Perverse incentives, which mean it is better for NHS managers to allow standards of care at hospitals to fall rather than admit they are failing, led to the scandal at Stafford Hospital, a health service expert has said.
Roger Taylor, co-founder of the health information service Dr Foster, said every incentive in the NHS system pushes NHS chief executives to “cut costs, cross (their) fingers and hope no one notices if standards of care deteriorate”.
In contrast, they risk losing their jobs by overspending or arguing to reorganise services.
In an interview with the Daily Telegraph, Mr Taylor said the risk that regulators will pick up on poor-quality services quickly or punish managers is “troublingly remote”.
His warning comes ahead of Wednesday’s publication of a report into the scandal at Mid Staffordshire Foundation Trust between 2005 and 2009.
Mr Taylor, whose firm devised the standardised measure of death rates which helped uncover the problems, said it was this attitude which led to the failings in patient care.
He urged health secretary Jeremy Hunt to address the incentives which lead managers to “do the wrong thing”.
He told the Telegraph: “What happens when a hospital trust like Mid Staffordshire finds it is struggling to deliver a high-quality service with the resources available?
“As an NHS chief executive in that situation, you could simply overspend and breach your targets - and quite likely lose your job.
“You could try to argue to reorganise services but you are likely to face considerable opposition from both clinicians and the public.
“Or you can just cut costs, cross your fingers and hope that no one notices if the standards of care deteriorate.”
He said the “the frightening truth about the NHS” is that managers are pushed to choose the third option by every incentive in the system.
The risk that this will be detected and have consequences on managers’ careers is “troublingly remote”, he added.
An inquiry into failings at the trust has been led by barrister Robert Francis QC.
His report is expected to recommend wide-ranging reforms of the NHS.
It is the latest in a string of inquiries, focusing on why the serious problems at the trust were not identified and acted on sooner, and what important lessons for the future of patient care can be identified.
NHS Confederation chief executive Mike Farrar predicted that the release of the report would be “one of the darkest days” in the history of the NHS and acknowledged that changes were needed to make patient feedback easier and give the public a clearer picture of how local services were performing.