Limegreen on Mid-Staffs Inquiry

The latest inquiry into the Staffordshire health scandal will be published next week.

As the NHS and its governing bodies prepare for the fall-out, relatives of those who died at Stafford Hospital say the NHS must stop “dabbling with quality and safety” and “change behaviours from the top to the frontline”. Julie Bailey, of the campaign group Cure the NHS, and whose mother died at Stafford, claims until a “zero-harm; right first time” attitude prevails across the service, nothing will change and “unnecessary deaths” will continue.

Her comments were made to LimeGreen Media a week before the publication of The Mid-Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Robert Francis QC, the inquiry was established to look into the role of the commissioning, supervisory and regulatory bodies in the monitoring of the Trust between 2005 and 2009. His first independent inquiry looked into the individual cases of patient care and the internal operation of Stafford Hospital. (
He concluded then that the most basic elements of care were neglected; that a chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care. Morale at the Trust was low, and while many staff did their best in difficult circumstances, others showed a disturbing lack of compassion towards their patients. Staff who spoke out felt ignored and there is strong evidence that many were deterred from doing so through fear and bullying.

In his opening statement to this second Inquiry, Francis said, “in my first inquiry I sat and listened to many stories of appalling care. As I did so, the questions that went constantly through my mind were: why did none of the many organisations charged with the supervision and regulation of our hospitals detect that something so serious was going on, and why was nothing done about it?”

Julie Bailey believes the NHS needs to introduce a safety management system;”one regulator, standardised practice, so that what happens in one institution happens in another” and only then will patients’ safety be guaranteed.

Debate and opinions over what the inquiry might recommend are widespread. The Health Secretary, Jeremy Hunt, wrote in the Sunday Telegraph (6 Jan 2013) that preventing such scandals requires openness and transparency, proper accountability and better use of technology; “Most of all we need a change of culture. Patients must never be treated as numbers but as human beings, indeed human beings at their frailest and most vulnerable.” (

In preparation for the launch of the inquiry’s report, the NHS Confederation
has developed an interactive presentation which gives a brief overview of the background and the key areas where it expects recommendations to be made.

The King’s Fund have published a variety of specialist reviews on what it considers will be the issues raised by the public inquiry;

• how to embed the patient voice throughout the system
• how to engage health care staff generally in the leadership and management of their organisations
• the standards set for the safety and quality of care, and who should have the responsibility for setting and enforcing them
• the role of foundation trust governors and members, and other local public, patient and staff representatives
• the collection, use and sharing of information and data

Their considerations of these issues can be found here;

Robert Francis QC plans to deliver his final report to the Secretary of State for Health on Tuesday 5 February 2013. The report will be published on Wednesday 6 February 2013.

Julie Bailey’s campaign Cure the NHS list their aims, expectations and consequences of the report here;

Julie says it’s time for the NHS to stop “bumbling along, learn lessons, put their hands up and say let’s make the changes necessary and stop it happening again.”

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January 31st 2013

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