Hospitals ‘need doctor in charge’

Nick Collins, The Telegraph

17th April 2013

Every hospital patient should have a single doctor who is in overall charge of their care to help prevent another Mid Staffordshire disaster, the head of the report into the NHS scandal has claimed.


Robert Francis QC said systemic failings which led to the preventable deaths of up to 1,200 patients at the Trust between 2004 and 2009 could mean there are “other Staffords” in the NHS.

Ensuring that every patient in every NHS hospital has one doctor in overall charge of their wellbeing is one step hospitals should implement to ensure medical staff take responsibility for patients, he said.

Mr Francis also expressed fears that hospitals are not acting quickly enough to improve standards following his damning report, which was published in February, as he criticised what he called the NHS tendency to “wait for someone else to tell it what to do”.

Speaking at the International Forum on Quality and Safety in Healthcare in London on Wednesday, Mr Francis said it was imperative that doctors and nurses take direct responsibility for their patients and do not simply “tolerate poor care”.

He said: “I’ve been now to a lot of hospitals – to visit patients as much as being chairman of the inquiry – and no-one ever seems to know who their doctor is, except in very exceptional cases, or who their nurse is.

“I think it’s essential for the feeling of responsibility, that on a day by day basis the patient knows who is the person in overall charge of the case.”

He said this would not rule out a “teamwork approach”, but would mean that the care of patients with complex needs, particularly the elderly, would be better managed and patients and their families would have someone to go to with any concerns.

“It doesn’t have to be the person delivering the care but there does need to be someone who has the responsibility for making sure it is being delivered,” he said.

Some elements of the Francis Report have already been accepted by government, although its official response last month did not address every recommendation in detail.

But Mr Francis admitted to being “worried” about the speed of progress and said there is an “awful lot” NHS bosses could be doing to improve care in hospitals without waiting for official directives.

For example, heads of NHS bodies could define a list of fundamental standards of care which should never be breached, and ensure systems are in place to monitor the performance of staff.

Asked whether he felt his recommendations were being adequately implemented, Mr Francis said: “At the moment it is too early to say, but the longer it goes on without action the more worried I will get.

“A lot of this can be done now and without government intervention. I think the health service needs to get away from a culture of waiting to be told what to do.”

The regulatory problems which allowed the scandalous care at Mid Staffordshire to go unnoticed were such that there is “no way of knowing at the moment whether there is another Stafford out there,” Mr Francis added.

While there may not be another trust with such extensive failings, it is perfectly possible that small “silos” in individual trusts may be guilty of similarly poor care.

“I think it’s right to say there are a lot of people out there who believe there are other Staffords, [and] I think more credibly there are certainly pockets in individual trusts which might look like Staffords,” he said. “I think there must be quite a lot of that going on around the NHS.”