Doctors must accept some portion of responsibility for events at Mid Staffordshire hospital, BMA says

BMJ 2013; 346 doi: (Published 06 February 2013) Cite this as: BMJ 2013;346:f848
  1. Gareth Iacobucci
  1. 1BMJ

Doctors must help foster a new culture in the NHS to end the climate of “fear, bullying and harassment” that allowed the Mid Staffordshire scandal to occur, the BMA’s chairman has urged.

Mark Porter said he was “profoundly disturbed and saddened” by the findings of Robert Francis QC’s public inquiry into the catastrophic failings at Mid Staffordshire NHS Trust that led to the deaths of thousands of patients at Stafford Hospital between 2005 and 2009.

In a rallying call to the profession, Porter called for a new culture to be adopted by doctors and managers in the NHS that showed “zero tolerance to poor and dangerous care.”

The report—finally published on 6 February—said that too many doctors in Mid Staffordshire “kept their heads down” and did not pursue management with sufficient vigour to deal with the unacceptable levels of care being provided.

Francis said that failures at all levels of the system had led to the “appalling and unnecessary suffering of hundreds of people”—with the trust’s board, local commissioners, the Department of Health, and Monitor all criticised.

But he stated that doctors must also accept some portion of responsibility. “The local medical community did not raise concerns until it was too late,” he said.

The report itself said: “Consultants at Stafford were not at the forefront of promoting change . . . clinicians did not pursue management with any vigour with concerns they may have had. Many kept their heads down. A degree of passivity about difficult personnel issues is all too common in the NHS as, perhaps, elsewhere. However, a system that is safe for patients requires a much more rigorous approach.”

Porter said it was essential that all parties worked together to develop “a different kind of health service.”

“Despite all the regulations and guidance to help staff raise concerns, a climate of fear, bullying, and harassment can stop clinicians from speaking out,” he said.

“Unless and until medical staff and management jointly promote the ethos that raising concerns is not only acceptable but a positive thing, the shadow of Mid Staffs will put us all into darkness. Doctors, along with other clinical staff, have a professional responsibility to show leadership in helping to change this culture. We must no longer accept the attitude that it is someone else’s job to worry about.”

The raft of recommendations put forward by Francis includes hospitals considering reinstating the practice of identifying a senior clinician to be in overall charge of each patient’s care, to ensure that patients have a direct point of contact if they want to complain about the quality of care they receive.

The report also calls for all medical practitioners that obstruct or provide untruthful or misleading information to a regulator to face criminal action, with adherence to this “duty of candour” policed by the Care Quality Commission.

At a national level, the report said senior clinicians were “not at the heart of decision making” at the trust, and urged the Department of Health to ensure “senior clinical involvement” in all policy decisions that might affect patient safety across the NHS.

Locally, it said that GPs should have a greater role in monitoring their patients who receive acute and specialist care, and should develop “internal systems” that allow them to track patterns of concern, rather than merely treating each case “on its individual merits.”

Changes to medical training and education are advised, including for the General Medical Council to amend its standards for undergraduate medical education to have a requirement for providers to “actively seek feedback from students and tutors” on how providers are complying with minimum standards of patient safety and quality of care.

The report also suggests that each clinician should be required—as part of the revalidation process—to demonstrate their “ongoing commitment, compassion and caring shown towards patients.”


Cite this as: BMJ 2013;346:f848