Everything you need to stay up to date on patient safety and workforce, plus my take on the most important under-the-radar stories. From patient safety correspondent Shaun Lintern
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Shaun Lintern, patient safety correspondent
Decision time for NMC chief
Professional regulation is designed to protect the public but its ability to do that well is in doubt after the spectacular failings of the NMC during the last week.
Other than Mid Staffs (where it also failed) there can’t have been a more high profile case for the NMC than midwifery shortcomings at the University Hospitals of Morecambe Bay Foundation Trust. Yet despite having almost eight years to prepare and get its case right the NMC has blundered in the first of several hearings against midwives linked to the death of baby Joshua Titcombe under the trust’s care.
Key relevant evidence was not provided to the fitness to practise panel despite the NMC having it in its possession. The NMC then tried to defend itself by claiming the FtP panel was not about getting to the facts of what happened, but only whether a midwife or nurse is fit to practise. The truth be damned, it seems.
The Professional Standards Authority says the NMC’s handling of the case was “deficient” but can’t be challenged in law. Bill Kirkup, author of the Morecambe Bay inquiry, says the case was a “lamentable failure.” The Department of Health has expressed as strongly as it can its displeasure with the regulator.
NMC chief executive Jackie Smith faces a choice. She has advanced the NMC from its dire post Mid Staffs doldrums and has loudly called for reforms to the watchdog. But having been at the helm since 2012 she must now decide whether to press ahead with necessary reforms and tackle unsafe processes that still exist within the NMC, or decide to consolidate and protect the few advances she has made and focus on reputation management. To take the latter course would be a serious error of judgement.
All of this must be seen in the context of recent calls for the NMC to begin regulating nursing associates in order to protect patients. Such a move would offer patients little real protection until the NMC can get its house in order. It must prove it can get cases like those from Morecambe Bay right first before taking on more responsibilities.
The Prime Minister blinked
In February 2013 Prime Minister David Cameron told the House of Commons that a “focus on finance and figures at the expense of patient care” was a key cause of the problems at Mid Staffordshire Foundation Trust. He told MPs things would be different under his premiership.
He said clearly this his government would “put patient care ahead of finances”.
Now it is clear that having starved the NHS of much needed real-terms investment, the government has gone back on its word.
A key recommendation of the Francis inquiry was for the National Institute for Health and Care Excellence to draw up clear evidence based safe staffing guidance. But this was suspended in 2015 and, in giving evidence to MPs, Charlie Massey, the Department of Health’s director general of strategy and external relations, has given us a clear reason why.
“The way in which we approached this was that NICE produced their guidance. I think the view among us at national level within the system was that trusts were hearing the quality message more strongly than the financial message, and therefore the degree to which the workforce plans and the financial plans were properly aligned was, it became clear, something we should have been questioning.”
So NICE’s work on safe staffing fell victim to financial considerations. Finance trumped quality.
Off the back of this the Public Accounts Committee produced a solid piece of work last week revealing the colossal failure of the NHS to ensure sufficient numbers of staff in the NHS.
A parallel universe
The new chair of the Mental Health Network, Bev Humphrey, has sensibly warned NHS England it is at risk of working in “parallel universes” to the mental health sector because of its disconnected policies on commissioning mental health specialist services.
This problem has been brewing for some time. CCGs and providers have been trying to improve care locally, while NHS England has had a moratorium on specialist commissioning since 2013. The central body is now exploring devolving those responsibilities to CCGs to better co-ordinate services. Ending the scandal of out of areas placements is a particular priority.
Ms Humphrey also highlighted the fact mental health providers need to be “mature” about not getting any transformation funding in 2016-17. But she was also spot on in pointing out that while mental health has been promised £1bn by 2020, it has already lost £600m in the last Parliament.
NHS England’s insistence that mental health spending has increased, like its assertion that there are £22bn of achievable efficiency savings, suggests it is well and truly in a parallel universe to the rest of us already.