In the fourth part of our series on contract management pitfalls, we look at the risks arising out of varying the terms of construction contracts.
The standards of care that patients and their families can expect from public and private health services in England and Wales are at the centre of an intense public debate.
On 5 February 2013 Robert Francis QC sent his report on the Mid Staffordshire NHS Foundation Trust Inquiry to Jeremy Hunt, the Secretary of State for Health. In his covering letter Robert Francis emphasised that the recent Stafford Hospital saga told a story “first and foremost of appalling suffering to patients” caused by a failure to “tackle an insidious negative culture”.
The Inquiry found that the whole NHS system, formed by “a plethora of agencies, scrutiny groups, commissioners, regulators and professional bodies” failed to detect and do anything to remedy a huge “non-compliance with acceptable standards of care”.
On 26 March the Government published its initial response, “Patients First and Foremost”. Like the report, the response has led to the voicing of strenuous and often conflicting opinions from professional bodies, patient groups and the general public.
The Government’s Response
The Government understandably wants the quality of patient care to be at the heart of future health and care services. The Health Secretary has announced in Parliament that a culture of compassion will be a key marker of success, supposedly spelling an end to the distorting impact of targets and box ticking, which led to the failings at Stafford Hospital.
In particular the Department of Health has decided that “hospitals and care homes will be encouraged to strive to be the best, while the basic values of dignity and respect will be central to care training and, if things go wrong, patients and their families will be told about it.”
Radical new measures are to be introduced to achieve this, including Ofsted-style ratings for hospitals and care homes. A pilot programme will also see nurses working for up to a year as a healthcare assistant as a prerequisite for receiving funding for their degrees, although nurse groups have questioned how workable this proposal is.
A Culture of Zero-Harm
At the centre of the Government’s response to the Francis Report is its intention to introduce a new regulatory system, with a culture of zero-harm at the core, under a strong and independent Chief Inspector of Hospitals. The Chief Inspector is expected to introduce single aggregated ratings for hospitals and will assess all hospital complaints procedures.
There will also be changes at the Care Quality Commission. In the future, hospital inspections will include judgements about a hospital’s overall performance, including whether patients are listened to and treated with dignity and respect. The safety of services, general responsiveness, proper clinical standards and sound governance will all be under review.
The Government has further announced that it intends to appoint a new Chief Inspector of Social Care to ensure the same rigour is applied across the health and care system. However, at the moment no specific details about the powers or terms of appointment for the Chief Inspector of Social Care have been announced.
Dealing with Wrongdoers
Finally, the Francis’ Report was concerned about the general lack of accountability of wrongdoers. In response to this the Government is considering introducing legal sanctions at a corporate level for providers of health services who knowingly generate misleading information or withhold information from patients or relatives.
As far as individual wrongdoers are concerned, the General Medical Council, the Nursing and Midwifery Council and the other professional regulators are being asked to tighten the procedures for dealing with individual health and social care professionals who have breached professional standards. Unsuitable healthcare assistants are to be barred from practice.
Whilst all of these proposals have raised some questions from within the medical sector, the most essential aspect of the Government’s response to the Francis Report is its desire to act, and to reduce the possibility of a scandal such as Stafford Hospital from ever happening again. There is no doubt that the workability of some of the suggestions needs to be explored, however as long as patient care is kept at the centre of the Government’s actions, the end result will certainly be positive.
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