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Changing the culture of the NHS

by Martyn Eden

The performance of Stafford Hospital between 2005 and 2008, when 1,200 patients died unnecessarily and patients were sometimes grossly neglected, fell well below acceptable standards expected in NHS hospitals. Robert Francis QC was appointed to investigate and recommend how high standards could be re-established and maintained. Francis took 31 months and delivered 290 recommendations in his three volume report.

This has been widely praised and many of Francis' recommendations have been accepted by both Government and Opposition. Jeremy Hunt, the current Health Secretary, presented his initial responses on Monday, focusing on five priorities. His first was to prevent a recurrence by creating a culture of zero harm and compassionate care that makes patient needs central. Too often success in hospitals is measured in compliance with regulations and meeting targets, not listening to patients and treating them with dignity, respect and high clinical standards. That had to change, said Hunt, who will appoint a Chief Inspector of hospitals and social care to root out failing hospitals.

He also wanted to ensure problems in patient care are detected early and proposed a new statutory duty of candour so that problems are not swept under the carpet. He said the issue at the Stafford hospital was not that the problems were unknown but nothing was done about them. A more robust accountability is needed and he would legislate to create legal sanctions at the corporate level of social care organisations that wilfully generate misleading information or withhold it altogether. Any manager found guilty of gross misconduct would be barred from working in the NHS.

More controversially, Secretary Hunt wants student nurses to spend a year working on the wards as healthcare assistants meeting the most basic personal needs of patients and learning to recognise their importance. This experience would be a prerequisite for receiving funding for their degree courses. Whilst Andy Burnham, the Shadow Health Secretary, cautiously welcomed this he challenged the Minister to address the issue of hospital staffing levels. He argued that culture change will never work if wards are understaffed and over-stretched and claimed that one in ten English hospitals do not have adequate staffing levels. Jeremy Hunt responded that there is 6000 more clinical staff in the NHS today than when the Stafford problems occurred.

Public opinion accords a high priority to health and the NHS and the treatment of patients in the Mid Stafford hospital were shocking. Failure to deal effectively with the causes would be electorally damaging. From a Christian perspective what happened was totally incompatible with the belief that all people are made in God's image and worthy of respect, however ill, disabled or demented they might be. Has this perspective been lost in our increasingly secular society? If so, is culture change possible without recognising this?

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