Intended for healthcare professionals

Observations Mid Staffs Inquiry

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

BMJ 2013; 346 doi: (Published 06 February 2013) Cite this as: BMJ 2013;346:f774
  1. Heather Wood, author of the Healthcare Commission’s 2009 report into Mid Staffordshire NHS Foundation Trust
  1. heatherawood{at}

The balance of power must shift back to the clinicians

The horrors at Stafford Hospital were failures of clinical care—but these were the symptoms, albeit deeply distressing, of a serious underlying illness. And that deep rooted pathology is the stranglehold that managers, many apparently devoid of an ethical code and certainly without a regulatory body, have on the NHS. Some of what follows has been expressed much more eloquently by Brian Jarman, director of the Dr Foster unit at Imperial College London,1 in his recent editorial, “When managers rule.”2

The line promulgated by the chief executive of the NHS in his evidence to the Francis inquiry that Mid Staffordshire was a one off is simply not sustainable. The media, the Patients Association, Age UK, and others reinforce the picture of poor care of older people.

In all the investigations involving acute hospitals that I led on behalf of the Healthcare Commission we found clear evidence of poor care on general wards, even when the focus was specifically on, for example, outbreaks of Clostridium difficile. Where some poor care may, arguably, stem from a fault line in the training of nurses, we found evidence that the poor care and failure to control infection were related to the determination of managers to drive through financial restraint and achievement of targets.

All the failings at Mid Staffs derived from the handing of control of decisions on priorities from the clinical professions to managers who were ultimately expected to follow the orders of senior managers. Those giving the orders often ignore or …

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