for the current NHS crisis after the CQC finds that three-quarters of the hospital trusts it visited had safety problems

The NHS was born on 5 July 1948 from a long held ideal that good healthcare should be available to all individuals regardless of their wealth.

The NHS that has provided safe and effective patient care for decades seems far removed from the NHS that we apparently have now in parts of the country and as described in the report from the CQC today.

So, who is to blame for running down parts of our NHS, a national treasure which we pay for through our taxes, or was it always inevitable that we would reach such a position, in an ever growing, ever ageing society.

Nearly 3 years after the Francis report that cost almost £13 million and made over 290 recommendations to improve client safety within the NHS following the Stafford hospital scandal the Government has failed to implement many of the recommendations.

It seems that Government has spent money commissioning further reports , but not really taking the action that is needed to address the problems.

Top level decisions from Government have had an impact on the standard of care that NHS Trusts can provide, cash strapped NHS Trusts face government cuts at every turn, but we must also  look at the Trusts as well – are they without blame?

The horrendous care provided by the Mid Staffordshire NHS Trust was due, at least in part, to massive staffing cuts, authorised at Board level, in order to reduce the Trust’s deficit. At the public inquiry into the failures at the Trust questions were asked about whether any attempt to reduce the deficit, was, in part, to try to help the Trust gain Foundation Trust status.

In his first report (2010) Robert Francis QC wrote:

“It is impossible to avoid the conclusion that the Board neither received nor sought sufficient professional advice about the impact of the changes it was approving in terms of the workforce reduction, and then when it was told that there were or could be staff deficiencies, failed to follow up those concerns with any urgency. It has been suggested that one cause of that was the focus on obtaining foundation trust status, and it is difficult to disagree. However, another reason is to be found in the absence of effective clinical governance”

In his final report published in 2013 Robert Francis QC wrote:

“Building on the report of the first inquiry, the story it tells is first and foremost of appalling suffering of many patients. This was primarily caused by a serious failure on the part of a provider Trust Board. It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the Trust’s attention. Above all, it failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities. This failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care.”

Dr Bill Kirkup CBE, in his report into The Morecambe Bay scandal in March 2015 wrote:

“Our findings are stark, and catalogue a series of failures at almost every level – from the maternity unit to those responsible for regulating and monitoring the Trust. The nature of these problems is serious and shocking, and it is important for the lessons of these events to be learnt and acted upon, not only to improve the safety of maternity services, but also to reduce risk elsewhere in NHS systems." 

Dr Kirkup went on to write: “At the same time, in early 2009, the Trust was heavily focused on achieving Foundation Trust (FT) status, and this played a significant part in what transpired.

We recently brought a case against Barking, Havering and Redbridge University Hospitals NHS Trust involving 17 cases of treatment and care that we joined together, because following our investigations, it was clear that these cases were not just about individual failures/negligence, but a breakdown of the staffing system.

We argued there was an overall “failure to take reasonable care to ensure that there was a safe system of healthcare provided”.

We identified points at which the Trust knew staffing levels were low and that record keeping was poor.  We identified failures of the Trust to provide a safe system of health care, which caused or contributed to individuals suffering injury.

As a registered ‘person’, the Trust was obliged to comply with the requirements specified in regulations 9 to 24 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 regarding quality and safety, which came into force on 1 April 2010.

This includes relating to staffing: “In order to safeguard the health, safety and welfare of service users, the registered person must take appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons employed for the purposes of carrying on the regulated activity.”

From as early as 2009 it was scored as double weak the only Trust in the country to attain such a score, and as such it was regarded as the worst performing NHS Trust in the country.

The CQC inspected the Trust on many occasions.  If you have a spare few hours have a read of the CQC reports on the Trust at the CQC website here I lost count of the number of times the CQC raised issues about staffing levels and safe and effective care.

In 2015 the CQC reported that safety was not a sufficient priority.

Themes I noticed seemed to be the CQC consistently referring to concerns about the Trust being unable to learn from the incidents or evidence contained in internal audits, or from complaints and the Board being more concerned about finance than quality, and so information being provided about the quality of care might not have attracted the same degree of scrutiny as information about financial matters.

So whilst I appreciate that Trusts have to manage in an age where money coming in is being reduced, until those given the responsibility of running an NHS Trust really commit to ensuring sufficient resources are spent employing sufficient numbers of suitable staff I find it difficult to know how staff working in a system which is in parts broken and failing can offer the safe and effective care we all should take as a given.