The must-read stories and debate in health policy and leadership.

The spectre of Stafford

Six years to the day the Mid Staffordshire Public Inquiry Report was published, health and social care secretary Matt Hancock spoke at a patient safety conference responding to a review of the fit and proper person test – born of a recommendation from the then Robert Francis QC, now Sir Robert.

The spectre of Mid Staffs loomed over Mr Hancock’s speech, as he reiterated the desire to make the NHS the safest healthcare system in the world but warned of the dangerous costs for the NHS of not reducing avoidable harm.

He said compensation payouts had quadrupled from £0.5bn to £2bn a year over the past decade, which he called “unacceptable and clearly unsustainable”.

He added: “If we don’t do something about the growing number, and value, of clinical negligence claims, it threatens to swallow up the record £20.5bn a year we’re putting into the NHS, and derail our long-term plan to transform the health service.”

The health secretary said the government had accepted two of the seven recommendations of the FPPR review, carried out by Tom Kark QC – one to establish a central database of senior managers’ experience and history, and the other to develop core competencies for senior directors to be assessed against.

On the other five recommendations, including creating a new body with the power to bar people from sitting on NHS boards, the government has delayed its decision. This is despite the Kark review making it clear the current fit and proper person test is not preventing poorly behaving managers from working in the NHS.

Mr Hancock said the delay would allow government to get the balance right between ability to strike off managers, and to attract high performers to the roles. That argument might not hold much water if a new care scandal emerges, with poor management in the firing line.

The wrong message

The Care Quality Commission’s suggestion that clinical excellence awards be routinely withheld from consultants at special measures trusts, uncovered by HSJ, has raised eyebrows.

The proposal, which was not adopted by the advisory committee on CEAs to the Department of Health and Social Care, would have seen the consideration sit alongside other measures in the assessment process, such as whether a medic was under investigation by the General Medical Council.

While some people felt penalising specific doctors for organisational failure would not be fair, others pointed to specific examples where consultants could be said to have contributed to the state of the trust.

If the CQC had found specific fault with individual senior medics and they were then given significant bonuses, you can see how it would “send the wrong message”, as the CQC’s chief inspector of hospitals Ted Baker put it.

Incidentally, in one recent legal dispute between a senior surgeon and her employer, the medic said the trust had accused her of exactly that.

Legal papers lodged with the High Court last year, where she successfully overturned a decision to exclude her pending an investigation, Marjan Jahangiri said her chief executive had told her she had “contributed” to the trust being placed in special measures.

Ms Jahangiri denied this but St George’s University Hospitals Foundation Trust did not support her CEA application.

St George’s internal proceedings continue but the example raises the question of how much individuals can – or should – be held accountable for organisational failings.

The minutes of the advisory committee on CEAs revealed the previous chief inspector of hospitals Sir Mike Richards had considered blocking a CEA from a medical director at a special measures trust; the identity of the doc and the trust were not disclosed.

The committee on CEAs hands out considerable amounts of money – more than £134m in 2017-18 – and a long-discussed reform of the system is now part of stalled consultant contract renegotiations.