Stafford Hospital Inquiry report out today

The tragedy of the last five years will be exposed today when Robert Francis QC makes his report public…

Awful for those people who have lost friends and family with yet more revelations in the fourth report on what is thought to be over 400 deaths in dubious circumstances at the hospital.

I met with Robert Francis, who has led the Inquiry team, six months ago to discuss his scope and approach in advance of him starting his work.

I wrote at the time that he seemed determined, honest and hopeful although it’s fair to say that during the ninety minutes we spent talking he was doubtful that his remit allowed a close enough look at the national hospital regulators… something I was certain he should look at from my experiences to date in the world of public inspection and regulation.

That meeting was soon after I’d taken up my new Cabinet responsibilities for Social Care and Health in Staffordshire and my only direct experience around the events at the hospital at that time was when I took part in a County debate on Stafford Hospital just before the elections of last June.

That debate and the research I’d done in prep also convinced me that apart from the obvious catastrophic failings of the hospital and Board, the regulators nationally must be at direct fault and local bodies looking at the hospital’s work clearly needed greater powers and much better coordination to be more effective.

I’ve spent much of the last seven months in post tackling the culture of ‘tick box’ inspection and the gathering of inordinate amounts of data to support inspection and the bureaucratic appetite of those ‘men in suits’ who swoop in and out of the public sector to take their ’snapshot’ based almost entirely on data and almost no people focussed view to quality.

And the industry that has grown up, in effect, to meet (or beat) that Government appetite for target based inspecting is too costly to the tax payer, takes money and resource away from front line delivery and devalues further the limited amount of data and target based inspection which may have some use. In the last seven months I’ve learned far more about the performance and service outcomes in my Department from human beings, internal and external… good and bad, rather than stats.

Figures and data can be made to say what is needed much of the time in the inspection busting world but talking to those at the sharp end, service users and providers, often gives one a sense of an organisation’s ‘health’ and effectiveness in a way bureaucracy cannot.

I’m not saying don’t collect any performance information… the right stuff in the right quantity is useful, particularly for an organisation’s self awareness. In Staffordshire’s Social Care and Health that message is now embedding nicely. One of my most senior officials regularly now says to management… ‘We do what’s right for people and for Staffordshire and if that gets the Stars (public services are often marked like hotel in star ratings) that’s a bonus, but we don’t live and die by it’. Wise words, I wonder who said that! 

That principle is fundamental to me and it’s clear that the management and Board of Stafford Hospital were focussed almost entirely on targets and providing rich pickings for those ‘men in suits’ rather than the people they should be… patients and quality staff.

I believe the robotic style of inspection and regulation has pretty well seen its day, and rightly so. Talk to people, talk to those who have human reasoning and use figures, data and bureaucracy to support or challenge those human views… don’t let it dominate.

As far as Stafford Hospital is concerned I said a year or so ago that ‘everyone was looking but nobody saw’ what was happening. By that I mean the other local bodies that oversee health in Staffordshire also broadly missed what was happening and certainly didn’t manage to stop it.

And there too it was pretty obvious that there were too many bodies overall and a lack of clear accountability and collaboration. The Local Involvement Network (LINk) is a good example as is its lack of joined up working with Staffordshire’s statutory Health Scrutiny Committee made up of elected Members.

I’ve written before about LINk and I decided it needed a fresh start, not directly because of Stafford Hospital (there were many bigger national regulatory failings than LINk), but because it wasn’t working and there was certainly little sign of the LINk volunteers being the boots on the ground for hands on practical inspection and then feeding back in to the Staffordshire Health Committee who are tasked with the strategic overview and have the teeth to ask the hardest questions of those running health and social services (including me!).

Going forwards, I know that the Health Committee since the June election has a more focussed approach and I’m determined that the relaunched LINk should work closer and more collaboratively with that statutory committee. So moving forwards I do have more confidence under the new and improved local arrangements now being developed since June.

I also have much greater confidence in Anthony Sumara, the new Chief Exec of the hospital. As I’ve said before he is not frightened to start at the ground up, working on basic human good manners, care and dignity for people. And he’s someone who has, not a low, but no tollerance of staff who cannot grasp that fundamental value. He’s also someone who is big enough (literally in Anthony’s case) to admit there’s a mountain to climb.

That’s fine, as long as there is clarity about the fastest and safest route to the top. I think he has that clarity and is actively, no, robustly determined to achieve what is needed.

As far as the past is concerned there a lot of people, hurt people, who feel they still don’t have all the answers. I think that the report which comes out today will answer many more questions than ever before but if a Public Inquiry offers people, so many people, the semi-closure and comfort it might then perhaps there is value for that reason alone.

The question I struggle with is this. What are the consequences for those who worked at the Mid Staffs Foundation Trust directly overseeing and contributing to such a human and managerial catastrophy? This was so bad, so cruel in places that the fact there are so few sanctions for such bad leadership other than living with what happened for the rest of their lives is troubling and, probably, wrong.

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