Intended for healthcare professionals


Regulators are likely to miss failing hospitals now, says Mid Staffordshire head

BMJ 2011; 342 doi: (Published 18 March 2011) Cite this as: BMJ 2011;342:d1778
  1. Clare Dyer
  1. 1BMJ

Poor standards of care and safety that went undetected for years at Mid Staffordshire NHS Foundation Trust could recur in the NHS, and there is no guarantee that regulators would spot them, the trust’s chief executive has told the public inquiry into lessons to be learnt from the trust’s failings.

A troubleshooter with nearly 30 years’ NHS experience, Antony Sumara was brought in to turn the trust around after a Healthcare Commission report in March 2009 found “appalling” standards of care and at least 400 excess deaths at Stafford Hospital between 2005 and 2008 (BMJ 2009;338:b1141, doi:10.1136/bmj.b1141).

In his oral evidence to the inquiry, chaired by Robert Francis QC, Mr Sumara said, “Would I have confidence that, given the lessons from Mid Staffs, regulators are now in a better position to spot a Mid Staffs? My answer would be ‘no.’”

The commission’s report noted concerns over high mortality at the trust dating as far back as 2003, yet in February 2008 the trust became a foundation trust, a status reserved for “high performing” trusts that gives them greater independence.

In his written witness statement Mr Sumara said that he only realised “the mess that the hospital was in” after starting there in August 2009. “I do not think that any of the external regulators, particularly Monitor, appreciated how bad the situation was at the time.”

A culture of denial pervaded the hospital at every level, he said. “The staff did not understand what they were supposed to be doing, and this was causing chaos and confusion.”

He added, “It was clear to me that the regulators did not have a grip of the issues. It was very much down to me to drive home to them how serious the situation was.”

Mr Sumara, who is due to stand down soon as chief executive, said that the job had had an “enormous” effect on him personally. “I still find it difficult to comprehend the enormous physical and emotional harm that we, as a hospital, have inflicted on people,” he said.

He said that he had met 150-200 family members of former patients. “The stories were so bad that they moved me to tears. What I heard from these people was horrific.”

Mr Sumara called for reform of the regulatory system. “The regulators only know that a hospital is experiencing problems when there is a major failure,” he said.

“When the hospital was at its worst the HCC [Healthcare Commission] awarded it 3 stars, then 2 stars, then 0 stars. At the same time, other regulators were granting it foundation trust status. Had the regulators talked to each other, they would have noticed that there was a clear disconnect.”

The trust failed for a number of key reasons, he said. It had an inexperienced management team and was struggling financially; and the primary care trust was in flux, with people concentrating on keeping their jobs rather than checking up on the hospital.

The focus on getting foundation trust status meant that no one was focusing on the things that mattered. “The distance of the regulators means that they would never have seen this coming, and that has not changed. With the pending [NHS] reforms, the same conditions exist now that did in 2006,” said Mr Sumara.


Cite this as: BMJ 2011;342:d1778