Although he has had other care quality scandals to respond to, this is the first time Jeremy Hunt has had to deal with one that both feels eerily like Mid Staffordshire, and that happened on the Conservatives’ watch.
The details are different, but the characteristics are the same. There are trust leaders blinded by an obscure desire to achieve foundation status; there is a dangerously ambitious cost cutting programme; there are curiously incurious regulators; there are commissioners distracted by a top down reorganisation (two if you count transforming community services along with Andrew Lansley’s Health Act 2012). There are patients suffering unnecessarily, and there are NHS managers covering it up.
The fallout from Mid Staffs was the making of Jeremy Hunt: patient safety became his signature theme and the programme of work that came out of the Francis report, particularly around provider inspections, will probably be his most enduring legacy.
The revelations about Liverpool – and particularly the wider system’s utterly inadequate response to it – illustrate the great gulf that exists in parts of the system between Mr Hunt’s agenda and how NHS leaders sometimes react to terrible events.
Mr Hunt does not have the luxury this time of hanging the scandal around the neck of a political opponent, as he did with Mid Staffs and Andy Burnham. Everything that went wrong at Liverpool Community Health Trust happened while the Cameron government was in charge, and much of it while Mr Hunt was health secretary.
Minister Steve Barclay’s response on Thursday revealed as much about the changing nature of the Department of Health and Social Care under Mr Hunt as it did the failures at the trust.
Mr Barclay, new to the DHSC, made no attempt to distance the wider NHS or regulatory system from what happened. This was not “principally a local failure” (Mr Burnham’s phrase describing Mid Staffs) or an “isolated incident” or the work of “a few bad apples”. Instead, his response drew attention to the possible systemic problems. It included a pledge to begin a wider review of the fit and proper person test, which Mr Hunt introduced after the Francis report, and which failed to be any use in this case.
Mr Barclay also announced an examination of sanctions available where records are lost or destroyed. Labour MP Rosie Cooper, who Conservative ministers rightly credited with uncovering this scandal after each and every administrative layer of the NHS failed to, alleged that one Liverpool Community Trust director spent her final days at the trust “at the shredder”.
There was also a clear message from the DHSC that appropriate disciplinary action should be taken against individuals.
Holding individuals to account is not something we saw in the NHS’s initial response: HSJ revealed on Thursday the NHS Trust Development Authority’s apparent laundering of Liverpool Community chief executive Bernie Cuthel. She was seemingly shifted, supported by “verbal references” from the TDA, to another trust whose leaders were not informed about why she might be moving from an executive job into a more junior position.
This happened in 2014, just a year after the Francis report came out, and after Liverpool Community Health was known to be toxic. It is hard to imagine how the TDA’s actions were supporting Mr Hunt’s well established safety agenda, or whether there was any organising principle at all behind its actions.
As with Mid Staffs, all of this happened recently enough that many key figures are still in circulation. Lyn Simpson, the TDA director who was said to have provided a reference to support Ms Cuthel’s move to another trust, now works for NHS Improvement in the same region. NHSI featured in the demise of Wirral hospital chief David Allison, who was offered a six month secondment at the regulator, despite NHSI North having received whistleblowing concerns about his conduct and his trust’s governance.
Ian Dalton finds himself in the Sir David Nicholson role, having led a now defunct regional authority criticised by the official report and now occupying a much higher profile national role. It is unlikely he will meet the same fate as Sir David, however, because the Daily Mail appears not to be interested in him, and other people closer to events are still around should a scalp be required.
Mr Barclay and the government have correctly identified that the way to tackle such issues in the NHS is to accept the responsibility they have as system leaders to make changes. Although ministers are behaving differently this time around, it may be that, exactly five years after the Francis report came out, the service has to learn the same lessons again.