• NHSI strikes conciliatory tone following CQC stating there will be more prosecutions of providers
  • Dalton indicates prosecutions will only happen in “very rare circumstances” and says he is against a “blame culture”
  • Also encourages trusts to have safe capacity and staffing in winter
  • Comes after the new CQC chief executive Ian Trenholme said there may be prosecutions of providers

The NHS Improvement chief executive has told local leaders he is against a “blame culture” and “fear of punishment”, in response to the Care Quality Commission’s new boss saying it will prosecute more providers.

Ian Dalton wrote to provider chiefs and other directors, and sustainability and transformation partnership leads, today about “winter preparation, safety and learning”.

He said transparency and open discussion of problems were “highly praised assets in all our organisations”, and that “blame and fear of punishment” would make it more likely problems were hidden.

It follows CQC chief executive Ian Trenholm telling HSJ last month that it was examining 31 potential prosecutions of health providers for breaching fundamental standards. He said: “You will see the number of prosecutions increasing.” He also said the CQC would not suspend routine inspections during winter as it had last year.

This sparked criticism from some NHS leaders, and subsequently Mr Trenholm, who joined in the summer, wrote a piece saying “very few” of its investigations would “come to court”, but that the regulator had to “use the tools at our disposal to ensure that people are not harmed again”.

In Mr Dalton’s letter today he stressed that: “I know from conversations with [Mr Trenholm] that he shares this view [about openness, learning and culture].”

The letter refers to ”discussions in recent weeks about steps that national bodies may take in extreme and very rare circumstances”.

He indicates prosecutions take place where there has been “deliberate or wilful neglect” and says: “The vast bulk of individuals and organisations do not behave this way.”

The letter says: “Our starting point is that transparency, learning and improvement should be highly-prized assets in all of our organisations, and I want to keep building a culture where these flourish as a more effective way to drive change.

“Blame, and fear of punishment, create a vicious cycle and make it more likely that problems are hidden…

“During challenging periods, it is particularly important that we collectively build and maintain a culture where teams can transparently raise concerns, talk about problems with care delivery, expose risks and confront head on the very real challenges of managing and delivering healthcare when resources are tight and demand is continuously increasing.”

Mr Dalton’s letter also encouraged trusts to put patient safety ahead of financial targets during winter, stating firstly that “no one would want rigid adherence to guidelines to get in the way of sound clinical judgements about how best to care for patients”.

It then added: “Financial considerations must not be a barrier to opening bed capacity that [trusts] will need during busy periods and all the evidence shows that by planning as early as possible you should be able to open additional capacity in the most cost-effective way.”

The comments come after one trust, Shrewsbury and Telford Hospital Trust, was given the green light to pay agency doctors extra to staff its emergency department, and NHS England previously stressing to trusts they should push elective work out to the private sector to free up beds for winter.