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

Peter Mahaffey has excellently summarised many of the elements that I perceive as problem areas.

Here are some further observations on the Inquiry Report -parts of it quoted below:

64. The codes of conduct and guidance for directors make it clear that their duty is
to provide strategic direction and that they should refrain from intervening in
operational detail, but that they are collectively accountable for all aspects of the
performance of the Trust.

66. The non-executive directors, including the Chair, had an appreciation that there
were serious deficiencies in certain areas of the Trust’s operation. The Chair
provided a list of them to the Inquiry. The other non-executives supported her to
set about remedying these by the replacement of the Chief Executive. ................

Gentlemen's agreements and custom and practice were the means by which the healthcare professions and the executives co-existed and collaborated when my Consultant career started.

Nowadays financial mismanagement is the only sin that seems to fetter a modern CEO's activities.

From the Francis Inquiry Report, Para 64 (above) of the Executive summary, one is left wondering how the holder of this pivotal office is constrained and advised. There seems to be no effective means of ensuring that CEOs carry out their duties in a capable and exemplary manner.

In practice, this may rarely be necessary. One can argue, however, that with weakening of professional influence on management, and a tendency for there to be less managerial engagement of Consultants the Non-Executive Directors as expert lay-people should have enhanced powers. I hope I am missing a point.

Competing interests: No competing interests

12 February 2013
Reginald Michael Sherratt
Consultant Physician
Luton & Dunstable Hospital
Lewsey Road Luton LU4 0DZ