What the sector can learn from the Mid Staffordshire NHS Trust scandal

Marie Staunton, former chief executive of Plan UK, says the Francis report contains important lessons for voluntary sector governance

Marie Staunton
Marie Staunton

As a charity chair, non-executive director and former charity chief executive, I got the shivers reading the recent report on the Mid Staffordshire NHS Foundation Trust scandal – I felt that there, but for good luck, go I.

I would advise everyone working in the sector to find 10 minutes this week to read the two-page covering letter sent to the Secretary of State for Health by Robert Francis QC, who carried out the public inquiry. His findings contain valuable lessons for all not-for-profit organisations.

Press reports spelt out the dereliction of duty in Mid Staffs, the inhumane and degrading treatment and the deaths. The report shows why it happened and how senior management and the board let it happen.

The new board was appointed to turn around a failing trust, and from the indications it received it was being successful – it passed inspections and even its risk register was approved by the NHS Litigation Authority, so it won foundation status.

As the trust explained to Francis, its role was strategy – operational, clinical and management roles were delegated. But the chief executive and the board are ultimately responsible, and it is their challenge to  know enough about what goes on in an organisation without resorting to micromanagement. And that is hard to do.

The top six lessons that I have taken from the Francis Report are:

1. Check that we have the right performance framework. Mid Staffs measured the money, its compliance with regulators and the milestones for its foundation statu - but not the patient experience and mortality rates. Is our performance framework in the voluntary sector based on what matters to beneficiaries or only on what matters to the board?

2. Make sure the risk register is not the business only of the finance committee. Regular review of risk is the chance for the whole management team, supported by the board, to remember why we are there and to examine the risk that we cannot achieve it – and that is more than just the financial risk that preoccupied Mid Staffs.

3. Check what we spend board time on and what messages that sends down the organisation. In the case of Mid Staffs, patient care and their right to humane treatment were not the board's priorities, and that set the tone.

4. Walk the wards, especially those that are busy and 'difficult'. See complaints as an asset and an opportunity to improve. As a lay board member this will give you the right questions to ask of the professionals.

5. Have the right understanding with management. "If you tell me about a mistake I will back you, but if you cover up you are on your own," should be the mantra. Organisations such as Mid Staffs filter out bad news on its way to the top unless the top shows that it is safer not to.

6. Reward staff behaviour that is valued by beneficiaries. Key qualities such as caring and respect were not seen to be valued or promoted by senior management, according to Francis. And endless management changes meant corporate memory was lost.

Those are my top six governance lessons. What are yours?

Marie Staunton is chair of the Equality and Diversity Forum, chair of Raleigh International and a non-executive director of Crown Agents. She was previously chief executive of Plan UK

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