Mid Staffordshire: a hospital that lost its way

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Stephen Moss, Chair of Mid Staffordshire NHS Foundation Trust opened the Point of Care conference this week by talking about the lessons he had learnt from the 'story of a hospital that lost its way'. He described how Mid Staffs had lost sight of its core purpose of providing safe and compassionate care. So what went wrong, and what can be done to prevent such a tragedy happening again?

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.'

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Comment date
23 January 2011
MB. My point was not to be critical of Healthcare Professionals and I am sorry if I caused offence. My issue was rather with the focus on "science" in healthcare education and less and less on the human person. My comment was in response to a situation in one Trust where the qualities you describe were found to be lacking to such a degree that they added to the suffering rather than healed. I speak not only from my own experience but from listening to the stories of patients and relatives with whom I am in contact daily and seeing the pressure you describe at first hand. I truly beleive Its not all about money or management..its about the art of medicine as well as the science. ..


Comment date
22 January 2011
I too have many years experience working in the NHS, and I am profoundly saddened by Mark's viewpoint (see above).
I work for a large and very busy Trust. The staffing numbers are not always what is required to deliver the best-possible care, but many, many of the staff (nursing/medical/housekeeping and a variety of others) work over and above the call of duty and frequently do not leave on time because they are caring for patients/relatives.They give up their break times (badly needed) to continue to offer washes/drinks/general help, against constantly -changing ward and organisational targets.
To accuse them of lack of compassion is clearly unfair, when they are trying to deliver excellent care against a backdrop of increasing numbers of frail elderly patients with multiple needs, requiring constant input, whilst the staff arrange discharges/ transfers/ discharge medications/ medical rounds / drug admiistration / talking to relatives.
I have seen staff comfort distressed patients and relatives, talking to them with great compassion, not lndicating in any way that they still have many tasks to complete.
It is not ALWAYS possible to offer this level of service, but I see it offered as the rule, rather than the exception, even when it encroaches on the member of staff's own time.
Mark, to answer your quote: We DO remember this today, and will tomorrow.
Please have consideration and compassion for the staff, because , frankly, I think they work miracles, and deserve rather more appreciation.


Comment date
21 January 2011
From many years experience of working in Health and Social Care it has become clear to me that words like "compassion" and love" have virtually disappeared from the vocabulary of the professions. These qualites cannot be taught in Universities and the academic power houses whre Doctors and Nurses are trained with their science and evidence base. In the 19th century William Osler, a distingusihed Physican wrote " thet practice of medicine is an art, not a trade, a calling not a business in which your heart will be exercised equally with your head". We would do well to rememebr this today.

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