Andrew Hind reminds charities of the lessons they should take from the public inquiry into the Mid Staffordshire NHS Foundation Trust.
Up to 1,200 people are believed to have died unnecessarily at Stafford Hospital between 2005 and 2008, making it the worst disaster in the history of the NHS.
As we all know, the results of the public inquiry into the appalling conditions and management inadequacies overseen by the Mid Staffordshire NHS Foundation Trust (which was responsible for the hospital) were published last month. The inquiry chairman, Robert Francis QC, concluded that patients were “routinely neglected by a Trust that was preoccupied with cost-cutting, targets and processes and which lost sight of its fundamental responsibility to provide safe care”.
I am sorry to say that there are lessons in this report that apply, to one degree or another, to many large charities. I defy you to read Robert Francis’s conclusions and not acknowledge – even if only to yourself – that some of the problems he describes do not apply to the charity (or charities) with which you are involved.
Cataclysmic
Here is a flavour of the cataclysmic series of problems at Mid Staffs which the Francis inquiry uncovered – for ‘patients’ you just have to substitute ‘beneficiaries’ or ‘service users’:
“The board, and other leaders within the Trust, failed to appreciate the enormity of what was happening, reacted too slowly, if at all, to some matters of concern of which they were aware, and downplayed the significance of others.
“There was an ingrained culture of tolerance of poor standards, a focus on finance and targets, denial of concerns, and an isolation from practice elsewhere. “The Trust’s culture was one of selfpromotion rather than critical analysis and openness. It took false assurance from good news, and yet tolerated or sought to explain away bad news.
“Staff and patient surveys continually gave signs of dissatisfaction with the way the Trust was run, and yet no effective action was taken and the board lacked an awareness of the reality of the care being provided to patients.
“The board failed to get a grip on its accountability and governance structure throughout the period under review. The Trust’s leadership was expected to focus on financial issues. Sadly, it paid insufficient attention to the risks in relation to the quality of service delivery this entailed.
“Throughout the period the Trust suffered financial challenges. The economies imposed by the Trust’s board, year after year, had a profound effect on the organisation’s ability to deliver a safe and effective service. The Trust prioritised its finances over its quality of care, and failed to put patients at the centre of its work.
“The board must collectively bear responsibility for allowing the mismatch between the resources allocated and the needs of the services to be delivered to persist without protest or warning of the consequences.
“It is a significant part of the Stafford story that patients and relatives felt excluded from effective participation in the patients’ care. The concept of patient and public involvement in health service provision starts and should be at its most effective at the front line.”
The main learning point for us in the charity sector is surely clear. In today’s austere financial environment, it is more important than ever to ensure that the quality of services to end-users is the central component of our boards’ strategic discussions.
Whether we are trustees or executive leaders, we must focus on creating in our charities what Francis calls “a common culture of caring, commitment and compassion”.
Finance and targets are important. But they must only ever be a means to an end; not the end itself. Let that be the lesson all of us in civil society take from the terrible events at Stafford Hospital.
