Hospitals which are not up to scratch should be forced to close with providers facing prosecution until "appalling standards of care" like those found at Mid Staffordshire NHS Foundation Trust are eradicated, an inquiry has found.
In a damning report that will have wide-ranging implications for the entire NHS, Robert Francis QC said NHS staff and managers should be held accountable, even face criminal proceedings, if patients suffer harm.
An estimated 400-1,200 patients are believed to have died at Stafford General Hospital between January 2005 and March 2009 as a result of poor care.
Francis made a total of 290 sweeping recommendations for healthcare regulators, providers and the government in his 1,782-page report.
If departments do not perform, they must close, he said. "Any service or part of a service that does not consistently fulfil the relevant fundamental standards should not be permitted to continue."
THE KEY RECOMMENDATIONS
- To cause death or harm to a patient by non-compliance should be a criminal offence, and monitored by the Care Quality Commission
- A new registered status for those working with elderly patients
- Healthcare leaders should be held to account and disqualification should be possible. A registration scheme should be implemented
- Fundamental standards should be policed by a single regulator - the Care Quality Commission (CQC)
- A legal obligation for medical staff to own up to mistakes and be open with families of patients - a duty of candour
- An increased culture of compassion and caring in nursing and recommended that there should also be a legal obligation for healthcare providers and medics to observe a "duty of candour"
- Regulator Monitor should be stripped of its powers to award trusts foundation trust status - a supposed marker of excellence in the NHS. The regulator awarded the trust the status in 2008 - at the height of its troubles
The NHS should never have allowed such a "serious systematic failure of this sort" as was found in the Mid Staffordshire NHS Foundation Trust, but had failed in its primary duty of protecting patients and authorities had not responded to "numerous" warning signs .
He slammed a "too great a degree of tolerance of poor standards" and pointed the finger at the trust's board for a "serious failure to tackle and insidious negative culture."
The trust's culture was one of "self-promotion rather than critical analysis and openness", the report states.
Nursing was "completely inadequate" on some wards and patients and families excluded from their care.
He attacked local health authorities and the trust board but he refused to blame any individual for failures at the trust - even though many have previously called for NHS Commissioning Board chief executive Sir David Nicholson to resign over the scandal.
"This is not a case where it was ever going to be possible or permissible to find an individual or a group of individuals was to blame for this," he said.
But f amilies of patients who died at the failure-ridden Stafford Hospital today called for heads to roll at the NHS, as the head of the inquiry into "appalling" failings at its Trust said there should be a "zero tolerance" approach to poor standards in the health system.
Julie Bailey, head of Cure the NHS, said Robert Francis QC's report would give patients "power", but called for the resignation of NHS chief Sir David Nicholson, as well as Royal College of Nursing chief executive Peter Carter.
Bailey said: "We don't want a bully at the top of this organisation, we want a leader who will inspire and guide the staff on the front line.
"Sir David Nicholson needs to resign today. Peter Carter needs to resign today, he has failed the front line.
"We want resignations, we are going nowhere. We have lost hundreds of lives within the NHS, we want accountability."
Speaking as the report was published, Francis said: "This is a story of appalling and unnecessary suffering of hundreds of people.
"They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.
"I have today made 290 recommendations designed to change this culture and make sure that patients come first.
"We need a patient-centred culture, no tolerance of non-compliance with fundamental standards, openness and transparency, candour to patients, strong cultural leadership, caring compassionate nursing, and useful and accurate information about services.
"Regrettably, there was a failure of the NHS system at every level to detect and take the action patients and the public were entitled to expect.
"The patient voice was not heard or listened to, either by the trust board or by local organisations, which were meant to represent their interests."
He said nothing was done about complaints, and the medical community did not raise concerns until it was too late.
The "duty of candour" recommended in the Francis report would represent "the biggest advance in patient safety and patients' rights in the history of the National Health Service", health campaigners said.
A legal obligation for medical staff to own up to mistakes and be open with families of patients should be implemented by the government as part of a "new dawn" of transparency and openness in the public health body, the Action Against Medical Accidents (AvMA) said.
"The government must now accept the recommendation for a legal duty of candour which would represent the biggest advance in patient safety and patients' rights in the history of the NHS," he said.
"So far they have fiercely resisted this.
"The duty of candour, together with other recommendations to ensure full openness and transparency represent a new dawn for the NHS.
"Organisations that sweep errors under the carpet do not learn lessons. An open and transparent NHS will be a safer NHS."
Some experts have expressed doubt that the measures will enact real change.
Caroline Klage, partner and medical negligence specialist at law firm Bolt Burdon Kemp, told HuffPost UK: "In the case of Stafford, the hospital’s application for Foundation Trust status and financial concerns were prioritised over patient care. Budget cuts led to understaffed wards and poorer training and supervision with staff struggling to meet the demands of patients. There was also an obsession with meeting targets to the detriment of patient welfare.
“Unfortunately, the report’s recommendations are unlikely to bring about positive change quickly as organisations are already struggling to cope with further structural changes and to deliver on budget cuts.
"Without additional funding to pay for more staff, appropriate training and better and increased supervision of staff, it is difficult to foresee how improvements can be made.”
David Welbourn, Visiting Professor in Health Systems Management at Cass Business School, commented: “The horror of the circumstances leading to the Francis enquiry demand urgent action.
"We understand the temptation to impose punitive controls on a system that demonstrably failed to understand its core purpose.
"But the danger of such populist intervention is that it will exacerbate the very cultural flaws that created the hole into which Mid Staffordshire Hospitals Trust fell. At its heart, there is only one sure-fire way forwards.
“The solution must lie in reinforcing the statutory duty Board directors already have.
"For too long, we have prevented leaders from making the right decisions at the right time, conditioning them to look over their shoulder to the heavy handed interference of the army of regulators, government departments and politicians.”