In April 2014, Mid Staffordshire NHS Foundation Trust was fined £200,000 for health and safety breaches over the death of a diabetic patient, it was also ordered to pay £27,000 in legal costs. Gillian Astbury, 66, died at Stafford Hospital in April 2007 after two nurses failed to give her insulin. The case is a significant landmark in the history of the Health and Safety Executive’s (HSE) scrutiny and prosecution of healthcare organisations, and may lead to an even greater focus on this sector by the HSE.

The Trust was sentenced at Stafford Crown Court after it had pleaded guilty at Stafford Magistrates’ Court on 9 October 2013, and the Magistrates Court ruled that their sentencing powers were insufficient as they can only fine up to £20,000 per offence. The Sentencing Hearing had been adjourned from earlier this year in February as the Judge had stated that the case had “wider implications” that meant that he needed “time to reflect”. Just a few days after this adjournment, the Trust was dissolved by the Health Secretary Jeremy Hunt.

The Trust’s guilty pleas had admitted that they had failed to manage and organise hospital services properly including its systems for record keeping and sharing patient information between staff members. An Inquest into Mrs Astbury’s death in 2010 had earlier ruled that there had been a failure to provide basic care.

“The prosecution and sentence of the Trust is significant for a number of reasons. Traditionally, the HSE have tended to prosecute healthcare bodies for technical health and safety offences relating to healthcare equipment, fire safety, risk assessments concerning building design, or under specific health and safety regulations such as those concerning manual handling, asbestos, falls from height and not for failures relating to the provision of healthcare. Therefore the HSE’s decision to prosecute Mid Staffordshire NHS Foundation Trust for failures relating purely to the provision of healthcare by medical professionals could mark a dramatic shift in the HSE’s enforcement strategy in this sector.”

Learning Lessons for Healthcare organisations

The lessons of the HSE prosecution, conviction, and sentence of Mid Staffordshire need to be heeded by all healthcare organisations. In the future there is likely to be greater scrutiny of healthcare organisations by the HSE, the police, and any future healthcare regulators that the Government decide to create.

The demand for a new offence of criminal neglect for healthcare organisations (widening the offence previously reserved for cases involving patients who lacked mental capacity) and for the implementation of criminal sanctions to hold healthcare organisations, medical professionals, and senior managers accountable for failing hospitals will be increased following the Gillian Astbury sentence. Finally, the level of fine in the Gillian Astbury decision shows that the Courts will no longer view healthcare organisations with leniency when they come to consider sentencing (particularly if they are large organisations and irrespective if they are public or private). Mid Staffordshire NHS Trust has been in severe financial difficulties for several years, and it became the first foundation trust to go into administration in April 2013. Indeed the Magistrates’ Court in October 2013 had heard that the Trust was running an annual operating deficit of about £11 million, and the NHS Litigation Authority, which provides indemnity cover for legal claims against NHS Trusts, said Mid Staffordshire's insurance would not cover a fine from the HSE. However despite all of this, the sentencing Judge still chose a very heavy financial sentence against the Mid Staffordshire Trust.

Recent Court of Appeal decisions have been quoted in Sentencing Courts all around the UK. Large organisations can now expect much higher fines for breaches of health and safety in cases involving both fatal and non-fatal incidents. Fines must be large enough to send a message to owners, shareholders, senior managers, and directors of organisations. After the sentence given to the Mid Staffordshire NHS Foundation Trust yesterday, we can be in no doubt that the Courts will have confidence to be strong in delivering large financial penalties to healthcare organisations for health and safety breaches in the future.