NHS: Mid Staffordshire NHS Foundation Trust

Viscount Eccles Excerpts

Monday 11th March 2013 Lords Chamber

[Viscount Eccles]

My Lords, it is a great pleasure to follow the noble Lord, Lord Patel. Of course, I must defer to him, as he knows far more about the National Health Service than I do. I have been a patient but do not have anything like his depth of knowledge.

There is not much that we do not know about Mid Staffs. A lot of it dates back a fair number of years. The Francis findings were amazing, and the taking and recording of the evidence was truly a wonderful job done. There was a complete failure of management. Nobody had any confidence in anybody else there. However, time has gone by and things have been done since, and I feel quite cautious about how much we should generalise out of the experience of one hospital. I think we should treat this with caution.

Much has been done since. There have been changes in the management and governors of the trust. It is well recorded that there have been significant improvements from a very bad position. Of course there is always more to be done, but that is a condition of all our lives; there is no end to continuous improvement and never will be.

This takes me to the 290 recommendations in the Francis report. I do not feel at all capable of dealing with those. As the noble Lord said, we await the Government’s response. In fact, there are rather more than 290 recommendations, if you add in the bullet points. There are some 10 bullet points within some recommendations. To me, the trust’s most important decision and most important choice is who to appoint as its chief executive, with the necessary knowledge and the team-building skills that go with that knowledge. Hospitals are complicated and continuous operations. No two patients present in the same way. Mid Staffs provides 48 distinct services.

The new chief executive has her chairman and his governors, six executive directors and four heads of clinical directorates: 10 people in executive positions. Of these 48 services, 40 are medical and the other eight finance, administration, and so on. I must be careful to point out that the trust and Mid Staffs are not exactly the same thing. The trust employs close to 3,000 employees, so the 48 services, with the 3,000 employees, are the management responsibility of the 10: the executive directors and the heads of the clinical directorates. Clearly with that number of employees and that number of services, there is a need for a detailed and well understood middle management structure. After all, there are 120 consultants, all professionally qualified and all of a certain seniority.

I will end with one example of how one needs to look at the middle management—the 800 in admin and estates—and the person within that system who is responsible for bed linen. That person needs to hold a budget, and needs to be sure that the supplies of bed linen are as they should be, that the laundry works as it should, and that the linen is available. If one looks back to the Francis report and tries to find how the reports that have been done have tackled these very detailed problems of middle management—MRI, ultrasound, X-ray, or what you will—there is not much to be found. I therefore urge us to concentrate our minds on the management, the staffing, and the leadership of individual hospitals, and not to widen our look too greatly.