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Mid Staffs: Monitor response to the Francis report

Joint statement from Monitor and the Care Quality Commission (CQC) on the current position at Mid Staffordshire NHS Foundation Trust.

The CQC believes Mid Staffordshire NHS Foundation Trust is safe to provide services. But it has also made it clear that the trust must address remaining concerns quickly.

On behalf of their patients, the trust must meet all the essential standards of safety and quality and the CQC will follow up robustly to ensure the trust improves in the areas that need further attention.

CQC and Monitor have strong powers of intervention and would not hesitate to take urgent action to protect patients if they thought this necessary.

The trust has made important progress since the period described in the Francis report. Steps have been taken to address immediate risks to patients and the new leadership of the trust has responded positively. Patients should be keen for their trust to do better still.

It is important to understand that the scale of change required in this organisation was very significant and was never going to happen overnight. To track progress, the CQC is to carry out another detailed assessment, starting in March, and Monitor continues to hold the trust’s leadership to account for progress against their transformation plan.

Statement from Monitor:

Chris Mellor, acting Chair of Monitor, said:

There are 126 foundation trusts and the vast majority of them provide safe, high-quality care. However, at this trust, the standard of care that patients received was clearly unacceptable, and the experiences described in this report by patients and their families are incredibly distressing. Absolutely every effort must be made to ensure this never happens again.

Monitor has taken action at Mid Staffordshire NHS Foundation Trust to put in place new and experienced leadership to drive improvement. We have worked with the trust to oversee the design and delivery of a transformation plan with clear priorities and rapid actions to secure patient safety.

The new leadership, which includes a new medical director and nursing director, has already made improvements in patient care, ensuring better infection control, increased numbers of nurses and delivery of a much improved mortality ratio. However, there is still more to do, especially in terms of embedding a new culture of openness, which must be a priority. We are continuing to work with the CQC to track progress at Mid Staffordshire very closely.

We welcome the Francis report, and the additional focus it has given to what went wrong at this trust. We will study the report carefully and where there are new lessons to learn we will work closely with the trust and the CQC to act on these.

Following the Healthcare Commission’s report on Mid Staffordshire in March 2009, Monitor commissioned an independent review of lessons learned and made changes to its processes as a result. Changes already made centre on better sharing of information across the healthcare system, in particular between Monitor and the CQC; in addition we are currently consulting on an enhanced approach to quality governance. We have also worked closely with the CQC, Department of Health and others on the National Quality Board report Early Warning Systems in the NHS, published today.

A further inquiry into the roles of the commissioning, regulatory and supervisory bodies in the events at Mid Staffordshire has been announced today; Monitor will work closely with the inquiry team going forward and implement any additional lessons that emerge from this review.

We note the Secretary of State’s comment on the possible de-authorisation of Mid Staffordshire NHS Foundation Trust. Any decision on de-authorisation rests with Monitor, as set out in the Health Act 2009. We are required by the Act to consult on how we will implement these new powers of de-authorisation and we intend to launch our consultation on this within the next few days. As these new proposals are clearly significant, the consultation period will run for 12 weeks in accordance with established best practice. After the consultation closes, we will need reasonable time to analyse and publish the responses we receive. We anticipate that this process will be completed by early summer.

Until this consultation has taken place, and the criteria for de-authorisation are decided, it is not possible to comment on whether or not any foundation trust should be de-authorised. We will continue to work closely with the trust and the CQC to ensure that the important progress already made at Mid Staffordshire continues; the CQC’s 12 month progress report will be an important indicator in assessing what tangible improvements this trust has made.

As the Secretary of State highlights, the foundation trust model of accountability to local communities through members and governors is a powerful tool for patient and public involvement. Every foundation trust has a duty to be truly publicly accountable whilst providing high-quality care - and to engage with patients on how successfully these goals are being met. The lessons from Mid Staffordshire should encourage every board to look closely at the processes they have in place to achieve this, and to take action to improve them if necessary.

Robert Francis Inquiry report into Mid-Staffordshire NHS Foundation Trust

Mid Staffs: learning and implications for Monitor