THE Francis Inquiry – which took three years and cost £13 million – was presented to the public on Wednesday 6th February.
Apparently finished last Summer, its publication was repeatedly postponed, most likely because it so clearly showed how forcing Mid Staffordshire hospital to make £10m savings to achieve foundation trust status caused dangerous understaffing and up to 1,200 excess patient deaths
The inquiry took evidence from over 250 witnesses and a million pages of documentary evidence. The account of the disastrous failures in patient care at Mid Staffs is given in Volume 1. The problems with the regulatory agencies is given in Volume 2, and with the culture of the organisations in Volume 3.
Volume 1 outlines the history of poor patient care in the trust from 2003 onwards. The physical details were first released after the inspections of the Healthcare Commission (HCC) in 2008 in their bombshell report of March 2009.
There were paediatric peer review reports of grossly inadequate care of critically ill and injured children. There were not enough haematologists. Nurses in palliative care for cancer patients were lacking.
Dr Foster reports of Standardised Hospital Mortality Ratios showed the hospital appeared to have excess deaths in 2007. In the same year, the Royal College of Surgeons called for the employment of an extra consultant surgeon. Patients’ notes were found to be in a terrible mess, with many records missing. Clinical coding was abysmal.
Alerted by the mortality figures and a flood of patient complaints HCC found on their inspections that the A&E was understaffed in relation to consultants, middle grade doctors and nurses; that receptionists were triaging patients, that there was no consultant surgeon cover at night, that patients were parked in a clinical decisions unit, unsupervised so as to adhere to four-hour wait targets.
It also itemised appalling care on some of the wards, with lack of staff and an excess of untrained healthcare assistants in relation to trained nurses.
It found that the trust board was totally absorbed with making a financial plan in 2005 to achieve foundation trust status.
The £10m savings were made by reducing 150 nursing staff and some medical staff at a time when there were already 120 nurse vacancies.
The Francis report makes clear that the Primary Care Trust and the Strategic Health Authority were completely aware of Mid Staffs financial plan and thought it was normal.
Under Labour health minister Patricia Hewitt, the Department of Health had contracted McKinseys management consultants nationally to eliminate trust debts.
David Nicholson, the current Chief Executive of the NHS, was interim CE of the Shropshire and Stafford SHA responsible for Mid Staffs Hospital in 2005/6. He told the inquiry there were no discussions about proposed workforce reductions.
The hospital was able to get into the black with these measures and even achieved a £1m surplus, and was authorised as a foundation trust on the 1st February 2008. Healthcare Commission did its first inspection in January 2008.
The parallels with today are resounding. Under the Health Act, every hospital trust has to become a foundation trust or be merged or closed.
Every trust is being dangerously financially squeezed by the national £20bn ‘efficiency savings’ cuts and reduced tariffs in the face of rising inflation.
The Francis report admits that the pressures faced by Mid Staffs are systemic.
His report states: ‘The failure was in part the consequence of allowing a focus on reaching national access targets, achieving financial balance and seeking foundation trust status to be at the cost of delivering acceptable standards of care.’
But it stops there. Moreover, Francis positively justifies not studying the root causes.
He states: ‘If there is one central message to emerge from this inquiry it is that the safety of patients and the requirements of fundamental standards are obligations which need to transcend particular policies and to permeate all considerations within the system.
‘Nothing in this report is meant to question or analyse the wisdom or appropriateness of individual policies, ranging from the creation of the foundation trusts concept through to the coalition government’s present reforms.’
With that, his inquiry blocks off the ability to understand what went wrong.
From the adoption of the NHS Plan in 2000, the Labour government accelerated the drive to bring in reforms to prepare the NHS for privatisation, ranging from the purchaser-provider split with PCT commissioning, to payment-by-results tariffs, to private treatment centres doing NHS work, to the requirement for all NHS trusts to become foundation trust businesses and make a surplus.
It was that drive, implemented by a draconian and hugely enlarging NHS management bureaucracy, which drove Mid Staffs to the wall financially and led to massive bed cuts and staff losses nationally in 2005/6.
Francis comes up with a long list of 290 recommendations to address the horrendous clinical negligence displayed at Mid Staffs. But they cannot deal with the problem.
It is no accident that four ‘advisors’, known for their commitment to the government’s reforms, were wheeled in to help him with his recommendations. These were: Nigel Edwards, Kings Fund senior analyst; Judith Smith, Nuffield Trust head of policy; Peter Homa, CE of Nottingham hospital; and Sir Cyril Chantler, chair of University College London Partners.
In his executive summary, Francis at no point questions the resources available. He refuses to criticise the lack of sufficient resources.
Among many detailed recommendations, he says nurses should be revalidated by the Nursing and Midwifery council, as doctors are by the GMC.
He wants healthcare support workers to be registered and undergo a nationally recognised training. They should not be employed in hospitals or care homes without this registration.
Nursing sisters should do ward rounds themselves and with doctors and know the care plans of patients on the wards and not be confined to offices. The RCN should separate its union role and its NHS role.
He wants the commissioners to enforce enhanced standards in their contracts.
Criminal prosecutions of staff are suggested.
He wants a single regulator, a chief hospital inspector.
All staff must tell the truth about standards and care. There must be no gagging clauses.
Francis’ desire for strict inspections leads him to demand hospital closures.
He says that ‘commissioners should be able to stop the provision of a service being supplied in breach of the fundamental and/or enhanced standards and/or require the provision of the service to be done in a different way, or by different personnel to protect patients.’
This gives the coalition government new ammunition to hasten its mass hospital closure programme.
Francis gives the green light for the CQC or the Commissioners (which will be private companies in the Commissioning Support Units to the Clinical commissioning groups) to decide to close down hospitals and replace them with new providers. His method is to ignore the savage government cuts and blame staff, opening the door to mass sackings, a rule of fear, closures and privatisation.
The NHS must be defended by forming Councils of Action that organise occupations to stop closures, and a general strike to bring down the coalition and go forward to a workers’ government and socialism.
