Stafford Hospital: Hiding mistakes 'should be criminal offence'


"A story of appalling suffering": Watch Robert Francis QC's statement in full

NHS staff should face prosecution if they are not open and honest about mistakes, according to a public inquiry into failings at Stafford Hospital.

Years of abuse and neglect at the hospital led to the unnecessary deaths of hundreds of patients.

But inquiry chairman, Robert Francis QC, said the failings went right to the top of the health service.

He made 290 recommendations, saying "fundamental change" was needed to prevent the public losing confidence.

His report comes after the families of victims have voiced anger that no-one has been sufficiently punished for their roles.

Senior managers were able to leave the trust with little sanction, while most doctors and nurses involved have escaped censure from their professional regulators.

Responding in the House of Commons, Prime Minister David Cameron apologised to the families of patients.

He said he was "truly sorry" for what happened at Stafford Hospital, which was "not just wrong, it was truly dreadful" and the government needed to "purge" a culture of complacency.

Mr Cameron said a full response to the inquiry would follow next month, but he did immediately announce that a new post of chief inspector of hospitals would be created in the autumn.

Previous investigations have already established in harrowing detail the abuse and neglect from 2005 to 2008.

This inquiry looked at why the system did not prevent the problems or at the very lest detect them earlier.

The Mid Staffs public inquiry

  • The public inquiry is the fifth major investigation into what happened
  • It has focused mainly on the commissioning, supervision and regulation of the trust from 2005 to 2009 - something campaigners felt had not been properly covered before
  • It was chaired by Robert Francis QC, who also led the fourth major investigation
  • It sat between November 2011 and December 2012 and cost £13m
  • More than 160 witnesses appeared at the hearings and one million pages of evidence have been sifted through
  • The final report contains 290 recommendations over nearly 1,800 pages.

In particular, it recommended:

  • The merger of the regulation of care into one body - two are currently involved
  • Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions
  • Hiding information about poor care to become a criminal offence as would failing to adhere to basic standards that lead to death or serious harm
  • A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
  • An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors

While it is well-known the trust management ignored patients' complaints, local GPs and MPs also failed to speak up for them, the inquiry said.

The local primary care trust and regional health authority were too quick to trust the hospital's management and national regulators were not challenging enough.

Meanwhile, the Royal College of Nursing was highlighted for not doing enough to support its members who were trying to raise concerns.

The Department of Health was also criticised for being too "remote" and embarking on "counterproductive" reorganisations.

The report said the failings created a culture where the patient was not put first.

Start Quote

This is a story of appalling and unnecessary suffering of hundreds of people”

End Quote Robert Francis QC

But the inquiry said the change needed did not require further reform.

Instead, it urged everyone from "porters and cleaners to the secretary of state" to work together to shift the culture and adopt a "zero tolerance" approach to poor care.

Mr 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."

He said the public's trust in the NHS had been "betrayed" and a change of culture was needed to "make sure that patients come first".

Target driven

The "appalling" levels of care that led to needless deaths have already been well documented by a 2009 report by the Healthcare Commission and an independent inquiry in 2010, which was also chaired by Mr Francis.

They both criticised the cost-cutting and target-chasing culture that had developed at the Mid Staffordshire Trust, which ran the hospital.

Time to care?

James Moore, who has left the NHS after working in A&E for 15 years, said reports of abuse made him "ashamed to be a nurse".

He blamed poor management rather than nurses no longer caring.

He drew parallels with being a waitress: "The restaurant gets busier, the waitress works harder and harder with the same resources and things start getting missed, she drops a meal here or there and people don't get their food on time and complaints are made".

Instead of dealing with the workload he said managers made the problem worse: "They'll ask the waitress to fill out more forms to tick that she's done certain things, then the restaurant gets busier and busier and the nurse has more and more forms to fill out."

Receptionists were left to decide which patients to treat, inexperienced doctors were put in charge of critically ill patients and nurses were not trained how to use vital equipment.

Cases have also been documented of patients left crying out for help because they did not get pain relief and food and drinks being left out of reach.

Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment.

There has been anger from some quarters after nobody lost their jobs as a result of the public inquiry.

James Duff's wife Doreen died in the hospital. He said: "Not one person has lost their job over this - instead they have been promoted and some people have been moved sideways.

"This has been a disaster yet nobody is accountable."

Sir David Nicholson has the focus of anger from families affected by the scandal. He is chief executive of the NHS and was briefly in charge of the Regional Health Authority while death rates were high at Stafford Hospital.

He responded to calls for him to go saying: "I think it's perfectly understandable, I understand the anger that they feel, the upset that they feel about the treatment of their loved ones in Mid-Staffordshire hospital.

"I absolutely understand all of that. At the time I apologised and in a sense I apologise again to the people of Stafford for what happened, but apologies are not enough.

"We need action, we need to make things happen."


Royal College of Nursing general secretary Peter Carter described it as a "powerful and monumental" report.

He said: "We welcome moves for overarching standards which enshrine what patients deserve from the NHS and from those who work for it.

"Appalling care cannot be tolerated and everything should be done to ensure that it does not happen again."

But campaigner Julie Bailey whose mother, Bella, died in 2007 at Stafford Hospital prompting her to set up Cure the NHS, which had been instrumental in pushing for the public inquiry, called for resignations.

"We've lost hundreds of lives in the NHS and we want accountability.

"We owe that to our society and to the deaths and the respect of all the loved ones that we have lost.

"We will go nowhere until we get accountability."

Katherine Murphy, the chief executive of the Patients Association, said the report was a "watershed moment" for the health service.

She said: "It is clear that he [Mr Francis] has understood some of the very real failings that patients and their families face day in and day out.

"It is clear from the report that there is a lot of blame to go around for what happened in Stafford. Unfortunately too many people have escaped genuine accountability."

BBC West Midlands special investigation, The Hospital That Didn't Care, on BBC One at 10.35pm on Wednesday, 6 February.


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  • rate this

    Comment number 250.

    Nurses in our area have told us about wilfully bad practice.

    Eg: food delivered on trays out of reach which is collected later untouched, there's no one their to feed the patients, the kitchen staff are too scared to raise the issue as are nurses.

    In another, it was obvious vital medication was not being given, as a result the patient died.

    A crime, YES, it all traces back to government.

  • rate this

    Comment number 249.

    @184. Rosetta

    The focus should and always has been on ACCESS to health care, regardless of ability to pay.

    Remember : Free health care for all.


    Little point in having free access to health care if it KILLS you but I do agree that the "free at the point of service" principle should remain.

    However who provides the care shouldn't matter, it is the quality of it that is paramount.

  • rate this

    Comment number 248.

    Any senior manger, and senior doctor who was working at the Stafford Hospital Trust who are still employed by the NHS should be sacked. This is one of the few ways to send an effective message that this kind of shambles will not be tolerated.

  • rate this

    Comment number 247.

    I see the blame has curved round those in Westminster, past and present.

  • rate this

    Comment number 246.

    The people who should be held responsible and prosecuted are the politicians who introduced the finance and target culture and turned the NHS vocation into nothing more than a 'job'. Blair and Brown have so much to answer for and this is just another almost criminal act which they carried out while in power. They should be ashamed. But they're too thick skinned and they're not!

  • rate this

    Comment number 245.

    Why does David Cameron have to apologise for this, it happened under Labours watch, get Brown and Blair back to apologise, or at worst get Milliband to apologise for his parties mismanagement.
    & don't give me that apologising for govt guff, this was Labour's mess.
    But Labour don't do apologies, they just do blame.

  • rate this

    Comment number 244.

    While continue to view social care as separate from healthcare, the growing elderly pop. will face these problems increasingly. We have wards staffed not by trained nurses, but mainly untrained nursing assistants. For the last 30 years the NHS has been the subject of gov. led reorganisation & the focus moved from patients to targets. We ask the NHS to cover everything for everyone, it can not.

  • rate this

    Comment number 243.


    Private competition improves services = less deaths.

