NHS reorganisations are a ‘contributory factor’ in poor patient care, the chair of the independent inquiry into failings at University Hospitals of Morecambe Bay Foundation Trust has said.
In an interview with HSJ, Bill Kirkup also called on NHS leaders to be more open and transparent about concerns over service quality in their organisations. He welcomed health secretary Jeremy Hunt’s call for an independent patient safety investigation body, describing it as a “logical step” to address concerns.
Mr Hunt said he would ask NHS England’s national director of patient safety Mike Durkin to look into the possibility of creating a body along similar lines to the Air Accidents Investigations Branch, which is part of the Department for Transport.
Dr Kirkup, a former associate chief medical officer at the Department of Health, said the government and policymakers needed to better assess the potential impact of policy changes on the frontline.
He said government reforms to NHS structure were “a contributory factor” in care failures, because they add to “the list of things that people have to deal with along with the day to day job of making sure they have safe, effective and responsive services”.
He said this did not mean there should be no future changes to the NHS, but added: “It is how [the changes are] done. People need to do a better impact assessment of the effect of those policies, not just individually but cumulatively. If you simultaneously introduce a policy which says everyone has to be a foundation trust by whenever, with a massive reorganisation of the way quality is regulated at the same time, then the cumulative impact is bigger than the sum of its parts.”
Dr Kirkup added: “I do think the NHS has suffered from too many reorganisations over too short a space of time.”
One of the recommendations of the inquiry is that the DH carries out a review of new policy impact assessments and the risks and resources needed.
Dr Kirkup said the inquiry had exposed the need for NHS managers and trusts to be more open. He said: “The biggest surprise for me was the extent to which people could carry on thinking ‘if we keep this to ourselves we can sort this out’. They were overoptimistic and the problems were too big and too difficult. It got harder and harder to say ‘we have made a mistake’.
“I have tried to say loud and clear in the report that it isn’t the fact things go wrong; the point is when they do, you have to be and transparent about it and you have to look effectively: learn what went wrong so you stop making the same mistakes over and over again.”
Dr Kirkup said it “must have been obvious to experienced staff that there were problems” in Morecambe Bay, but there was “no systematic effort, that we could find, to raise that to a higher level”.
He said some people went to great lengths to ensure information did not come out, which was “the point where people cross the line”.
Recommendations from the inquiry, if implemented, could force trusts to be more open would “build on” those made in the wake of the Mid Staffordshire public inquiry. Dr Kirkup said he believed it was important trusts publish external reviews and investigations into their services and to publicly report any concerns they may have.
He said: “The point is to foster a culture in which we regard these things as something to investigate and learn from and not something to fend off.”
Overall, Dr Kirkup said the “attention and priority” given to safety and quality in the system since the Francis reports and the safety review by Lord Darzi in 2008 “was leading us in the right direction”.
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Exclusive: NHS reorganisations ‘contribute’ to poor care, says Kirkup