NHS Overhaul Will Include 'Ofsted-Style' Ratings For Hospitals, Blacklisting Bad Managers, Says Jeremy Hunt

NHS managers responsible for their hospitals' failures will be "struck off" and barred from working in the health service and under-performing hospitals will be named and shamed under new plans to prevent a repeat of the "horrific" Stafford Hospital scandal.

And aspiring nurses will have to work for up to a year as a healthcare assistant or support worker before they can apply to become a nurse, Health Secretary Jeremy Hunt announced on Tuesday.

Hunt said the events at Mid Staffordshire NHS Foundation Trust were a "betrayal of the worst kind" to patients and their families.

Julie Bailey, founder of Cure The NHS with protesters outside an NHS board meeting in Manchester

But the leading campaigner for changes in the NHS in the wake of the Mid Staffs scandal said the changes did not go far enough. Julie Bailey, who set up the Cure The NHS group after her mother Bella died at Stafford Hospital in 2007, told the BBC: "I really don't feel the changes go far enough.

"This was a failing from ward to Whitehall, we lost hundreds of people here."

More controversially, Hunt backed NHS boss Sir David Nicholson, who was in charge of the regional health authority responsible for the trust for a short period while patients were being mistreated.

Many, including Bailey, have angrily called for his resignation in the wake of the Mid Staffs scandal.

Hunt said he has an "honest different of opinion" with a number of people about Sir David's responsibility for what happened at the trust.

"But I will accept that he was a manager in a system that failed to spot this happening and he shares some responsibility for that.

"The key point about him though is that he was in charge of 50 hospitals for a nine month period when some of the horrific things at Mid Staffs were happening and nothing in the system brought that to the surface.

"What today is about is creating a structure which will make it impossible for those kinds of problems to happen without them surfacing."

Bailey said in response: "These policies came from the top, and they worked all the way down to the ward. We don't need this command and control type management.

"We need a new leader at the top of the NHS, we need a leader that galvanises and inspires the workforce. We've got staff who don't want to work for the NHS, we've got patients frightened, older people frightened to go into NHS hospitals.

"This has got to change, and it's not going to change with this style leadership, command and control, we need much more emphasis on the culture and behaviours of the people within the NHS, and that starts at the top."

Responding to the Francis report into serious failings at the trust, Hunt said a new chief inspector of hospitals will be appointed and will shine the spotlight on failing trusts.

He also introduced a legal duty for the NHS to be honest about mistakes in care.

He announced plans to introduce a "national barring list" for managers who let their patients and the NHS down.

A number of Hunt's measures were criticised by health experts.

Health Secretary, Jeremy Hunt announces to the House of Commons that aspiring nurses will have to work for up to a year as a healthcare assistant or support worker before they can apply to become a nurse

The Royal College of Nursing said the response is "muddled and piecemeal" and should have introduced minimum staffing levels.

The Alzheimer's Society said the failure to introduce a regulatory system for healthcare assistants could compromise patient safety.

And others, including think tank The King's Fund and the British Medical Association, questioned the move for Ofsted-style ratings.

Chris Ham, chief executive at think tank The King's Fund said: "The value of aggregated ratings for hospitals is highly questionable; these are complex organisations with different services and specialisms that may vary in quality so an overall rating can hide significant failings within a trust."

Dr Mark Porter, chair of council at the British Medical Association, added: "The purpose of the inspection regime should be to ensure that NHS organisations are focusing on their primary mission - to provide safe, high-quality care. We need to avoid a system that encourages managers to focus unduly on ratings.

"It's important that patients have access to information about the quality of services. However, most healthcare providers are extraordinarily complex organisations, and it is impossible to reduce everything they do to a single meaningful score.

"Even individual hospital departments and GP practices provide a wide range of different services.

"It is vitally important that we do not allow a ratings system to create a misleading picture of any hospital department or GP practice. This would be unhelpful to patients, as well as demoralising to staff."

Labour's shadow health Secretary Andy Burnham said the response "falls short" of what was promised following the publication of the inquiry report last month.

He added: "Robert Francis made a very clear case for a new system of regulation of healthcare assistants to improve basic standards. Yet this didn't feature in today's response.

"Labour supports moves to rebalance nurse training to include more hands-on experience, but safe staffing is the glaring omission today. We will never get the right culture on our wards if they are understaffed and over-stretched."