    I agree because The NHS does real surgery which is dangerous and has risks attached to it's procedures

    whereas The Private Sector deals with removal of tattoos or nose jobs which aren't real surgery.

    When the surgery is difficult The Private Sector passes its patients to the NHS

    Thereby avoiding the risks

  • rate this

    Comment number 242.

    The more i read this piece the more i want to scream .

    How can the BBC write the Labour party out of this .

    Those who presided over this are still in parliament , why is the BBC protecting them?

    The BBC is condoning gross negligence that led to hundreds of deaths .
    And it STINKS .

  • rate this

    Comment number 241.

    If poor care must be disclosed in the NHS it must be disclosed in privatre medicine as well

  • rate this

    Comment number 240.

    The simple story is:

    If you (anyone!) see something happening that you would not like to happen to you - make a fuss and report it and keep reporting it until someone takes notice and takes remedial action.

    Any organisation that tries to muzzle your complaint should be prosecuted and the individual concerned sacked as should any lawyer taking part in the attempt.

  • rate this

    Comment number 239.

    The crime is that NHS is being deliberately starved of funds and resources to make it 'fail' so that it can be privatised with money going straight to greedy hands out of control of public - SO IF YOU CAN'T AFFORD PRIVATE HEALTH COVER YOU'VE HAD IT BECAUSE UNUM WANTS YOUR MONEY AND MORE TIME TO WAKE UP

  • rate this

    Comment number 238.

    The NHS has an institutional bullying problem. Staff are often afraid to raise concerns and those best at their jobs are often bullied out of employment by insecure management who dislike overachievers outside of their own cliques. Until such a culture is tackled head on, problems will remain and grow to the detriment of patients.

  • rate this

    Comment number 237.

    167. Little Old Me
    One-off? Unfortunately not.
    I suggest you read up on paediatric cardiac surgery at Bristol. A scandal revealed by Private Eye.
    A quote from the excellent 'Trust Me I'm a Doctor' book.
    'Research published in BMJ...11% of inpatients at 2 London hospitals had an "adverse event".
    Rolled across NHS thats 70,000 deaths a year from coming into contact with health service.'

  • rate this

    Comment number 236.

    Another Milibandwagon for liberal-left bien pensants to jump on... It's not about funding, it's about straightforward incompetence. When will we wake up to the fact that a budget of £120bn a year should be in the hands of people who know how to run a b*****ss. Yes, that dirty 'B' word we're all so ashamed of, but which ultimately pays for our NHS.

  • rate this

    Comment number 235.

    Judging from the BBC reports, the problem really is with the criteria for Trust status. The hospital had sacked 150 nurses so that it could claim it had done well by saving costs! In other words it is the ACCOUNTANTS who see everything in money terms and not what should be tested: standards of patient care. The test should have depended on random and anonymous checks by MEDICAL professionals.

  • rate this

    Comment number 234.

    "The focus should and always has been on ACCESS to health care, regardless of ability to pay.

    Remember : Free health care for all"
    How exactly is it free?
    Nothing is free.
    The focus should be on freedom, not theft to fund your "free" health care. You get to get to keep the fruits of your labours, and so do I.

  • rate this

    Comment number 233.

    184. Rosetta

    The focus should be on the quality of care, not who provides it.
    Incorrect. The focus should and always has been on ACCESS to health care, regardless of ability to pay.

    Remember : Free health care for all.

    No point have access if it kills you now is there?

  • rate this

    Comment number 232.

    When my parents were in nursing in the last century I was told that after an imposed reorganisation the number of administrators per bed went up from 4 to 10. It would be interesting to know what the ratio is now and how many many 'non' jobs there were at Stafford whilst all this was going on. Come on Tax Payers Alliance - do your thing!

  • rate this

    Comment number 231.

    It is smokescreen after smokescreen with successive Governments on NHS cover-ups, white collar "crime" and MP's scandels.

    We are destined to be reading these types of stories again and again until accountibility and criminal prosecutions are imposed for these types of criminal & immoral behaviour, right to the very top of society.


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