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NHS faces 'tension' over finances


Robert Francis said NHS trusts accepted that "quality needs to be given much greater priority"

Robert Francis said NHS trusts accepted that "quality needs to be given much greater priority"

Robert Francis said NHS trusts accepted that "quality needs to be given much greater priority"

The NHS is facing a "profound tension" between financial constraints and the need to provide high quality care, according to a report published on the anniversary of the inquiry into Mid Staffs.

The study, involving key managers in NHS trusts, found agreement that the need for excellent care must have a higher priority in the health service.

It comes after Health Secretary, Jeremy Hunt, said yesterday the scandal at Stafford Hospital was the "worst thing" in the history of the NHS and warned more hospitals could end up in special measures.

In a foreword to today's report, Robert Francis QC, who chaired the public inquiry into Mid Staffs, said NHS staff must understand that criticism of "poor and unacceptable practice" is not aimed at them but is "part of a struggle to support everything they stand for".

He said the vast majority of NHS staff are "consistently hard-working, conscientious and compassionate" and want to do what is best for their patients.

Mr Francis' inquiry report was published exactly a year ago and contained 290 recommendations for action to prevent another scandal like at Stafford Hospital.

Between 400 and 1,200 more patients died than would normally be expected at Mid Staffordshire NHS Foundation Trust during years of neglect.

Mr Francis identified a culture where patients were not at the heart of the system and said failings went from the top to the bottom of the NHS.

In his foreword, Mr Francis said it the study revealed a general acceptance among trusts that "quality needs to be given much greater priority".

He said where trusts could not provide quality services for patients within the money allocated to them, it was up to trust leaders "to communicate that openly to those responsible for commissioning and funding services.

"That then needs to lead to a frank discussion about what needs to be provided within the available resources and what cannot. It is unacceptable to pretend that all can be provided to an acceptable standard when that is not true."

The research involved 48 in-depth interviews with predominantly senior staff at five hospitals, and the responses of 53 hospital trusts to an electronic survey.

It found general enthusiasm for the contents of the Francis Inquiry report, but noted a "profound tension" between the desire to provide quality services and financial constraints.

One leader said: "I'd rather be hung for money than for quality and safety."

The report said Francis had "brought a powerful sense of professional shame" but added: "The pressure to stay within limited budgets that existed at the time of Mid Staffordshire has not gone away but has intensified, as funding increases for the NHS have been frozen in real terms since 2011/12.

"Resolving concerns about poor-quality care with additional expenditure on staff is likely to be challenging for trusts, as they try to ensure safe staffing levels and skill mix within the context of often-stringent cost-improvement programmes and the pressure to meet their financial objectives."

The report also said some staff still do not feel comfortable in raising concerns about poor care in their trusts.

Mr Hunt said yesterday he thought the " last year has been an absolute nightmare for the NHS."

He added: "The Mid Staffs shock was probably the worst thing that has happened to the NHS in 65 years."

Mr Hunt said he believed the public would be "very reassured" by the report.

"Of course there are lots of challenges, the changes aren't going to happen overnight," he told BBC Breakfast.

He said it was an "encouraging start", but added that there is "lots, lots more to do".

Speaking on BBC Radio 4's Today programme, Mr Francis said changing the culture in the health service would take "a long time".

He said providing proper care need not cost more - but if it did there should be "frank conversations" about funding levels.

"Clearly, as everyone would accept, there is still a lot of work to do," he said."Even I still receive letters from people who are not satisfied with the way their concerns are dealt with.

"It takes a long time for a very complicated and huge organisation to change. It requires great leadership at trust level. It requires registrars and others not to be continually appearing to be bullying people, even if that is not their intention."

Mr Francis went on: "Clearly there must continue to be conversations about money. But where the mistake is often made is a belief that you cannot have safe and effective care being provided without spending a lot more money. All the evidence shows that safe and proper care actually costs you less in the long run.

"I am afraid in my job as a barrister doing clinical negligence I see the bill that comes in from not doing it properly.

"You have to remember what we found at Stafford. We found cases of patients being left in their dry faeces because they were not being cleaned. I don't think we can properly say the NHS is providing proper care if it cannot stop that happening.

"If that costs money and they haven't got the money, then we need to have a very frank conversation about what the priorities are."

Mr Francis suggested that prescribing how many nurses should be on duty in a ward may not be appropriate, but he backed moves to provide better guidance for managers on staffing levels for different situations.

The report on interviews with NHS managers was published by the Nuffield Trust.