Last week Mid Staffordshire NHS Foundation Trust was fined £200,000 and ordered to pay £27,000 in costs as a result of a criminal prosecution into care.
The Mid Staffordshire Trust has been subject to a number of Inquiries but in this particular case the Health and Safety Executive (HSE) brought a case against the trust over the death of Gillian Astbury. She died in 2007 as a result of nursing failures.
This would not normally be a case in which the HSE would be involved. The HSE’s normal role is to investigate accidents at work but recently it has agreed to work with the Quality and Care Commission which deals with standards of health and social care.
However this was a case in which the preparation was already undertaken as a result of the Francis Inquiry. This investigated poor standards of care at Mid Staffs and in particular it looked in detail at the Astbury case. In fact, the Francis Inquiry criticised the HSE for being apparently unable to decide whether to prosecute or not. As a result of that criticism and the public outrage, the HSE announced that it would bring a case. The trust itself pleaded guilty to an offence under the Health and Safety at Work Act.
Ms Astbury died following the failure to give her routine insulin. The control of diabetes by insulin is something that even junior nursing staff should be well aware of during the course of their training. There is and can never be any excuse for a failure to provide a patient with insulin when it is needed. Any diabetic patient should be regularly checked for their blood sugar levels to ensure that they are maintained within safe levels and if necessary, sugars in the form of glucose or food or insulin given as necessary. In this instance, two nurses failed to notice the high blood sugar levels. One has subsequently been struck off by the Nursing and Midwifery Council.
There is no doubt that the fine is significant but is it likely to change the culture? The answer is probably no. The people providing this care and poor care generally, some of whom remain in practice, have no real connection with the level of fine. The hospital is a multimillion pound business. The £200,000 fine, whilst substantial, is the equivalent to a premier league footballer losing wages for a week or two. However, there clearly is a balance between the level of fine imposed and the wish to avoid causing further harm by reducing funds available for patient care. Fines are unlikely to be at such a level to cause a change in culture.
Could Mid-Staffs happen again?
I recently have dealt with a case where my client, a nurse herself, described having to do her own wound care. This was despite having a colostomy (newly formed), an open wound which was unable to be closed surgically, a drip and having recently undergone two lots of major surgery. The client was in a side ward, was given no assistance and did not see a stoma nurse through the whole of her time there. Her husband who was in attendance for much of this time verifies her account as does the rest of her family.
Assuming they are correct (and I have no reason to doubt the veracity of their evidence), then this is care similar in standard to that which Francis uncovered. This was a London hospital in 2010. Their evidence is not unusual in my office although the degree of problems identified was uncommon. Clearly there are hospitals where the patient care falls well below that that is acceptable. These are perhaps isolated cases, but perhaps not.
What changed at Stafford was the Francis enquiry and the public outrage by what had happened. A fine even as substantial as this in the scale of a multimillion pound business isn’t really going to change the culture. Public condemnation may, certainly media attention will. Prosecutions and fines probably have a much smaller part to play in the review of medical and nursing culture and the management of NHS hospitals.
Where the failings are isolated, media attention is likely to be missing and public outrage less demanding. For those cases, hospitals still may be able to ignore the issue. That is a worry. I hope the culture changes sooner rather than later but I doubt finance will change it all.