Today, Robert Francis QC, Chairman of the Inquiry publishes his final report following consideration of over 250 witnesses and over one million pages of documentary evidence from Mid Staffordshire NHS Foundation Trust.
The Inquiry identifies a story of terrible and unnecessary suffering of hundreds of people who were failed by a system which ignored the warning signs of poor care and put corporate self interest and cost control ahead of patients and their safety.
“Elderly and vulnerable patients were deprived of dignity and respect. Some patients were left in excrement-stained beds” says Francis.
There was an institutional culture in which the business of the system was put ahead of the wellbeing of patients, he says.
In his report, Francis makes 290 recommendations designed to change this culture and make sure patients come first by creating a common patient centred culture across the NHS.
We need a commitment by all who work with patients to serve and protect them, Francis says.
Five key points from the report are:
• Clearly understood fundamental standards. To cause death or harm to a patient by non-compliance should be a criminal offence. This must be policed by the CQC.
• Openness, transparency and candour throughout the system. A duty of candour should be imposed and underpinned by statute and the deliberate obstruction of this duty should be a criminal offence.
• No one should have hands-on care of a patient without being properly trained and registered. He calls for a new registered status for those working with older patients
• Strong patient-centred healthcare leadership. The public are entitled to see leaders held to account. It should be possible to disqualify those seriously breaching the code of conduct. This will require a registration scheme.
• Accurate, useful and relevant information. Patients should also have access to this. Difficulties in achieving this are no excuse for inaction.
Ciarán Devane, Chief Executive of Macmillan Cancer Support, says:
“Francis has exposed a sub-culture within parts of the NHS which time and again severely compromises patient safety and quality of care…..More regulation is not the answer. The focus must be on working with hospitals to transform their understanding of patient care”.
Here is a link to the full Francis report.