Observations Mid Staffs Inquiry

Mid Staffs is evidence of all that is wrong with NHS management

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f774 (Published 06 February 2013) Cite this as: BMJ 2013;346:f774

Re: Mid Staffs is evidence of all that is wrong with NHS management

This is a brilliant summary of the situation in which the NHS tragically finds itself with the release of the Stafford report. Politicians have been trapped by the dual conflicts of on the one hand popularist promises to 'preserve the NHS' and on the other by the inexorable rise in healthcare costs as expensive new techniques daily become part of standard healthcare armamentaria.

But particular questions must be raised about why senior doctors, normally so articulate and unafraid to voice their opinions, appear to have become blind to appalling everyday deficiences in the basic care of their patients. For example, how could consultants possibly not have been aware that patients under their care were dehydrated or lying in their own faeces? Were things really so bad in Stafford that they not did not even do ward rounds and observe these privations?

The Francis report was suggested that there should be a legal obligation for NHS staff members to speak out when they witness sub-standard care. But for doctors this obligation is already enshrined in the copious new GMC rules imposed on members of the medical profession. There seem to be two reasons for senior medical silence. One philosophical (and identified by Heather Wood) that they became increasingly alienated by constant managerial exhortations over targets. The other material and so far completely unidentified in comment following the release of the Stafford report. This is that clinical excellence awards, the only way that senior NHS medical staff can financially advance beyond modest salary stage increments, are now at the behest of committees controlled by local managers. Previously such awards were decided by regional committees insulated to some extent from local influence. Thus there is a huge but insidious pressure not to rock the boat upon both ordinary consultants and also those who have undertaken managerial roles. It is crucial that decisions about these awards are removed completely from management and put back under professional control at a safe distance, or else abolished completely.

Competing interests: NHS employee under pressure to meet targets

11 February 2013
Peter J Mahaffey
consultant surgeon
Bedford Hospital NHS Trust
Kempston Rd, Bedford MK42 9DJ