The quality of care in England’s hospitals will come under fierce scrutiny in the first few months of 2013. The catalyst and focus will be Robert Francis’ report into care failings at Mid Staffordshire Foundation Trust, but the debate will be wider and deeper than that sparked by the inquiry’s findings.

‘Care scandals could have as much impact on public opinion and policy as the “I’ve been waiting a year” stories of the 1990s’

Growing financial pressure, a government committed to transparency of organisational and clinical performance and the “something must be done” atmosphere created by the inquiry have the potential to create a perfect storm.

HSJ’s latest Barometer survey of acute trust chief executives revealed the level of nervousness which persists around key areas of care. The survey asked chief executives how confident they were about their trust’s out-of-hours cover. The aggregate score was 6 out of 10.

Commenting on the findings, Salford Foundation Trust chief executive David Dalton said: “For too long boards have not challenged themselves about the standards of care that should be available to their patients every hour of the day and every day of the week.”

NHS Confederation hospital forum chair Dr Mark Newbold added: “I’d be interested to hear from those who feel their services are equally safe at all hours, because I haven’t seen any evidence from anywhere that this is the case.”

The challenge for hospitals

This is an admission − which although obvious to most healthcare leaders − will be very hard to justify in a post-Francis world. There is every chance the out of hours care scandal could have as much impact on public opinion and policy direction as the “I’ve been waiting a year” stories of the 1990s or the “my mother died from a hospital infection” reports of the last decade.

A welter of initiatives are churning through the system to tackle issues associated with care quality, including the first push in more than a decade to change how hospital consultants are rewarded and the wave of community service proposals being prepared by clinical commissioning groups to reduce secondary care demand. But many of these ideas are slow burn, with outcomes that are uncertain and only likely to have significant effect in three or more years.

The planning guidance released by the board just before Christmas made it clear that hospitals will have to continue to deal with both a tightening financial regime as well as new penalties for below par performance. The NHS Trust Development Authority has effectively decided to rerun the 2011 exercise to determine which non-foundation trusts have a viable independent future.

HSJ would highlight staff engagement and morale as the biggest unacknowledged danger facing the service’

Some financially struggling FTs and non-FTs have a decent care record, but many have clear areas of weakness and, as a result, the question marks over an increasing number of trusts grow bigger. Yet many of the reconfigurations and consolidations being planned to resolve these problems face political resistance and have an evidence base which gives little confidence for a quick or sustained return on quality or value for money.

Financial stability became non-negotiable in 2010 − publicly perceived care quality will join it in 2013. It is an iron rule of NHS performance that with every new “must do”, something ceases to become a priority. That “something” will differ from area to area and trust to trust, but HSJ would highlight staff engagement and morale as the biggest unacknowledged danger facing the service.

This is not a glib point about staff goodwill, nor a failure to recognise all staff groups are likely to have to look hard at working patterns and career paths. It is simply to state that a key challenge for hospital leaders in 2013 will be to create and/or maintain a sense of mission and shared endeavour as the storm howls outside.