The events at Stafford Hospital have depressing echoes of Bristol and Alder Hey in the UK and Winnipeg in Canada and King Edward Memorial in Perth, Western Australia in the 1990s. These events had a profound effect on the development of clinical governance in the UK. In spite of all the enquiries, all the newspaper inches and the indignant editorials, here we are again.
Press reports (e.g. the Telegraph, March 1st) are suggesting as many as 1200 patients died amid substandard conditions and care. Of course, it is not known how many cases are directly attributable to the poor care. After all, many were seriously ill. Equally, many patients who did not die will have suffered unnecessarily. It now appears that carers and relatives will be pursuing charges of corporate manslaughter against individual senior managers, who have not been disciplined and have moved on, sometimes with large payoffs.
The problems appear sufficiently serious to have produced multiple and complex symptoms. Although blamed on an obsession with targets and indicators, patients and carers also point to failings in basic compassion and care, suggesting that if the malaise started as management failings it spread to almost every aspect of care. Patients, were “robbed of their dignity”, left in soiled bedclothes, unwashed and in states of undress in full view of others
The problem is now to judge the implications for the broader NHS and especially for the debate about health policy leading into the 2010 election. Stafford was a flagship Foundation Trust with 3 stars. On the one hand, it is embarrassing indictment of some of the Government’s flagship policies. Although the substandard care was eventually highlighted by the inspection regime, many patients had suffered by the time the true facts were revealed.
Whilst this may appear a gift for the opposition this close to an election, Tory plans to reduce targets and lighten the inspection regime may reduce the risk of another Stafford, but offer the spectre of taking even longer to highlight such problems. Worse, Foundation Trusts are the logical inheritance of the internal market first introduced by the previous Tory administration. Although the internal market was temporarily demoted in Government rhetoric in the euphoria following the 1997 election victory, it was never far away and may now be seen in Foundation Trusts as providers, and PCTs as commissioners (aka purchasers) not to mention Practice Based Comissioning or fund holding as it used to be called in the bad old days.
The NHS is a remarkable achievement, and has seen huge improvements in the last decade in access and outcomes for a modest increase in resources when judged against the rest of the world. We need to know what went wrong at Stafford, but it would be regrettable if it triggered a knee jerk reaction. It is too important to become an election football, and hopefully, election planning blight will facilitate cool reflection instead.
