Government should not take “big stick” to NHS after Mid Staffs report, says think tank

Moves to punish the NHS for failings at the Mid Staffordshire NHS Foundation Trust would undermine any chance of a positive change in the health service towards more openness, claims a leading health think tank.

The Nuffield Trust published a report on 14 March to help inform the government’s own response to the report of Robert Francis QC’s public inquiry into the problems at Mid Staffordshire.1 2

In its report the think tank said that it fully supported Francis’s recommendations that listening to and understanding patients must come first in NHS services. It also backed the idea of a new statutory duty of candour to encourage a new culture within the NHS, one that was comfortable with reporting concerns about performance in an open and transparent way.

However, the report says, “We would encourage the government to avoid the temptation to over-regulate or be too punitive—a ‘big stick approach’ will not work and will serve only to further alienate staff and reproduce the distortions created over the past decade by targets.”

A punitive approach could also undermine the readiness of staff and organisations to be open and honest when things went wrong.

The government is expected to make its official response to the Francis report before the end of March.

The Nuffield Trust said that the Francis report alluded to but did not spell out some “important underlying tensions in the current system”—namely, that a candid and honest approach to quality, as the inquiry recommended, might not sit easily with a more competitive approach to health service improvement, given that trusts were expected to compete with each other to attract patients.

The trust also backed Francis’s recommendation for fundamental, enhanced, and developmental standards of care in the NHS to be defined. Francis proposed that these be drawn up by the NHS regulator the Care Quality Commission, with input from patients, staff, the National Institute for Health and Clinical Excellence, and commissioners.

In addition, setting of care standards for the care of vulnerable older people should be the first priority in this work.

In the future, individual general practices and clinical commissioning groups should be more proactive, says the report, and GPs might be encouraged to follow up patients who have recently spent time in hospital.

Awareness among staff of the NHS Constitution should be raised, argues the report. This could be achieved by promoting the values of the constitution in NHS recruitment, induction, and appraisal processes.

More clarity is needed over regulatory arrangements, says the report. The two main regulators, Monitor and the Care Quality Commission, should work together more closely and share information.

Ruth Thorlby, senior research fellow at the Nuffield Trust, said, “It is ultimately the responsibility of boards to ensure their hospitals are providing high quality care for patients, but the public inquiry shows how difficult it is for providers, commissioners, and regulators of health services to detect and respond to individual failures that might be occurring within one ward or department of an otherwise high performing hospital, as well as to identify and respond to larger scale, more systematic failures of individual institutions.

“In part this is a technical challenge, based on how we use information better. But what the Francis report reminds us powerfully is that we need a renewed focus on hearing and understanding what patients are saying.”