An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire.
The report being published on 6 February 2013 of the public inquiry chaired by Robert Francis QC will be the fifth official report into the scandal since 2009, and Francis’s second into the hospital’s failings.
The often horrifying evidence that has emerged means “Mid Staffs” has become a byword for NHS care at its most negligent. It is often described as the worst hospital care scandal of recent times. In 2009 Sir Ian Kennedy, the chairman of the Healthcare Commission, the regulator of NHS care standards at the time, said it was the most shocking scandal he had investigated.
It is commonly known as the Mid Staffs scandal because Stafford hospital was and is run by the Mid Staffordshire NHS hospital trust, which in 2008 acquired foundation trust status, making it semi-independent of Department of Health (DH) control. Decision-making and especially cost-cutting as part of its pursuit of that status was later cited as a key reason why poor care took hold and was allowed to persist for so long.
2. Why is it in the news again now?
On Wednesday 6 February Francis will publish the report of his 31-month-long public inquiry into the scandal. His first report, published in February 2010, was an independent report under the NHS Act rather than a full-blown public inquiry. It examined the quality of care at Stafford hospital in 2005-09 and the many reasons why it was so bad, such as inadequate staffing, and produced devastating conclusions.
The public inquiry began in July 2010. Its remit was to investigate what a wide range of commissioning, supervisory and regulatory bodies and systems in the NHS had done to detect poor care at Stafford and to intervene. As such it probed the role of the bodies and individuals all the way from the hospital itself – including the trust’s board and its patient liaison group – up to the most senior figures at the Department of Health in Whitehall, including ministers, senior civil servants and key figures in the NHS.
Its brief included its duty “to examine why problems at the trust were not identified sooner; and appropriate action taken. This includes, but is not limited to, examining the actions of the Department of Health, the local Strategic Health Authority, the local primary care trust(s), the Independent Regulator of NHS Foundation trusts (Monitor), the Care Quality Commission, the Health and Safety Executive, local scrutiny and public engagement bodies and the local coroner.”
3. How did the poor care come to light?
Although care was poor from at least the start of 2006, concerns about that only began emerging in mid-2007. At that time the Healthcare Commission (HCC), the then NHS care regulator, became anxious that Stafford seemed to have unusually high death rates, drawing on information from Professor Brian Jarman, an expert in patient safety and hospital death rates at Imperial College London.
By January 2008 the watchdog had identified seven different patient safety alerts at Stafford: warning signs that there were problems. Dissatisfied with the hospital’s explanation for the apparently high mortality rate – that it was down to “coding errors” – the HCC told a team of its investigators under Heather Wood, renowned as its “hard cases woman”, to get to the bottom of what was happening at the hospital. That was the first of the five inquiries.
Julie Bailey, whose 86-year-old mother Bella died in the hospital as a result of poor care in late 2007, also played a key role in exposing the Mid Staffs scandal. She quickly came across other families who had lost a loved one, realised there was a problem and, with other bereaved relatives, formed the campaign group Cure The NHS to demand a public inquiry and hold those reponsible to account.
4. The public inquiry
Andrew Lansley, the then health secretary, commissioned the full public inquiryin June 2010, soon after the coalition took power. It was held under the Public Inquiries Act 2005. Labour in 2009 and 2010 had refused to accede to persistent requests from relatives of victims of the Mid Staffs scandal to hold such an inquiry. Instead ministers commissioned the first Francis report as well as two other, separate inquiries into specific aspects of how the hospital and local healthcare system operated. They were led by Professor George Alberti, the DH’s national clinical director for emergency care, and Dr David Colin-Thome, his counterpart at the DH for primary care. They reported in April 2009.
Francis began gathering evidence in July 2010. He initially hoped to deliver a report to ministers by early 2011. Instead it became a particularly in-depth and long-running inquiry. The inquiry took oral evidence from 164 witnesses over the 139 days it sat between November 2010 and December 2011, and also received 87 witness statements and 39 provisional statements, and over a million pages of evidence in total.
Tom Kark QC, counsel to the inquiry, and Francis himself questioned witnesses.
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