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Mid Staffordshire inquiry: Fundamental changes are needed in the NHS

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A fundamental change in the culture of the NHS is needed, a public inquiry into the Stafford Hospital scandal says.

The Francis report into the lessons to be learnt from the scandal of Stafford Hospital has called for all medical staff to be made personally liable for the care they provide to their patients.

The report has stated that medical staff should face criminal prosecution if they fail to provide basic standards of safe care to their patients.

In Robert Francis QC letter to secretary of state for health, Jeremy Hunt, he says that the report: "Tells the story first and foremost of appalling suffering of many patients.

"Above all it failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from managerial and leadership responsibilities."

The report stated that the failings created a culture where the patient was not put first.

The report outlined a total of 290 recommendations for healthcare regulators, providers and the Government. The key ones included:

Senior managers to be given a code of conduct and the ability to disqualify them if they are not fit to hold such positions

Hiding information about poor care to become a criminal offence

An increased focus on compassion in the recruitment, training and education of nurses, including an aptitude test for new recruits and regular checks of competence as is being rolled out for doctors

A new register for health care support workers, which would be able to "strike off" poorly performing staff. There would also be a code of conduct and new minimum training standards for such staff.

The report refused to blame failings on individuals or on one policy, saying there was an "institutional culture" where the business of the system was put ahead the priority of patient protection and public trust.

The report stated the NHS was full of "dedicated, skilled people committed to providing the best possible care to their patients", but said the service was in danger of losing public trust unless everyone in it took personal and collective responsibility.

Speaking to HR magazine before the publication of the inquiry, co-founder of taskforce, Engage for Success, Nita Clarke, spoke about the critical importance of employee voice relating to the report.

She said: "I know it will say that people in that organisation knew about the catastrophic failures of care going on, but were either bullied into silence, too scared to say anything or were ignored."