There's concern, rightly, that the Mid Staffordshire NHS Trust let people down spectacularly.
The inquiry has released a lengthy report on this, with evidence from over 900 patients/carers as well as staff from the hospital.
His headline message is, dishearteningly, not surprising. It is that, "The Inquiry found that a chronic shortage of staff, particularly nursing staff, was largely responsible for the substandard care."
The grim care described is not that different from some of the patients I've seen in our local hospital. Some of the ignored dementia patients rolling around in faeces, and patients left with food out of reach, is exactly the same as poor care that I have seen in our acute Trust, up the road. Therefore the Health Secretary's assertion that, "This was ultimately a local failure," does not ring true. Sadly, I'm more convinced that the president of the Patients Association comment has it nailed with, "The scale of problems at Stafford might have been unique but failures in essential nursing care are not."
If you don't have enough staff, you can't deliver quality care, but heck you can't even deliver acceptable care. How viable is it for ward staff to close the doors and refuse admissions because they feel it's unsafe to do so? Notionally they're obliged to, since the NMC and GMC require nurses and doctors to provide safe care. We've been that bold in community teams, refusing referrals because we can't provide safe care. You wouldn't believe the trouble that got me in to (being summoned to explain this to the great and the good, which was incredibly illuminating for them!) but I still do it (and have done so twice this week already - we deliver good care and can't accept work then deliver substandard care) but it's only working because the team's convinced it's the right thing to do.
Managers have had to accept this. Managers can direct systems, they can't manage direct clinical care. A manager can't say that I have to see Mr Smith and tell him blah and prescribe drug X for him at this dose. Sure, they can generate a framework for me to see patients and can force a Job Plan on me determining where I am and when I'm there, but qualified staff are professionals. Rather than technicians, undertaking what we're tasked to do, that means we're responsible for making decisions on the specific clinical care of the patient in front of us. Managers can't meddle with that. This empowers clinicians, enabling significant leverage in service delivery. We can do what's right for our patients, which can mean suggesting referral to another provider since we aren't in a position to provide appropriate care.
The NMC Code requires nurses to advocate for their patients. Do nurses advocate that admission to Ward X is unsafe? Do nurses allow admissions when they feel the ward's inadequately staffed/resourced to provide appropriate clinical care? They do so usually because nursing hierarchy is notoriously hierarchical and it's seen as unthinkable to say, "No!" to a boss. But when the whole team says, "No!" and it's the Consultant writing the letter saying we'd love to provide care but we're not in a position to do so since such care would be unsafe (and we can't accept then deliver unsafe care), shifting it from a managerial to a clinical decision changes the problem (and solutions) significantly.
Team work. It has to be the way forward.