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Failing hospitals to be named and shamed in NHS care overhaul

This article is more than 11 years old
Jeremy Hunt says managers responsible for failures will be barred from working in NHS

Failing hospitals will be named and shamed and NHS managers responsible for failures will be barred from working in the health service under government plans to ensure a Mid Staffs-style care scandal never happens again.

NHS staff's pay will be linked to how well they care for patients and health professionals will be obliged to own up when they harm or kill patients, the health secretary announced.

Jeremy Hunt unveiled the building blocks for what he called "a culture of zero harm and compassionate care" and a remedy for the "unacceptable and, in some cases, inhumane treatment" displayed in the scandal at Stafford hospital, governed by the Mid Staffordshire NHS trust, between 2005-09. This contributed to the death of between 400 and 1,200 mainly elderly patients.

"The events at Stafford hospital were a betrayal of the worst kind," he told MPs. "A betrayal of the patients, of the families, and of the vast majority of NHS staff who do everything in their power to give their patients the high quality, compassionate care they deserve."

Hunt, who was presenting the government's initial response to the appalling care catalogued in last month's landmark report by Robert Francis, had trailed some changes in advance. These included a requirement for nurses to spend up to a year getting hands-on experience on hospital wards at the start of their training and the creation of a new chief inspector of hospitals. But there was disappointment that the duty of candour would be a legal requirement for NHS organisations rather than staff and managers.

Lisa Jordan, a medical lawyer at Irwin Mitchell, which has investigated over 50 cases of alleged negligence at Mid Staffs since 2005, said many patients would wonder why a zero-harm culture wasn't already in place.

"Until ministers give their full response and put a detailed plan of action together responding to each of the 290 recommendations set out in the Francis reports, patients and their families will be left with questions unanswered as to how this could have happened in the first place and left waiting for the assurances they want that patient safety will never again be compromised to this extent," she said.

Welcoming the statutory duty of candour and penalties for executives who withheld important information, Jordan said questions remained "as to what will happen to less senior members of staff who are found to withhold information or cover up inexcusable mistakes".

Hunt's proposals failed to impress Patient Concern, a patient campaign group. Roger Goss, its co-director, criticised the minister's refusal to implement what he called a core recommendation of the Francis inquiry – mandatory minimum staffing levels for hospitals. "Hunt's refusal to implement this, claiming that there is no relationship between nurse numbers per ward and quality of care or patient safety, is preposterous. 'Not the government's problem or responsibility' appears his attitude."

Goss added: "Whether nurses will retain an interest in tender loving care when they graduate after a mandatory year as healthcare assistants seems questionable. But the requirement is worth a try." Making nursing a degree-based profession already excluded many potential candidates who could be excellent caring and compassionate nurses, he said.

The health service ombudsman, Dame Julie Mellor, while welcoming Hunt's statement, called it a "first step". She said: "Complaints are key to learning and improving … Ensuring that hospital trust boards receive and take action from meaningful complaint information to identify patterns, trends and themes will be central to making this change happen."

Hunt is pressing ahead with plans to introduce a new ratings system for hospitals closely based on the way Ofsted assesses the performance and quality of schools in England. Hospitals could be rated "poor", "requiring improvement", "good" or "outstanding" by a newly created chief inspector of hospitals, who Hunt said would become the NHS's new whistleblower-in-chief. Individual departments, such as cancer care and maternity services, would be rated separately and the hospital given an overall score.

In addition, senior doctors will be brought from other hospitals to join beefed-up inspections and help assess the quality of care in certain departments. Tougher inspections could last for a month, Hunt said, in a new drive to identify and stop poor care emerging.

Hunt also said nurses would have their performance subjected to regular review known as "revalidation", along the lines of the same system that has recently been agreed for doctors, and that NHS pay would include an element related to their performance and how well they treated patients. NHS managers who have been responsible for failures will be barred from working in the service again. Gagging clauses on staff who leave the service will be banned.

The healthcare watchdog, the Care Quality Commission (CQC), will in future be responsible for the toughened inspection regime but not for putting right failures. This will be the responsibility of Monitor, the body that at present regulates the NHS's foundation trusts.

The CQC chief executive, David Behan, said it would inspect acute hospitals and mental health trusts by focusing "on the four key areas that are most important to people: safety, caring, effectiveness and how well they are led."

The NHS Employers organisation was lukewarm about the new duty of candour. Dean Royles, its chief executive, said that while such a requirement "makes sense … we need to beware the law of unintended consequences. You don't improve culture by creating a climate of fear."

Mike Farrar, chief executive of the NHS Confederation, representing health service organisations, said Hunt had found "the right balance between external assurance measures and internal changes focused on transforming the NHS culture" but added this would not happen overnight.

Jane Cummings, the chief nursing officer at NHS England, formerly called the NHS commissioning board in the runup to next month's structural change to the health service, said: "There are so many NHS staff doing brilliant work for their patients. But we all know there is a serious job to be done to rebuild public confidence. The NHS must grasp this positively and seize the opportunity to drive change."

A final decision on new legal sanctions against staff will depend on the outcome of a review of patient safety in the NHS being conducted by Don Berwick, a global expert in patient safety who has advised the US president, Barack Obama. Berwick will report before parliament's summer recess in July. Many medical organisations have expressed concern that such a move would deter staff from owning up to errors and open the NHS to a flood of new litigation.

Regulation of the 500,000-600,000 healthcare assistants working in both the NHS and social care would result in "a bureaucratic quagmire", Hunt said. Instead, there will be a new code of practice governing their behaviour and new minimum training standards.

Hunt again defended Sir David Nicholson, chief executive of the NHS in England, who has been under growing pressure from MPs and relatives of the patients who died to resign for failing to do more to stop the poor care unfolding when he headed the NHS's regional strategic health authority in 2005-06.

Nicholson was responsible for 50 hospitals in the West Midlands at the time and no one in the NHS system at the time flagged major concerns to him about the emerging problems at Stafford hospital, Hunt said.

Although the NHS's overall boss bears "some responsibility" for the NHS's failure to spot the poor care sooner, Nicholson had also ensured that the NHS met key waiting times targets and brought levels of healthcare-acquired infections down very dramatically.

More on this story

More on this story

  • Jeremy Hunt's response to Mid Staffs report is just beginning

  • Jeremy Hunt: failing hospitals will be brought to account – video

  • NHS care overhaul measures don't go far enough, say patient groups

  • Theresa May's statement on the UK Border Agency: Politics live blog

  • NHS care overhaul: Jeremy Hunt's plan is ambitious but possibly unrealistic

  • Nurses must spend a year on basic care

  • How will nurses and their leaders respond to the Francis report?

  • Nurses already do hands-on work and of course we care about patients

  • Jeremy Hunt's dangerous belief in a single 'truth' about hospitals

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