The first inquiry into Mid Staffordshire NHS Foundation Trust catalogued extensive examples of neglectful care and appalling patient experiences. Stories of people being ignored, dehydrated, abused were visible signs of an organisation that had forgotten basic principles of care and at worst, wilfully put organisational considerations ahead of patients. Many, if not most, of the patients involved were older people.
The second inquiry reported in February and included 290 recommendations
that could help to avoid the same situation arising again, not just in Staffordshire, but throughout the NHS. You can see what we said about it in our blog.
The government yesterday gave its response to the report in a paper titled Patients first and foremost, and there’s much to be positive about in what it says.
The paper outlines changes to how services are regulated, reflecting an on-going review by the health and care regulator the Care Quality Commission (CQC). It describes much wider use of expert inspectors in hospitals including members of the public that bring expertise derived from their experience of care.
There will be better information for the public in the form of a ratings systems for hospitals so people will have a much clearer picture about the quality of care. This could be a tool for helping people to choose where they are cared for but also a driver for under-performing hospitals.
There will be a chief inspector of hospitals and a set of fundamental standards that care settings must not dip below. Failing managers could be barred from taking up posts in other parts of the NHS.
These system-level changes are potentially useful, but there’s possibly more interesting territory in proposed changes to the education and development of care staff.
One of the big headlines on the morning of the report’s publication was the proposal to require nurse undergraduates receiving state supported education to undertake up to a year of support work similar to the role performed by healthcare assistants. This typically involves direct, hands-on care such as washing and supporting people to eat and drink. The paper leaves the door open to extend this to other NHS trainees (which we would strongly support).
The paper recognises that most health professionals will spend a large proportion, if not most, of their time caring for older people yet the skills acquired during education and training do not reflect this. It proposes strengthening the focus “on the complex physical and emotional needs of frail older people throughout nursing and other healthcare training”. This is long overdue and if implemented properly is potentially one of the most transformative aspects of the proposals.
These are all welcome and useful changes. As ever, it is only in implementation that their true value can be judged and we will expect rapid progress in the coming months, not least for the many older people that are in hospital right now and cannot wait for longer-term changes to take effect.
If there is something to criticise in the paper, it is perhaps that the content does not quite live up to the title. These are predominantly systems-level changes that will hopefully make it easier and quicker to detect and correct problems. However, what is less convincing is that the value of patients being “first and foremost” is truly recognised. I think few will read this paper and have any real sense of how healthcare based on partnership between individuals and those caring for them is going to be achieved.
Patient-centred care is not an end in itself – it is the means to achieving the best possible outcomes and at the very least a basic expectation. An NHS built on this principle is probably the best hope in preventing another Mid Staffordshire and for finally and comprehensively improving older people’s care.
In partnership with the NHS Confederation and the Local Government Group, Age UK launched the Dignity in Care Commission to drive improvements in the levels of care provided to older people in hospitals and care homes. Find out more about the work of the Dignity in Care Commission