Intended for healthcare professionals

Rapid response to:


Staff concerns at Mid Staffordshire trust were “lost in a black hole”

BMJ 2009; 338 doi: (Published 04 June 2009) Cite this as: BMJ 2009;338:b2297

Rapid Response:

Staff Concerns and Management Action - More Data Needed

At one time in my career, before I joined the Healthcare Commission,
I had an opportunity to scrutinise adverse incident reports in a large
acute hospital. There was a very large spike in one specialty. Further
scrutiny revealed that one member of the nursing team submitted an adverse
incident form at the start of every shift, indicating that nursing levels
were too low for safe and effective care to be fully assured. Management
were satisfied that nursing was of an acceptable level and certainly
without this individual's forms there would have been no spike in the
specialty relative to others. In other words, other nurses were not
submitting forms, whatever their views may have been. This is not to
suggest that any concerns submitted by nurses and others in Staffs were
not serious or justified. They may well have been. But before we can say
that hospital workers' concerns were ignored in Staffs, we need to know in
how many other places hospital workers' concerns are not acted on, and the
extent to which this was due to management and workers taking a different
view of the situation. It is possible that management not acting on
workers' concerns is more common than a single case and so we need to
understand more about what happens to workers' complaints and concerns in
a much wider group of hospitals before we can conclude that what happened
in this case was particularly extreme. Management may have neglected
hospital workers' concerns but they may have felt that they were over-
stated and that services were safe. Only a full enquiry locally and a
larger study nationally can tell us what is really happening to medical,
nursing and other workers' concerns which they report to management.

Competing interests:
Peter West was for three years the head of value for money at the Healthcare Commission

Competing interests: No competing interests

13 June 2009
Peter A West
Personal Communication
SW20 0LP