  • Hospitals will be subject to Ofsted-style ratings and will be given a single rank such as "outstanding", "good", "requiring improvement" or "poor".
  • Failing NHS bosses will be put on a blacklist to ensure they can no longer work in the health service.
  • A new Chief Inspector of Hospitals will name and shame poorly performing trusts.
  • The new inspector will also act as the "nation's whistleblower".
  • There will be a "statutory duty of candour" for NHS providers so patients are fully informed if something has gone wrong with their care.
  • There will be a ban on gagging clauses which prevent NHS staff speaking out on patient safety issues.
  • Surgery survival rates will be published to "improve standards".
  • Trusts that fiddle mortality data figures will face "legal sanctions at a corporate level".
  • A new set of "fundamental standards" will be drawn up so every patient knows what basic rights they should expect of the health service.
  • NHS trusts which do not deliver adequate care to patients could be put into a "failure regime" and put into administration.
  • NHS pay progression will be linked to performance in delivering high-quality care.
  • There will be a review to assess how the "bureaucratic burden" on frontline staff can be reduced.
  • Aspiring nurses will have to work for up to a year as a healthcare assistant or support worker before they can apply to become a nurse.
  • Nurses will face a revalidation process - similar to the one recently introduced for doctors - to prove they are fit to practise.
  • Healthcare assistants and support workers will be given a new code of practice and will receive training which must meet minimum standards.
  • The support staff could also be put on a blacklist if they are deemed "unsuitable" to care for patients.
  • An NHS management MBA-style qualification to entice more leaders into the health care system.
  • All civil servants working in the Department of Health will be given "hands on" experience in the NHS to ensure they know how frontline staff operate.
  • A new Chief Inspector of Social Care will be introduced to apply a new ratings system to care homes.

In the report, Robert Francis QC, chair of the public inquiry into the "disaster" at Mid Staffordshire, highlighted "appalling and unnecessary suffering of hundreds of people" at the trust between 2005 and 2009.

As many as 1,200 patients may have died needlessly after they were "routinely neglected" at the hospital.

Many were left lying in their own urine and excrement for days, forced to drink water from vases or given the wrong medication.

Outlining the Government's initial response to the report, which was published seven weeks ago, Hunt also confirmed that hospitals would be subject to Ofsted-style ratings - where hospitals will be given a single rating such as "outstanding", "good", "requiring improvement" or "poor".

The chief inspector of hospitals, who will be responsible for giving hospitals the ratings, will also act as "whistleblower-in-chief" and will be able to highlight care failings "without fear or favour from politicians", the plans say.

If trusts do not deliver adequate care to patients, they could be put into a "failure regime" and may ultimately be put into administration, Hunt added.

He outlined plans to link NHS pay progression to performance in delivering high-quality care and also proposed "statutory duty of candour" for NHS providers so that patients are fully informed if something has gone wrong with their care.

Hunt said he wants to embed a culture of "zero harm and compassionate care" in the NHS.

"The events at Stafford Hospital were a betrayal of the worst kind," Hunt said.

"A betrayal of the patients, of the families, and of the vast majority of NHS staff who do everything in their power to give their patients the high-quality, compassionate care they deserve.

"The health and care system must change. We cannot merely tinker around the edges - we need a radical overhaul with high-quality care and compassion at its heart. Today I am setting out an initial response to

Robert Francis's recommendations. But this is just the start of a fundamental change to the system.

"I can pledge that every patient will be treated in a hospital judged on the quality of its care and the experience of its patients. They will be cared for in a place with a culture of zero harm, by highly-trained staff with the right values and skills.

"And if something should go wrong, then those mistakes will be admitted, the patient told about them and steps taken to rectify them with proper accountability.

"I and the chairs of key organisations involved in care have pledged to do this and make our health and care system the best and safest in the world."

Francis made a total of 290 sweeping recommendations for healthcare regulators, providers and the Government, but it is unclear how many of the recommendations were taken on by ministers.

However, a number were noticeably absent from the Government's response.

Francis called for a regulation system for the NHS's army of healthcare assistants. But Mr Hunt only announced a code of practice and minimum training standards for the support staff, saying that a regulatory system could create a "bureaucratic quagmire".

The QC also said there should be individual criminal liability for staff who harm or kill patients.

But Hunt said he was waiting for a report from expert Professor Don Berwick, who is looking to instil a culture of "zero harm" in the NHS, before making a decision on the matter.