Well, at face value, the underlying circumstances at Mid Staffs were not dissimilar to those faced by many trusts today: the drive to become a foundation trust, the need for savings, but, critically, savings made without considering the potential impact on the care of patients. And the result? A loss of public confidence, plummeting staff morale, negative media attention and increased scrutiny from regulators. We can all learn from this story.
So what could have been done differently?
Sir Stephen had some constructive messages for trust boards: first, be clear about your values, remembering the human impact of what you do, and have zero tolerance of poor care and lack of compassion. He reminded boards that, ultimately, the buck stops with you for quality of care – ignore the fundamentals of care at your peril.
At the conference we heard how Mid Staffs is changing to incorporate their values: the board is becoming more engaged with the reality of patients' experiences, through patients' stories, and on the wards; there is greater openness and transparency, with increased public participation in board meetings and better engagement in clinical networks. And we heard that strong leadership, and especially the role of the executive nurse, is crucial in keeping the focus on quality. Sir Stephen urged conference delegates to read and learn from the practical guidance in Dr Foster's recent Intelligent Board on patient experience.
These messages were picked up later in the morning when we heard about the efforts made by other trusts to ensure that from ward to board, the experience of patients is at the top of the agenda. From Nancy Fontaine and Tim Keogh we heard an inspiring example of how Whipps Cross Hospital had moved on from poor patient survey results, harnessing the passion and commitment of staff to help focus and build on examples of excellence. And from Annie Laverty and Northumbria Healthcare, we heard about innovative ways of making sure that patients' experiences are monitored regularly, and how this information helps everyone from frontline clinical staff to the executive team to keep the focus on patients.
It is hard to motivate a demoralised workforce. But throughout the day we were reminded of the strong link between the experience of staff and that of their patients. The introduction of the Schwartz Center Rounds at the Royal Free and Cheltenham hospitals was held up as an exemplar, offering a means of supporting staff with the emotional impact of caring.
Cuts will affect the NHS for years to come. But the lesson from Mid Staffs is that cuts cannot be made without considering safety and patients' experiences. Sir Robert Francis' words were quoted throughout the day and remain essential: 'Always remember, people come before numbers.'