Francis call for standards backed by law

Robert Francis QC has called for the publication of a list of fundamental standards defining basic NHS care at the end of his long inquiry into the scandal at Mid Staffordshire Hospital NHS Foundation Trust.

The chair of the inquiry, which issued its final report in London this morning, said these standards should be used to hold health organisations to account.

He also said that “causing death or serious harm to a patient by non-compliance [with the standards] without reasonable excuse” should be a criminal offence.

Francis has also put a new emphasis on “candour” in the NHS, arguing that staff should be obliged to report incidents and that trusts should be “open and honest” in the quality accounts that they already have to publish.

He calls for another criminal offence to be created, aimed at the directors of trusts who “give deliberately misleading information to the public and the regulators.”

Other ideas in the inquiry’s 1,700 page report and 290 recommendations include improved regulation of both healthcare staff and managers, the creation of a single financial and care regulator backed by a "specialist cadre" of inspectors, and the establishment of an NHS leadership college.

Further recommendations focus on the need for new information systems, focused on data recorded at the bedside, and improved analysis and publication of data, to make sure that the new initiatives are working.

Shortly after his report was presented to Parliament at 11.30 this morning, Francis said: “We need to ensure these fundamental standards are enforceable by law – and the criminal law in the most serious of cases.

“Senior managers should be made accountable, patients need to be protected from poor nursing standards, and al staff should be empowered to be open and transparent.”

In relation to information, he told a press conference: "Improvements are needed in the core information systems for the collection of data about patients, both for their individual treatment and for the accurate collation of information for statistical purposes. Difficulties in achieving this are no excuse for inaction."

The scandal at Mid Staffordshire NHS Foundation Trust first started to come to light in 2007, when the Healthcare Commission, the predecessor of today’s Care Quality Commission, spotted that it might have high death rates, after an alert by Dr Foster.

The HC launched an investigation the following year, which led to the first of Robert Francis’ inquiries into what had happened at the trust. This reported in 2010 and concluded that the trust had not only suffered high death rates, but appalling care in its A&E unit an on some wards.

In the worst cases, patients were left in pain, in soiled bedding, and even drinking from flower vases. The public inquiry that reports today was set up to air the problems in full, to find out why senior managers and regulators failed to spot the problems, and to come up with recommendations to stop them arising again.

Francis said this morning: “The recommendations I am making today represent not the end but the beginning of a journey towards a healthier culture in the NHS, where patients are the first and foremost consideration of the system and those who work in it.”

Responding to the inquiry, Prime Minister David Cameron apologised for the trust’s failures, but was careful to say that the trust’s failures could not be attributed to the government or policies of the time.

Instead, he said the trust had "focused on finance and figures at the expense of patient care", while there was a wider attitude that "patient care was always someone else’s problem."

He said a number of important steps had already been taken, including the establishment of the NHS Commissioning Board, a "tough new regime" of reporting on specific quality issues, including falls, pressure sores and infections, and the introduction of the "friends and family test."

He said he had also asked the Care Quality Commission to create a new post of chief inspector of hositals. The government will respond in full next month.