Our advice to government

Heads roll when there are major scandals such as those at Mid-Staffordshire or Maidstone and Tunbridge Wells, but the cynic would say that is as much because of the embarrassment they have caused by getting found out as because people have come to harm. Patients want to see a system where tragedies are avoided in the first place, and where safety, caring and compassion are as much a priority for managers as budgets and performance targets.

Individual clinicians are personally responsible for ensuring their practice is safe. Those whose actions or inactions result in the death of a patient can be – and are – held to account. At the last resort, they can be struck off their professional register.

Accountable

As we have seen in the case of Mid-Staffordshire, managers and boards can make decisions that contribute to the deaths of tens and hundreds of patients. Yet there is no clear system for holding them accountable. The public outrage at this system must be obvious to even the most sheltered of bureaucrats.

Although Trust Boards and executives are theoretically responsible for patient safety under the Clinical Governance Code, in practice what is everyone’s responsibility becomes no-one’s.

Every NHS hospital is obliged to appoint an Accountable Officer, invariably the chief executive. But he or she is not accountable for the quality of care patients receive. Accountable Officers are responsible for financial management, and know their job is on the line if they get it wrong. The temptation to cut corners − to put patient safety at risk, so as to avoid an overspend or to maximise income − is obvious.

There is a second Accountable Officer, responsible for controlled drugs. The message is clear. As far as the NHS is concerned, money and medications are of greater significance than the welfare of patients.

The Patients’ Council says we need another Accountable Officer – a senior executive, preferably the chief executive, who has personal responsibility for patient safety, who has the power to block decisions which put safety at serious risk, and whose job is on the line if he or she gets it wrong. There should be no more golden goodbyes for those whose decisions lead to suffering and even deaths of patients in their care.

Regulation

At the same time, health service managers should be regulated in exactly the same way as doctors and nurses. We need a management equivalent of the GMC to ensure that only qualified and registered individuals are permitted to practice as managers in any organisation that provides NHS patient care – not just organisations that are run by the NHS but any that treat NHS patients. A Healthcare Management Council would establish good practice guidance that all managers would be expected to follow. Registered managers who failed to provide safe and acceptable quality standards of patient care, staff and budget management, could be required to undergo re-training, have restrictions put on their roles or, in extreme cases, be struck off. These proposals would allow managers to stand up for the patient when and if they are faced with policies and proposals that they believe would damage patient safety.

This is not a new idea. Sir Ian Kennedy proposed it in his report on the Bristol Babies. Following the Francis Report into the deaths at Mid-Staffordshire, then Prime Minister Gordon Brown announced such a scheme would be introduced. The time for action is now.